News

New mothers get help through MOMS

Ten-year-old program was first of its kind on the West Coast

El Camino Hospital's Maternal Outreach Mood Services program was born out of tragedy.

A mother who had sought help at the Mountain View hospital died by suicide in 2006. At the time, neither El Camino nor any other Bay Area hospital had a specialized program for new mothers in need of psychiatric care.

El Camino brought together OB-GYNs, pediatricians, psychiatrists and marriage and family therapists for a task force to assess whether such services were widely needed in the community and whether the hospital had the capacity to provide them. They answered both questions in the affirmative.

A survey of El Camino Hospital's own data showed that as many as one in five women delivering there were at risk of postpartum depression, according to hospital administrators. With a $25,000 seed grant from a philanthropic women's health committee, the hospital followed the task force's recommendation to create an intensive outpatient program for new and expecting mothers — the first of its kind in the western United States and the second in the country.

Known as the MOMS program, it opened in 2008 in a small basement room with just two staff, including psychiatrist and medical director Nirmaljit Dhami. Steady demand for the services drove growth: The program now has a designated space at El Camino and a full team including Dhami, licensed therapists, registered nurses, volunteers and interns. The program has served close to 600 mothers. Most insurance plans cover the cost of participating in the program.

Help sustain the local news you depend on.

Your contribution matters. Become a member today.

Join

The program runs Monday through Thursday from 10 a.m. to 1:30 p.m. Mothers start out attending four days a week and then come less often as they move through the program, which typically takes six to eight weeks. They attend individual and couples therapy and classes and spend time with their baby. There's education about self-care, sleep, breastfeeding, communication, mother-baby bonding and medication, Dhami said. (About 40 to 60 percent of women in the program go on medications, she said.)

They learn about "shame resiliency," or the link between prior trauma and current depression and anxiety. An entire curriculum is devoted to addressing the guilt and shame patients feel out of fear of not being a good mother.

Dhami's interest in the mother-baby relationship was sparked by visiting a shelter in her native India, where she held abandoned, "unreactive" babies. After starting work after medical school, she observed firsthand the absence of treatment for postpartum psychosis and depression.

When she came to the United States, she volunteered with Stanford University psychiatrist David Spiegel on psychosocial trauma research and became the medical director of a Veterans Affairs substance-abuse program before being hired for the MOMS program. Her own challenging pregnancy and delivery of twin babies showed her the "incredible amount of pressure put on mothers and how that impacts wellness."

The most prominent issues among mothers in the program, Dhami said, "are that they feel no connection with their baby. They don't feel any joy when they see their baby. They have a sense of anxiety and panic, and they feel overwhelmed."

Stay informed

Get the latest local news and information sent straight to your inbox.

Stay informed

Get the latest local news and information sent straight to your inbox.

Some mothers experience thoughts of harming themselves or their baby, even if they have no intention of doing so, Dhami said. These kind of thoughts trigger high levels anxiety and panic, she said.

The program uses three approaches concurrently: treating the mother, the mother-baby relationship and the family unit. Partners and parents, if involved, are required to attend a family group, which is critical to helping them understand what the mother is going through, Dhami said.

"The mother's depression and anxiety just doesn't affect her," she said. "There's a bi-directional relationship here. As the mother improves, the relationship with the child shifts. I think that's the critical piece."

A decade after El Camino started the MOMS program, specialized mental health treatment for mothers is still rare, though much-needed. Postpartum depression affects between 8 to 20 percent of women in Silicon Valley — slightly higher than the national average of 8 to 12 percent, according to Dhami. She attributes this to a culture of stress, lack of resources, short maternity leaves and pressure for new mothers to return to work quickly.

The program has made it a point to not have a wait-list, believing fiercely that "the sooner you can get them into treatment the faster the intervention works," Dhami said.

But the biggest unmet mental health need for new mothers, Dhami said, remains inpatient psychiatric hospitalization. El Camino Hospital is planning to open a new six-bed women's unit in 2019. Unlike most psychiatric wards, it will have staff trained in perinatal mental health and will facilitate monitored visits between mother and baby.

Research shows that considering the family as the baby's natural environment and preserving that as much as possible "has the best outcome — not (only) short term but long term for both mother and the baby," Dhami said.

