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 bit.ly/2B25pAo.
WATCH IT ONLINE
This week's "Behind the Headlines" webcast and podcast will feature MOMS program Medical Director Nirmaljit Dhami in conversation with reporter Elena Kadvany and will be posted by Friday evening. Watch it on Youtube.com/paweekly/videos or download the podcast at paloaltoonline.com/podcasts/behind_the_headlines.
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