How A Social Worker Has Helped To Bring Awareness And Accessibility To Maternal Mental Health...

Pregnancy and postpartum can be wonderful experiences, but they can also have a significant impact on the birthing person. Depression and anxiety could strain the new parent, leaving them lost and afraid. That potential outcome is why NCCC founder Amy Green has strived to provide birthing parents support and education to help them overcome mental health struggles.

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Amy Green The Rooted-Bridge

For some, the course of pregnancy and postpartum can be a turbulent and difficult experience, one that sees changes in the physical body along with the many life transitions that a new child brings with it into the world, impacting everyone around it. As a result of the alterations, birthing parents can become depressed, anxious, and overwhelmed.

Pregnancy and postpartum depression are part of the field known as maternal mental health, which according to LCSW Amy Green, “We go through a lot of hormonal changes [and] a lot of body changes when pregnant.” “All of these changes are commonplace, and it is normal to experience some stress during these adjustments, it is such a huge transition,” she said.

Green is the founder and chief executive officer of the Nashville Collaborative Counseling Center (NCCC), a practice dedicated to helping birthing parents and families struggling with maternal mental health. According to Green, one out of every ten birthing persons experience pregnancy and postpartum depression. A history of trauma or traumatic birth experience can increase an individual’s risk for developing a perinatal mood disorder. Over 600,000 birthing persons are expected to be impacted by postpartum depression every year.

“When we have baby blues, which 80% of women experience after giving birth, that should last between two to around 60 [days], and after that we see a stabilizing of the mood. If that doesn’t happen and [the birthing person] is still struggling to engage the baby, or to pick the baby up, or is sleeping all the time or struggling to fall asleep/stay asleep, [then] that’s when we encourage the mother to see a therapist and get support.”

“I talk about this being like a trifecta. We have a huge hormonal disruption and adjustment, we have a lack of sleep, and we have the birth, which is incredibly taxing on a birthing person’s body. And all of those require their own support to sustain a birthing person through postpartum.”

Maternal mental health can have serious, long-lasting consequences if not dealt with professionally. While it is uncommon, Green stated that suicide in the first year postpartum can be a leading cause of death for birthing parents. Postpartum psychosis — another uncommon illness that arises from hormonal disruption, affecting 1-2 of 1,000 birthing parents — can lead to rapid mood swings, hallucinations, and delusional thinking. If a parent is experiencing these symptoms, they are life threatening and the parent should connect to emergency support immediately by calling 911 or going to the nearest emergency room.

A newborn child’s connection with the birthing parent can also be impacted if the parent is not able to get the correct support and help they deserve. “When left untreated, it can absolutely impact bonding and attachment, and we can see babies experience the ill effects of nonattachment. They may be more fussy or harder to soothe, we may experience babies who start to shut down more because they don’t necessarily have that responsive, attached caregiver.”

However, cases like this are rarer because of the backup support a birthing parent can have. “The majority of the time, most family systems have the ability to have supportive caregivers around them, so while the birthing person may not be able to attend to the baby in that moment because they’re still working through their own healing, there is another available, supportive caregiver who can show up for the baby.”

However, the birthing parent isn’t the only figure susceptible to postpartum and pregnancy depression and anxiety. Indeed, other members of the family system can experience maternal mental health disorders, as well, which, in some cases can be the result of causation. “One in 10 partners experience a postpartum mood disorder, and that is more commonplace when the birthing person also is experiencing one,” Green said.

Another challenge that birthing parents face — which could result in them ignoring their mental health — are stigmas that childbirth and parenthood are wonderful experiences that everyone should enjoy. “Sometimes parents don’t enjoy pregnancy because they are sick or in pain the majority of the time.”

Amy Green The Rooted Bridge

“It’s given birthing people a space to share their stories, which can be a really important place to start, to connect, [and] be reminded that [you’re] not alone.”