This unit will be the second of its kind in the United States. El Camino Hospital is collaborating with staff at the country's only mother-baby inpatient unit at the University of North Carolina School of Medicine.

"The cost of this (unit) is high, but it's considered less in light of ... the disastrous costs that follow in the absence of early intervention," Dhami said.

For more information about the El Camino program, call 866-789-6089 or 650-988-8468 to schedule a free, confidential assessment or go to elcaminohospital.org.

This article part of a larger story titled "More than the baby blues."

This week's "Behind the Headlines" webcast and podcast features MOMS program Medical Director Nirmaljit Dhami in conversation with reporter Elena Kadvany. Watch the show on our YouTube channel or listen to the discussion on our podcast page.

Craving a new voice in Peninsula dining?

Sign up for the Peninsula Foodist newsletter.

Sign up now

Follow Palo Alto Online and the Palo Alto Weekly on Twitter @paloaltoweekly, Facebook and on Instagram @paloaltoonline for breaking news, local events, photos, videos and more.

New mothers get help through MOMS

Ten-year-old program was first of its kind on the West Coast

by Elena Kadvany / Palo Alto Weekly

Uploaded: Fri, Nov 16, 2018, 6:36 am

El Camino Hospital's Maternal Outreach Mood Services program was born out of tragedy.

A mother who had sought help at the Mountain View hospital died by suicide in 2006. At the time, neither El Camino nor any other Bay Area hospital had a specialized program for new mothers in need of psychiatric care.

El Camino brought together OB-GYNs, pediatricians, psychiatrists and marriage and family therapists for a task force to assess whether such services were widely needed in the community and whether the hospital had the capacity to provide them. They answered both questions in the affirmative.

A survey of El Camino Hospital's own data showed that as many as one in five women delivering there were at risk of postpartum depression, according to hospital administrators. With a $25,000 seed grant from a philanthropic women's health committee, the hospital followed the task force's recommendation to create an intensive outpatient program for new and expecting mothers — the first of its kind in the western United States and the second in the country.

Known as the MOMS program, it opened in 2008 in a small basement room with just two staff, including psychiatrist and medical director Nirmaljit Dhami. Steady demand for the services drove growth: The program now has a designated space at El Camino and a full team including Dhami, licensed therapists, registered nurses, volunteers and interns. The program has served close to 600 mothers. Most insurance plans cover the cost of participating in the program.

The program runs Monday through Thursday from 10 a.m. to 1:30 p.m. Mothers start out attending four days a week and then come less often as they move through the program, which typically takes six to eight weeks. They attend individual and couples therapy and classes and spend time with their baby. There's education about self-care, sleep, breastfeeding, communication, mother-baby bonding and medication, Dhami said. (About 40 to 60 percent of women in the program go on medications, she said.)

They learn about "shame resiliency," or the link between prior trauma and current depression and anxiety. An entire curriculum is devoted to addressing the guilt and shame patients feel out of fear of not being a good mother.

Dhami's interest in the mother-baby relationship was sparked by visiting a shelter in her native India, where she held abandoned, "unreactive" babies. After starting work after medical school, she observed firsthand the absence of treatment for postpartum psychosis and depression.

When she came to the United States, she volunteered with Stanford University psychiatrist David Spiegel on psychosocial trauma research and became the medical director of a Veterans Affairs substance-abuse program before being hired for the MOMS program. Her own challenging pregnancy and delivery of twin babies showed her the "incredible amount of pressure put on mothers and how that impacts wellness."

The most prominent issues among mothers in the program, Dhami said, "are that they feel no connection with their baby. They don't feel any joy when they see their baby. They have a sense of anxiety and panic, and they feel overwhelmed."

Some mothers experience thoughts of harming themselves or their baby, even if they have no intention of doing so, Dhami said. These kind of thoughts trigger high levels anxiety and panic, she said.

The program uses three approaches concurrently: treating the mother, the mother-baby relationship and the family unit. Partners and parents, if involved, are required to attend a family group, which is critical to helping them understand what the mother is going through, Dhami said.

"The mother's depression and anxiety just doesn't affect her," she said. "There's a bi-directional relationship here. As the mother improves, the relationship with the child shifts. I think that's the critical piece."

