LISTEN: Women without access to health care — including mental health care — are more likely to die from pregnancy-related issues. Now, specialists across the state aretreating mental health of moms in the first few years after pregnancy. GPB’s Ellen Eldridge has more.
Vanessa was 32 and pregnant with her first child when a massive stroke left her mother paralyzed and in need of care.
“Your mother is like your best friend,” said Vanessa, who asked to use her first name only. “And this is something that I've wanted to, you know, go through with her. And I couldn't.”
Then, the baby came.
“All of a sudden, I'm just sad," Vanessa said.
Vanessa knew her son was healthy, and that she was expected to feel happy, but she couldn’t process her emotions.
“I couldn't, like, connect with the baby,” she said. “I couldn't even see the baby. I couldn't stand him crying. It was just hard for me. And before this season of my life, I was a, you know, happy go lucky person.”
The perinatal period for pregnant people includes the weeks before birth and up to a year after a baby is born. Depression and anxiety are common any time during pregnancy and in the two years that follow. So-called “baby blues” are expected with fluctuating hormones and life changes involved with caring for an infant.
During those years in Vanessa’s life, her mother died, and her second son was born prematurely. He weighed only 3 pounds and spent two months in the neonatal intensive care unit, where Vanessa couldn’t even hold him.
She also had trouble connecting emotionally with her 2-year-old. She felt like she had to just “go, go, go” all the time.
"I would be gone all day and come home at night and he's like, 'Mommy, where are you?'" she said. "You know, he's missing me."
To fully be there for her son, Vanessa said she needed therapy for her mental wellness the same way she needed rest for her physical wellness.
Perinatal mental disorders are the most common complication of childbearing with an estimated 30,000 Georgians experiencing these illnesses every year.
Underlying mental health conditions are the leading cause of maternal deaths, and, between 2015 and 2020, there were 28 deaths by suicide in Georgia where the person was “pregnant at time of death, within one year of death or not otherwise specified,” according to data from the Centers for Disease Control and Prevention.
Vanessa is an example of the 1 in 7 women who experience postpartum depression (PPD), a psychiatric issue that often goes unrecognized in the weeks following birth.
Close to 700 Georgians reported postpartum depressive symptoms in 2020, though the number of unreported cases likely makes that number much higher, according to the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD).
The statistics around maternal and new parent mental health conditions are “eye-opening,” according to the Georgia chapter of the National Alliance on Mental Illness (NAMI).
Bridget Cross, a Savannah-based perinatal mental health specialist, said 1 in 5 women of childbearing age in Georgia does not have health insurance, which means they don’t have access to health care before pregnancy and can easily become overwhelmed.
The clients who meet with Cross during pregnancy generally do much better in postpartum than those who start counseling two to six months after having a baby, she said, because it's much easier to plan for mental health care when you’ve identified sources of support in your community, family or with your partner.
It's much easier to plan for that before your baby's here.
“Once baby's here, most moms and birthing people are in a state of some kind of crisis because they're completely overwhelmed,” Cross said. “They don't have support; their mental health is struggling. Their physical health might be, you know, as well.”
Many experts with specialized training like Cross work in private practice and don't accept even private health insurance.
“Another piece of it is we are really under-resourced as a state in how many trained, certified, experienced perinatal mental health providers we have," Cross said. "I believe we have still fewer than 100 with the certification that I have.”
The Perinatal Mental Health Certification (PMH-C) recognizes individuals who possess the competency required to help mothers, fathers, and families experiencing perinatal mood and anxiety disorders in the perinatal period.
The statistic often cited is that 1 in 5 pregnant or postpartum women will experience a mental health issue, Cross said, and 1 in 10 men experience postpartum depression.
“Most of us who work in that field, like, understand that that's a huge underestimation," she said. "Because that's only people who are actually going to get treatment."
Cross started the Georgia Fund for Perinatal Mental Health in 2022 to help more people access and afford expert treatment, by providing direct access to perinatal therapists via telehealth and covering the cost of services.
Rural Georgians have even less support after giving birth than folks in metropolitan areas because they don't have the same access to services.
“Back to the point in the beginning about the costs and challenges of caring for a kid, if you have to drive long distances, have less availability for childcare services, etc., a lot of these issues could accelerate,” Cross said. “These are the types of communities that seem to really benefit from home visiting where someone is driving to them to check.”
Out of Georgia’s 159 counties, all but seven currently have a mental health care shortage.
Dr. Joy Baker works in LaGrange, about an hour-and-a-half southwest of Atlanta, near the Alabama line.
There are no labor and delivery units in Troup County, where LaGrange is located.
“Our nearest hospitals are 40 to 50 miles away,” Baker said. “So, we have a hospital that's in Newnan, and we have a hospital in Columbus. Essentially, we're serving about five counties where we are.”
Rural parts of the state see fewer births — about 1,000 annually — which makes staffing labor and delivery units 24/7 difficult. Rural hospitals also don't get the same levels of reimbursement as metropolitan hospitals.
The payer mix is a lot different in terms of commercial insurance versus Medicaid, Baker said, and there are differences in the reimbursement rates to the physicians and hospitals in those rural or under-resourced areas.
That's why these rural hospitals are closing their labor and delivery units or even closing the hospital altogether because of that mismatch in the money, Baker said.
Nine rural hospitals have closed in Georgia since 2010, according to Georgians for a Healthy Future, putting Georgia third in the nation for hospital closures behind Tennessee and Texas.
Rural hospitals in states with no Medicaid expansion are more likely to close, shutting off access to care for their communities.
The Georgia Association for Infant Mental Health promotes family, infant and early childhood mental health as foundational to development, and, in 2021, Georgia’s Department of Early Care and Learning (DECAL) Infant and Early Childhood Mental Health (IECMH) Task Force was established to carry out recommendations from the Georgia Legislative House Study Committee on Infant and Toddler Social Emotional Health.
The group serves as a cross-agency collaborative focused on early child mental health policy, finance, workforce development and promotion/prevention efforts to support infant and early childhood mental health in Georgia.
Dr. Avivah McPherson is a perinatal psychologist who joined the maternal mental health program at Northside Hospital Atlanta in 2023 after moving to Georgia from California, where McPherson said infant and early intervention is integrated into health care.
“When I came to the state of Georgia is when I realized that maternal mental health, and, more specifically, infant mental health wasn't recognized,” McPherson said.
“When I came to Northside, I introduced infant mental health, which was an opportunity to support not just mom, but mom and baby,” McPherson said.
Vanessa, who struggled to care for her newborn and her toddler after her mother’s death, was McPherson’s first patient.
"I love therapy," Vanessa said. Therapy taught Vanessa to relax and recharge so that she can support her children’s mental health.
McPherson asked Vanessa how she’s doing, reminding her to care for her mental health by doing something simple, like having a cup of tea at night before going to bed.
“I've learned that you have to take some time for you,” Vanessa said. “Take a break a little bit so that you could be fulfilled and you could be your best self again.”
Which can help children grow into their best selves, too.
"A big focus of our treatment is also to support mom and baby with reconnecting so that they can, in fact, get on track with their development," McPherson said.
GPB is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center and newsrooms in select states across the country.
