Problem: Postpartum depression can affect the health of both mothers and their children. But there are no models for health professionals to treat the mother and infant together, even though the health of the mother and the health of the child are inextricably linked.
Background: Janice Goodman, Ph.D., R.N., P.M.H.C.N.S.-B.C., has covered a lot of ground in the nursing profession: She’s been a psychiatric nurse, a lactation consultant, a nurse scientist and a professor of nursing, and her professional interests range from mental health to breastfeeding to the maternal-child bond.
Recently named a Robert Wood Johnson Foundation Nurse Faculty Scholar, she is now able to combine all of those interests in that single role.
“This is just a perfect fit for me,” she says.
Goodman wanted to be a nurse for as long as she can remember. She read the biography of Florence Nightingale as a young girl, volunteered as a candy striper as a teenager, earned a master’s degree in nursing as a young woman and then became a psychiatric clinical nurse specialist.
When her own four children were young, Goodman took a break from psychiatric nursing and became a lactation consultant, making home visits to new mothers to help them with breastfeeding. As an expert in mental health, Goodman was prepared to find some new mothers in a state of depression in visits to their homes.
But she was surprised to discover the emotional intensity around breastfeeding. Mothers, she found, were plagued by guilt if they experienced difficulty nursing, and many would not allow themselves to stop breastfeeding even if they were in excruciating pain. Others were struggling with issues adjusting to motherhood that far surpassed breastfeeding.
Goodman gradually realized that she found the emotional challenges of motherhood more interesting than the mechanics of lactation and decided to return to school. She enrolled in a doctoral program at Boston College and earned her Ph.D. in nursing in 2004.
She is now an associate professor at MGH Institute of Health Professions’ School of Nursing in Boston. She also maintains a private practice where she provides mental health care to pregnant and postpartum women and mothers of young children.
Solution: Goodman was recently named a Nurse Faculty Scholar for her work on postpartum depression and mother-infant relationships. Nurse Faculty Scholars receive $350,000 over three years from the Foundation to support their research.
During her research, Goodman found a deep trove of material on the effects of postpartum depression on the mother’s mental health and on the child’s development. Infants with depressed mothers are more likely to suffer from compromised emotional and cognitive development, behavioral and social problems, and depression.
But she couldn’t find anything in the medical literature about how to treat both the mothers’ depression and the negative effects on the child simultaneously.
Adult psychiatrists tend to focus on maternal depression, and infant development specialists zoom in on infant health. But these two camps have yet to come together, even though they’re studying flip sides of the same coin—the mother-child relationship.
“Our models for taking care of postpartum women are for the most part centered on treating the mother’s depression,” she says. “There aren’t models out there to work with the mother and infant together, so we can’t address both the mother’s depression and the infant’s development at the same time—even though they are inextricably linked.”
Recent research suggests that treating the mother’s depression does not eliminate health risks for the infant, she notes. Even when treatment for depression is effective and the mother recovers, the developmental and other risks to the infant, and the risks to the maternal-infant relationship, remain.
“The mother-infant dyad is a unit, and we need to treat it as such,” she says. “Otherwise, the negative effects of depression remain for the relationship and for the infant—even though the mother looks better and feels better.”
To remedy that problem, Goodman has developed and will test an early intervention to treat depressed mothers and infants together. Over a three-month period, trained nurses will provide eight home visit intervention sessions to mother-infant dyads. A control group of mothers will receive brief intervention phone calls on the same schedule.
The results are not yet in, but Goodman suspects that treating mothers and infants together will have positive implications for both. The simultaneous treatment, Goodman predicts, will have a synergistic, therapeutic effect for both. “The more the mother understands and knows her infant, the more likely it is that she’ll feel confident and competent in caring for the infant, and that can affect them both.”
In the meantime, Goodman is also working to change policies about postpartum depression care. In January, she testified before Massachusetts state legislators about a bill that would require health care providers to screen pregnant and postpartum women for depression. The bill would also provide resources to educate providers and the public about the condition and would require health insurers to cover the minimal costs associated with screening and referral to treatment.
She was also gratified to see the recent passage of the Melanie Blocker Stokes Act, a provision of the recently enacted federal health reform law. It would provide funding for support programs serving women suffering from postpartum depression and psychosis. “That’s been a long time coming,” Goodman says. “Because of that new law, there will be more resources for researchers like myself to study ways to improve treatment of post-partum depression.”
RWJF Perspective: For her work, the Foundation has named Goodman a Nurse Faculty Scholar (2009-2012). The program aims to develop the next generation of national leaders in academic nursing through career development awards for outstanding junior nursing faculty. The goal of the program is to strengthen the academic productivity and overall excellence of nursing schools by providing mentorship, leadership training and salary and research support to young faculty.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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