Getting trained in perinatal mental health concerns: Notes from the frontline
Ramblings about my experiences with Postpartum Support International's Perinatal Mood Disorders trainings
Last week, I spent three days in Portland, Maine, in multiple trainings hosted by Postpartum Support International (PSI). I participated in the two-day introductory Perinatal Mood Disorders and the one-day Advanced Psychotherapy trainings. These workshops help prepare practitioners in assessing and treating common mental health concerns in pregnancy and postpartum (collectively known as the “perinatal” period, from conception through the first year of the baby’s life). These trainings are required by PSI as part of their Perinatal Mental Health Certification, something I’m planning to pursue as a therapist. To make it fun, I went with my fellow mom/psychologist friend (hi, Meg!) After our jam-packed workshop days, we went shopping, ate amazing food (the Duckfat fries & milkshakes live up to the hype), and slept in past 7AM. All in all, it was a great time.
Despite having a PhD in clinical psychology from one of the top ranked institutions in the country, I have never received any formal education on perinatal mental health concerns until now. From grad school I vividly recall a fellow therapist-in-training discussing a client of hers who had experienced a miscarriage and not knowing how to help her. Such training would have been so valuable for us.
However, these concerns are frequently treated as a “niche interest,” something optional and only for mental health providers who want to specialize in it. My guess is that many people become interested in these concerns the same way that I did: After becoming a parent. However, throughout the training, I found myself growing increasingly angry that perinatal mental health was not part of my graduate program's core curriculum.
Clinical psychology programs are required to provide students a breadth of educational experiences in order to meet accreditation standards, such as those from the American Psychological Association. This often includes learning about the biological basis of behavior, the assessment and treatment of children and adults, and special considerations on the mental health of people of all ages (from infancy to death). Perinatal mental health concerns fit into all of these categories: What bigger life transition is there than becoming a caregiver? What bigger biological shift for an individual is there (outside of puberty) than becoming pregnant and giving birth?
If you’re reading this newsletter, you don’t need convincing that the mental health concerns of pregnant people and new parents are important. You can also probably guess my stance that the lack of focus on perinatal mental health concerns in clinical training programs is due to the same complicated layers of misogyny that our society treats mothers on so many issues (and, because presenting as a woman means you are perpetually defined by your status as a caregiver, how it treats all women). Motherhood is supposed to be all-consuming and beautiful and come naturally. If it doesn't, then you’re “just hormonal,” or it’s the baby blues, or maybe you’re just a bad mom. There are probably well-meaning mental health experts out there who view the postpartum period as like any other time in a person’s life, thus not needing specialized training. Or, worse, experts who view it as unimportant because it’s temporary. Women will eventually just snap out of it, right?
Instead of being bombarded with messages like these, my days in Maine were spent with trained professionals saying over and over again how the pressure to be “supermom” is so detrimental to one’s mental health. I learned about special considerations for the perinatal mental health of dads and trans parents. We discussed the racial disparities in mental health outcomes for women of color, and the importance of cultural humility in addressing them. Intrusive thoughts were a major theme, including the importance of normalizing these experiences as well as understanding when they may become overly distressing or impairing. The importance of providers having knowledge on local abortion providers as well as their state's laws in the area as a crucial part of supporting new parents was highlighted. One of the trainers specialized in helping parents of babies with fetal anomalies and discussed the specific trauma that a NICU experience can contribute to. I learned so much, the content of which will not only fuel future posts in this newsletter, but inform my therapy practice.
One of my favorite parts of the training was led by a reproductive psychiatrist (a specialty I didn’t even know existed!) who discussed the evidence for and against taking various psychiatric medications throughout pregnancy and postpartum. Rather than solely focusing on the health of the fetus/baby, she instead framed her presentation on our tendency to focus on the harm of doing something, such as taking a medication, versus doing nothing (aka the omission bias). When it comes to our mental health, often doing nothing is the worst thing we can do to both ourselves and our children.
