The UVA Health Perinatal Mood Disorders Clinic provides specialized care and support for mothers experiencing psychiatric illnesses during and after pregnancy.
Do you know someone who recently became a mother? Or maybe you’re a new mom yourself! Sure, there are absolutely wonderful moments that new moms share with their little ones: Watching those tiny yawns, feeling their entire hand wrap around just one of your fingers, and enjoying all of those sweet snuggles.
There’s also another side of motherhood you’re less likely to see on social media: The sleepless nights, the untouched meals—and let’s not even get started on teething.
Being a mom can be exhausting, and adjusting to that new role can be difficult. For some women, the change manifests as a psychiatric illness. For others—both during and after pregnancy—the change can trigger a formerly controlled mental illness, especially if the mother stopped taking medications that treat the condition.
In an effort to provide support for mothers experiencing a variety of mental health conditions, there’s a new outpatient opportunity in Charlottesville: The UVA Health Perinatal Mood Disorders Clinic.
The clinic sees women who are pregnant or who have given birth within the last year, and also provides one-time pre-pregnancy consults for women who want to plan how to manage their psychiatric medications during pregnancy.
The clinic is led by Dr. Jennifer Payne, a psychiatrist specializing in reproductive psychiatry; Ginny Bowers, a certified nurse midwife who is training with Payne for certification as a psychiatric nurse practitioner; and Dr. Chantal Scott, an OB-GYN. The three women recently participated in a media briefing where they spoke about the new clinic.
The Postpartum Period
Up to 85% of new moms experience at least some negative feelings or mood swings after their baby is born. For some mothers, those difficult emotions come and go for a few days. Those are commonly called the “baby blues.”
For others, the overwhelming feelings occur for a longer period of time—and that could mean the mom is experiencing postpartum depression (PPD).
Approximately one in seven women will experience PPD after giving birth, according to the National Library of Medicine. Unfortunately, cases are often missed or overlooked.
Currently, many healthcare providers use the Edinburgh Postnatal Depression Scale to screen for PPD. The screening consists of 10 questions, and moms select the responses that most closely align with how they’ve felt for the past week. A higher score could indicate PPD—but the test is a screening tool, not a diagnostic device.
“Even though postpartum depression is the most common complication of giving birth, less than 50% of women are identified and diagnosed with postpartum depression,” Payne, one of the doctors at the clinic, said. “We can be doing a lot better than that, and I think clinics like this are a step in the right direction.”
Pregnancy and Prescriptions
When you’re pregnant or breastfeeding, should you continue or discontinue psychiatric medications? That’s an area patients are welcome to explore with providers at the UVA Health Perinatal Mood Disorders Clinic.
Scott, one of the doctors at the new clinic, noted that in her past experiences, many obstetricians were comfortable managing psychiatric disorders to a certain degree. However, when patients with a complex mental health history sought care, it was “hard to know what to do.”
Unfortunately, women with previous psychiatric illness who stop their medications for pregnancy can—and often do—experience a relapse.
“Women with a previous history of major depression, if they stop their medication, have about a 70% relapse rate with depression during pregnancy,” Payne said. “Bipolar disorder, it’s even higher—so 80% to 100% of women who stop their medications for pregnancy will relapse with that illness in the postpartum time period.”
The clinic is working to help doctors and mothers alike better understand the relationship between psychiatric medications and pregnancy. Scott expressed hope that the clinic—with appointments generally available in “a timely manner,” rather than in “months”—would help curb that issue.
“The management of psychiatric disorders is incredibly important during pregnancy. A lot of moms will get the message that they should muscle through a pregnancy and not take medication or treat their psychiatric illness, when study after study has shown that mom being psychiatrically ill during pregnancy really increases negative outcomes for the pregnancy and for the child,” Payne said. “And then many people feel very uncomfortable treating women psychiatrically during pregnancy. So this clinic is an attempt to make it A) commonplace, but B) give smart and intelligent care to women with psychiatric illness during and after pregnancy.”
Caring for the Mother
Just because you’ve never experienced a mental illness prior to becoming pregnant doesn’t mean you’re immune. Women can develop psychiatric illnesses during, as a result of, or after childbirth. Some instances include perinatal obsessive-compulsive disorder, post traumatic stress disorder, and even postpartum psychosis.
Bowers, who works at the clinic, was a certified nurse midwife for 10 years. During that time, she saw the devastating effects of perinatal mental illness firsthand.
“We’re just simply not trained adequately outside of psychiatry to properly address this,” Bowers said. “We can kind of touch the surface, but, you know, I found myself struggling to provide [women with psychiatric disorders] the level of care that they deserved.”
That’s why she decided to return back to school to become a licensed and certified psychiatric nurse practitioner.
“Women who are going through this really, truly have no idea how lost they are. So they just are kind of lost out in the world, out in the community, without any real lifelines,” Bowers said. “Being able to provide this service is huge.”
Scott noted the adjustments many mothers experience—including struggling with breastfeeding, lack of sleep, and bonding with their baby—yet sometimes hesitate to discuss.
“They feel guilt because they are supposed to feel this immediate love and connection, and they have trouble when they’re depressed,” Scott said. “It’s just sort of a very difficult cycle, and it’s hard to talk about. I think for them, it feels like, ‘I’m supposed to be happy. Why am I not?’ And patients feel a lot of guilt around that.”
At the Charlottesville clinic, new mothers can have open and honest conversations about those difficult feelings.
Setting Up an Appointment
If you’re interested in being seen at the UVA Health Perinatal Mood Disorders Clinic, appointments are currently available on Tuesday mornings and Wednesday afternoons. The clinic plans to offer more appointment times in the future.
To set up an appointment, contact the clinic at (434) 243-4646.