Two Birmingham moms are working to change the ways postpartum care is offered to mothers in Alabama.
Many people think of labor and delivery as the most dangerous part of pregnancy. But new national research reveals that the deadliest time for mothers can be after a baby is born – and that expanded counseling, mental health care and resources are needed to help new parents thrive.
“We were trying to make the best of it,” Anjanette Robinson recalled of a breastfeeding support group that she attended after the birth of her daughter. The group turned into an informal support group for other things many women were dealing with after birth.
Now, Robinson, a licensed professional counselor and doula, counsels new parents dealing with postpartum struggles and manages the StrongParent Group, which is a community support initiative.
Sarah Parkhurst launched Previa Alliance, a group that offers postpartum depression screening and connects new moms with mental health resources through partnerships with OB-GYNs.
Parkhurst gave birth to her son in Birmingham in 2018. She was diagnosed with a condition called vasa previa, meaning fetal blood vessels connecting the placenta to the umbilical cord run across or close to the cervix. Parkhurst was told that if she went into labor, those vessels could rupture, and there would only be about 10 minutes from the rupture for her and her baby to survive.
Parkhurst was admitted to the hospital at 34 weeks for monitoring. She woke up the next day covered in blood. Her son was delivered just in time.
He’d spend 10 days in the NICU. The trauma surrounding his birth led to Parkhurst developing postpartum depression. She said she never received a screening.
Her husband, a physician, was in a fellowship at the time, and Parkhurst was alone most of the time. Parkhurst began to spiral..
Parkhurst’s home flooded, and she moved in with her parents. She said she recalls a day when she called her mom and told her to come home, saying “I want to die.”
After telling Parkhurst they’d take things minute by minute, her mother encouraged her to seek help for the sake of her son.
“I needed someone to tell me that, ‘It’s in your head, you’re convinced he’s going to be better without you,’ which is not reality, you know, but you just have to have someone else say it,” Parkhurst said.
She sought therapy with a maternal mental health specialist, a process she described as “a needle in a haystack.”
Her condition improved, and by her second pregnancy, she was prepared to combat postpartum depression. While her experience was different with the birth of her second son, she said she still was never screened for depression.
“Why are we not telling moms and their family members what is maternal mental health, what are the signs and symptoms? Because how do you expect them to ask for help, but they don’t even know they need it?” Parkhurst asked. “So this is where Previa was born.”
Mental health screening for new parents
Previa Alliance contracts with four OB-GYN offices and serves more than 200 women, Parkhurst said in January.
Using the Previa website, which is HIPAA compliant, new moms can be screened for postpartum depression symptoms. If results indicate that someone is struggling, Parkhurst and her team connect the mom to a contracted maternal mental health professional.
“On their every email, there’s a ‘connect to therapy’ button. On all their texts, they can connect to therapy, and we have our patient coordinator set up their therapy options with them,” Parkhurst said. “We have seven maternal mental health therapists that we’re contracted with in the local Birmingham area.”
She and her team figure out how to make therapy work with moms’ insurance. Moms in the Previa program also have access to a digital library, where Parkhurst has worked with medical professionals to provide education and tips on how to navigate the postpartum period.
Parkhurst calls it taking “the hard out of asking.”
She said Previa sticks with moms through the first year of the postpartum period. Research shows that most maternal suicides occur between nine months to a year after birth.
Right now, Previa is in what Parkhurst calls the “proof of concept stage.” She’s offering services to enrolled OB-GYNs free of charge. The only thing the women who use the services pay for is their insurance co-pays if they decide on therapy.
She said the program’s costs are coming out of her pocket – something she’s fine with, because she said it’s her life’s work. She’s hoping to expand the program across the state, and Parkhurst is passionate about making sure all moms have access, not just those who can pay out of pocket.
More support for new moms
For Robinson, who gave birth to her now 21-year-old daughter in Birmingham, her struggle with postpartum depression showed her how few resources were available to help moms in similar situations, but she didn’t have the capacity to try and meet those needs herself.
Her breastfeeding support group functioned like a postpartum depression support group.
“While breastfeeding our babies we talked, as women do, about things that were going on and I realized that a lot of the women were feeling isolated and overwhelmed, and overtouched, and overworked and trying to live up to these high expectations of what a new mother should be doing, and trying to make it through situations that were not typical and not okay,” she said. “We were trying to make the best of it.”
Robinson worked at a mental health agency for more than two decades before starting her own private practice. She had always been interested in health care, she said, but was always more interested in providing quality care than the specific practice of medicine.
One day nearly seven years ago, she came across a brochure for doula training.
“It actually tapped into that idea that made me want to be a doctor in the first place to provide care, quality care and support for people when they’re going through some trying times,” she said. “A lot of my clients actually come to me because they see I work with individuals with postpartum depression and anxiety, or they come to me because I’m a doula and they understand what that means, and the trauma-informed care that most people receive when they access a doula or a midwife.”
Robinson accepts Medicaid, and she said many of her patients are enrolled in the program.
“That’s when I realized that a lot of Medicaid clients are not getting access to postpartum therapy work, and with the restrictions there are on how many sessions you can have… it’s a mess. It’s a hot mess,” Robinson said.
Robinson said Medicaid only covers six sessions, but postpartum depression isn’t always something that can be addressed that quickly.
She wants to create assistance for moms who might struggle to access therapy through central support groups, called The StrongParent group. She and another doula are working with the local Housing Authority to set up support groups in housing developments.
They aim to offer multiple support groups at one time, with therapists, doulas, medical professionals and lactation consultants. Robinson plans to work with a doctor, who would perform a quick check for the baby, then check a mom’s blood pressure and assist her with screenings. Often, she said, mothers miss followup appointments for their own medical care after birth.
“Historically, mothers don’t go back. They don’t follow up with their aftercare,” she said.
Robinson and other doulas in the Birmingham area also are working on ways to expand clinics, increase training options and add awareness of doula services.
“Doulas are an amazing group of people,” Robinson said. “We will find you someone. If you reached out, we’ll help you.”