The training wasn’t perfect. The importance of sleep and mental health was repeatedly emphasized, but sleep training was never discussed. There were these wonderful invited speakers who discussed their experiences with postpartum depression and they both talked about how the societal pressure to breastfeed affected them negatively. However, combination or formula feeding was only talked about during the training in the context of adoption, which I found particularly glaring given the current formula shortage. The notion that 3-6 months postpartum is a particularly sensitive time for mood symptoms to emerge was mentioned without the context that the timing coincides with when maternity leave ends (for those lucky enough to receive it at all). In fact, the difficulties of transitioning back to work was never discussed. Additionally, there was the problematic insinuation at times that addressing perinatal mental health concerns is most important because it helps women become better mothers, as if enjoying or “succeeding” at motherhood is the biggest upside to one's journey towards better mental health.
Despite these faults, I found the training empowering and, honestly, healing. I don’t think I’ve ever experienced a professional setting where all the attendees and leaders were women (including multiple women of color!) and most were probably parents. The majority of attendees appeared to be licensed clinical social workers, but there were also doulas, nurses, at least two psychologists (me and my friend), and one pediatrician. Multiple pregnant people were there. At least one person was visibly pumping. At one point, we were watching a video where a woman accidentally spilled her freshly-pumped breast milk, and everyone in the audience gasped. Then, we all laughed, acknowledging our collective empathy for this specific parenthood moment.
As someone who probably has more personal boundaries than most and was trained to limit how much I share about myself with clients, I was most taken aback by how much other attendees shared to a room full of strangers. Attendees raised their hands to ask questions on how to best serve their clients, but they also discussed their own experiences with fetal loss, or spousal mental health concerns (in addition to their own), or fat-shaming by their medical team. At first I was uncomfortable with this, but by the end of the training I was impressed by other professionals’ abilities to be so vulnerable, and the importance of that vulnerability when working with new parents. More than anything, it was highlighted throughout the training that so many parents feel alone in their experiences, and the most healing thing we can do as providers is to show them how untrue that is.
This was the longest time I had spent away from my toddler, which was both harder and easier than I expected. Right before I left, my son’s daycare notified us that it was closed for the second week in a row due to a COVID exposure in his class. The only way I was able to leave was because my spouse was willing and able to take off work and assume primary caregiving duties. I entered the training feeling a mixture of gratitude to be there, excitement for the time away, and guilt about leaving my family in that context. Of course, I knew I shouldn't feel guilty, that my feeling was coming from a place of sexist bullshit, that no one was making me feel this way but me. I still felt it. There’s a joke in there, somewhere: The mom who feels guilty about leaving her family in order to get trained on addressing perinatal mental health concerns. My friend and I laughed on our drive home about how we missed our children, and yet knew as soon as got back, we would want another break.
I haven’t had many professional experiences where a training not only helped me become a better therapist, but applied so profoundly to my personal life. I’m barely out of the postpartum period, and that time still feels pretty raw. I teared up when one of the facilitators said, “There are seasons of giving and seasons of receiving. Being a new parent is a season of receiving,” as one means of providing our clients (and, apparently, ourselves) permission to accept help. Being in that room, where for multiple days my mental health concerns were taken seriously, was magical. I won’t forget it anytime soon.
Happy Mental Health Awareness Month! I would be remiss not to mention the truly amazing resources PSI offers. They currently have a phone/text helpline where you can get resources and support if you’re experiencing perinatal mental health concerns. Soon, they will be launching a 24/7 hotline where you can talk to someone directly as soon as you call. They have all the (virtual) support groups, with topics ranging from Teenage Mothers, Queer and Trans Parents, South Asian Moms, Pregnancy After Loss, and so much more. They have a directory of providers (including prescribers) that they vouch for having some knowledge of perinatal mental health concerns (which I’ll be joining soon!) Definitely check them out.
I don’t need to tell you that things are rough out in the world, y’all. Roe vs. Wade is likely to be overturned. There is a national infant formula shortage, endangering the health of so many children. Children under five still cannot be vaccinated against COVID. Mass shootings rooted in white supremacy continue. Monkeypox.
Check out this website that details abortion funds in every state (as a former Ohioan, I donated to Women Have Options). Here’s a fact sheet that includes store-brand formula alternatives that were not part of the Abbott-related recall. You can also sign up for this baby formula exchange, whether you have or need formula. And, you know, please take care of yourselves and each other.