A decade after El Camino started the MOMS program, specialized mental health treatment for mothers is still rare, though much-needed. Postpartum depression affects between 8 to 20 percent of women in Silicon Valley — slightly higher than the national average of 8 to 12 percent, according to Dhami. She attributes this to a culture of stress, lack of resources, short maternity leaves and pressure for new mothers to return to work quickly.

The program has made it a point to not have a wait-list, believing fiercely that "the sooner you can get them into treatment the faster the intervention works," Dhami said.

But the biggest unmet mental health need for new mothers, Dhami said, remains inpatient psychiatric hospitalization. El Camino Hospital is planning to open a new six-bed women's unit in 2019. Unlike most psychiatric wards, it will have staff trained in perinatal mental health and will facilitate monitored visits between mother and baby.

Research shows that considering the family as the baby's natural environment and preserving that as much as possible "has the best outcome — not (only) short term but long term for both mother and the baby," Dhami said.

This unit will be the second of its kind in the United States. El Camino Hospital is collaborating with staff at the country's only mother-baby inpatient unit at the University of North Carolina School of Medicine.

"The cost of this (unit) is high, but it's considered less in light of ... the disastrous costs that follow in the absence of early intervention," Dhami said.

For more information about the El Camino program, call 866-789-6089 or 650-988-8468 to schedule a free, confidential assessment or go to elcaminohospital.org.

This article part of a larger story titled "More than the baby blues."

This week's "Behind the Headlines" webcast and podcast features MOMS program Medical Director Nirmaljit Dhami in conversation with reporter Elena Kadvany. Watch the show on our YouTube channel or listen to the discussion on our podcast page.

Comments

Charlie
another community
on Nov 16, 2018 at 10:10 am
Charlie, another community
on Nov 16, 2018 at 10:10 am

So proud of you for sharing your story, sis, and for everything else you are doing to help those around you!


Sarah1000
Registered user
Los Altos
on Nov 16, 2018 at 10:15 am
Sarah1000, Los Altos
Registered user
on Nov 16, 2018 at 10:15 am

Thanks, Elena for this amazing article. There will be a postpartum unit in the gorgeous mental health building being built on El Camino Hospital’s Mountain View campus. It should be opening next summer. If you are at all interested in mental health, you should go take a look at the construction. It’s so heartwarming to see commitment becoming reality.


A small related note
Barron Park
on Nov 16, 2018 at 1:02 pm
A small related note, Barron Park
on Nov 16, 2018 at 1:02 pm

Thank you for this wonderful article, and for the moms who were willing to open up about their experiences to help others. What incredible strength that took to be that vulnerable in order to spare others the pain you experienced.

Thank you for mentioning that men can get depression, too; they seem even less supported to talk about it and get help. My own spouse had to take on so much during that time, he was the one who experienced the depression from sleep loss.

I just wanted to share another thing to be aware of as a possible contributor to an already difficult situation. When someone is already experiencing something that changes their mood so much, it can be easy to miss other contributing factors. Like the moms interviewed here, I am bringing this up because I experienced this in my life and wish someone had helped me.

Caffeine can cause many of the same symptoms, especially flash-point irritability and anger, and not just immediately following ingesting the caffeine. I’m not suggesting caffeine is the *cause* of anyone’s postpartum depression, rather, that it can amplify existing symptoms or add a similar symptom such as flash-point anger that everyone then attributes to the postpartum depression rather than recognizing the additive effect of another influence.

Caffeine can amplify existing mood problems, or make it seem as if treatments for the mood problems are less or not effective, a concern for someone with postpartum mood disorders.

Caffeine can have major impacts, even in very small amounts, like a cup or two of even green tea in a sensitive person, and most people who are sensitive don’t realize it because of myths about who is and isn’t affected by it. Not everyone is affected the same by caffeine, but even more important to realize is that the same person’s reaction can change for physiological reasons, such as medications. The flash-point anger and irritability I experience from caffeine didn’t begin until I was well into middle age. My DNA analysis does not predict this, but then, it can’t know my health history and relevant medications.

