Maternal mental health can be affected by a combination of factors during and after pregnancy: biological (hormones, genetics, sleep), psychological (history of mental illness, trauma, stress, identity changes), and social/environmental (lack of support, financial stress, discrimination, difficult birth/pregnancy, relationship issues).
In many communities, the problem only seems to be getting worse.
“I would say that maybe we see about eight to 10 patients a day and at least one of them is experiencing symptoms of anxiety or depression during their pregnancy or postpartum,” said Fabiola Martinez Castillo, a Licensed Master Social Worker who works in the Healthy Steps Program provided by the Behavioral Health Department at the Open Door Care Network in Port Chester. Healthy Steps is a pediatric evidence-based program supported by the New York State Office of Mental Health and foundation and donor contributions.
“There have been spikes of anxiety and concern about the future within our community about immigration and what this means for birthright citizenship. It’s a reality for them. If they’re not facing it themselves, it’s their partner or someone in their family or support system who they’re at risk of losing. It’s derailed their birthing plan: what plans they have for after the birth, who they’re going to stay with, how they’re going to support themselves during that postpartum period.”
One patient, said Castillo, had her partner deported days before having a C-section. Others have open cases themselves and face looming court dates to determine their status. Experts say it’s the entire family that becomes affected by such common symptoms of maternal mental health as extreme mood swings, inability to cope with daily stress, social withdrawal, significant changes in sleep/appetite, impaired concentration, paranoia, and illogical thinking, often creating instability or an emotionally chaotic environment.
“It can affect the relationship she has with her partner, the relationship with her other kids, even her outside support system,” said Castillo. “It puts cracks in the foundation. If it’s not addressed early on, it could really derail the family, and developmentally-wise, the child’s future.”
Caring for a predominantly Spanish-speaking, Latino population, Open Door’s Healthy Steps specialists/ behavioral health clinicians begin screening patients for signs of depression, anxiety and other behavioral health issues once they begin prenatal care. Screening and support continue during pregnancy and after birth. Collaborating closely with medical providers, the behavioral health team ensures that families receive comprehensive, coordinated, and compassionate care. This includes conducting timely mental health and developmental screenings, developing appropriate age interventions, and coordinating referrals and follow-ups for additional services needed by offering guidance, education, and emotional support. They provide patients with access to therapy, also provided by Open Door, and/or collaborate with medical providers who prescribe medication when needed.
“We listen to our patients and remind them of the different services not only at Open Door but in the community that might be of help to them,” said Rosa Alvarez-Ladapo, a Licensed Clinical Social Worker and Associate Director of Behavioral Health at Open Door. This can range from housing, to food and household supplies, including those needed for caring for a baby; to therapeutic services and support groups. Most patients, she said, don’t hide the fact that they’re having feelings of anxiety and depression.
“I feel like they’re very open to speaking to us,” said Emily Gonzalez, a Licensed Master Social Worker and Healthy Steps’ behavioral health specialist at Open Door. “For the most part, they want to let everything out. When I’m doing the screenings for depression and anxiety and they answer ‘yes’ to a question, I’ll try to explore a little bit more and that’s when they open up. When they discuss their history, and at times there is a lot of trauma, things can get emotional.”
The most important message to those going through this, said Alvarez-Ladapo, is that help is available. “You can call Open Door’s call center or you can walk into any of our sites and just say you would like to speak to someone, and then we’ll take it from there.”
To get help, call Open Door at 914-632-2737.