Green reassured that negative feelings regarding the changes to both your body and life are normal to have, and they shouldn’t be viewed as emotions to hide away or to not share them. “It’s okay to not enjoy this. It’s okay to not be thrilled about the changes that are happening to your body. And if you find yourself not being able to connect with others or struggling with depression/anxiety more than normal during pregnancy, that is a good indicator that therapy could be helpful.”

Normalizing depressive and anxious thoughts like those have become much more frequent due to the rise of social media, where users continue to shower each other with love and support while also calling attention to the broader issues they may be experiencing. “So much of Instagram and social media has brought attention to postpartum depression, postpartum anxiety, miscarriage, loss, [and] infertility struggles.”

Of course, stigmas aren’t only connected to heterosexual couples. LGBTQIA parents can encounter the same kinds of hormonal and body changes that any woman would face. “If they’re able to physically carry a pregnancy, they will experience [the same] hormonal changes in a pregnancy as any other woman would.”

Unfortunately, societal and cultural stigmas have the abilities to create even more complex barriers for LGBTQIA members, Green explained. Particular geographic regions and religious communities, along with the local and state laws in place there, may be less progressive and therefore hindering to LGBTQIA couples in their attempts to build a family. Adoption agency policies can also be less progressive in nature, affecting those who cannot biologically produce a child.

“I have found that the challenges that LGBTQIA families have to jump through to build their family systems can be more complex, challenging, and layered, and therefore deserving of so much more therapeutic support and a safe space to process and navigate those additional challenges and layers.”

When working with clients, NCCC will often use CBT (Cognitive Behavioral Therapy) and Internal Family Systems models as techniques to help birthing parents work through their pregnancy and postpartum distress. “CBT is a type of therapy treatment that is commonly utilized for treatment of depression and anxiety in pregnancy and postpartum. Internal family systems is another modality that we utilize, which helps to focus on the internal and external worlds around the birthing person, and to bring compassion and a gentleness to how the mother relates to themselves and others around them.”

“We would never turn a client away because of a lack of ability to pay. That’s a commitment that we’ve held from the start.”

Green — who’s also the founder of The Rooted Bridge, a nonprofit organization that works to expand access to parental support  — has worked hard to emphasize quality care of mental health since opening NCCC in 2018. The nonprofit’s progression to offering assistance to vulnerable parents and families within the community has provided Green with a sense of responsibility to continue to facilitate greater access to care for all families.

Making sure the services offered are accessible to all — regardless of income — Green utilizes a sliding scale thanks to strong intern programs through university partnerships with Belmont, Vanderbilt, and University of Tennessee. “Our interns serve a lot of our deep sliding scale clients so that we can support them in their healing.”

In order to help not just their growth, but to prioritize that a patient has access to the best and most specialized care possible, NCCC hosts monthly “lunch and learn” events that operate as an open invitation for providers in the area to build and create collaborative relationships.  Attendees can range from OBGYNs, psychiatrists, nurse practitioners, as well as other therapists. 

Through this offering, NCCC establishes a working relationship and referral pathway that allows for it to refer clients to providers that they know and trust when they have a patient in need, and vice versa — when referral partners have a patient who needs help, and NCCC specializes in that area, their referral partners can refer to them.

In order to accomplish the goals of the company, Green was adamant she wouldn’t be able to reach them if not for NCCC’s dedicated, attentive, and hardworking staff of more than 40, who take the goal of creating greater access to quality mental healthcare seriously. “I am humbled and grateful that I get to work alongside my staff every day; it’s because of them that I get to do this work [that] allows my heart to come alive,” she said.

“It’s also because of them that we were able to treat more than 1,500 patients in our community in 2021. This is not work I do alone. This is because of a team that cares deeply about the community and people and is dedicated to supporting and empowering clients in their healing through providing access to quality mental healthcare services. Healing happens together.”

To learn more about NCCC’s services, you can visit their website here. If you are in need of help or support during pregnancy or postpartum, or know someone who is, another great resource is Postpartum Support International.

Amy Green The Rooted Bridge