People tend to develop strong ideas about how they react to caffeine, but they don’t take into account how things change because of other biological or medication changes, so a person who thinks they don’t have problems with caffeine or that they react one way may suddenly be affected in ways they just don’t recognize. Even if they do recognize that things have changed, a failure to understand can lead people to cut back and see an improvement, so they think they’ve done enough, even if it’s not enough to avoid still major contributions to their mood problems. The most common thing I hear from people who have even recognized that they have a problem with caffeine is that they cut back to one cup a day or to decaf, and they just don’t want to see what everyone else can see, that it’s still not enough caffeine avoidance to solve the problem enough.

People don’t want to believe caffeine can be such a problem, especially since caffeine is viewed as a way to help through the sleep deprivation of new parenthood. And since coffee (and chocolate, and green tea, and kombucha, etc) are seen to have positive impacts in other ways. They taste good, and give momentary respite under stressful times. So it’s easy to end up in denial. If someone does anything impulsive out of sleep deprivation, it’s very hard to see how much caffeine may have contributed, most people are just going to believe the problem was them or their poorly controlled depression.

My point is, as nice as they are, caffeine is really not worth it if other mood disorders or conditions mean that irritability or similar symptoms are a problem for leading a safe and normal life. If you have mood or sleep problems postpartum, especially out-of-control flashpoint anger or irritability, and would do anything to get better, consider stopping caffeine completely for a few months and then reintroduce it very slowly, watching for effects over a few days after ingesting it. (In my experience, the effects can be cumulative over a few days, like having a cup of green tea, then a few pieces of dark chocolate, a cup of decaf, etc, and the irritability can manifest over that time rather than just right after ingesting the caffeine.). There are also low-caffeine products that can take the place of the high caffeine ones. It doesn’t have to mean sensory deprivation, and the improvements in one’s sense of control and relationships are worth it regardless.

The problems I had with caffeine had to happen to me for way too long before it was recognized, and because other stressors contributed (or, the caffeine contributed to a poor response to those stressors), I thought those stressors and other health reasons were the reason for the episodes, which were ruining my life. It wasn’t until I cut out the caffeine entirely and experimented with reintroducing it that I and my family realized just how much caffeine, even in very small amounts (albeit proportionately to the amounts), was contributing to the problems.

I just wanted to share since caffeine and sleep deprivation so often go hand in hand, and people who never thought they had problems with caffeine before are the last ones to realize how big an issue this can be.


Japanese Acupuncture Can Help
Menlo Park
on Nov 16, 2018 at 9:22 pm
Japanese Acupuncture Can Help, Menlo Park
on Nov 16, 2018 at 9:22 pm
Bottle Blues
Stanford
on Nov 17, 2018 at 6:39 pm
Bottle Blues, Stanford
on Nov 17, 2018 at 6:39 pm

My wife had PRE-partum depression prior to giving birth. I suspect it was because she couldn't enjoy a beer or glass of wine (actually two at dinner) while carrying our child.

She got over it following childbirth and since our baby was being bottle-fed, there were no side-effects or detriments along the way.

Now everything is back to normal and we have decided to only have one child.


Excuse
Adobe-Meadow
on Nov 17, 2018 at 7:56 pm
Excuse, Adobe-Meadow
on Nov 17, 2018 at 7:56 pm
Couvade
Community Center
on Nov 18, 2018 at 10:15 am
Couvade, Community Center
on Nov 18, 2018 at 10:15 am

[Post removed due to same poster using multiple names]


Daychin Campbell
East Palo Alto
on Nov 21, 2018 at 10:04 am
Daychin Campbell, East Palo Alto
on Nov 21, 2018 at 10:04 am

Glad to have seen this article in the Palo Alto Weekly that came to my house but disheartened that the Weekly didn't even list our very Blossom Birth Services (on California Ave in Palo Alto) as having a great resource, their long-standing "Pregnancy and Postpartum Moods and Challenges" support group led by the wonderful Eva Roodman, LCSW, therapist and doula. This should have been in the Resources section. It's local, the groups meet weekly, and Eva is on-site at Blossom three days a week.


Don't miss out on the discussion!
Sign up to be notified of new comments on this topic.

Post a comment

Sorry, but further commenting on this topic has been closed.