Professional Resource

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The PROMISE of Perinatal Intervention for Mom-Baby Mental Health

Aviva K. Olsavsky, Amelia Ehmer, Debbie Carter, Stephen Scott, and Bethany Ashby

Abstract

The University of Colorado PROMISE Clinic is an integrated mental health program housed in the obstetrics/gynecology outpatient clinics. A team of medical and mental health professionals care for a racially, ethnically, and socioeconomically diverse patient population. They provide integrated mental health services from consultation through co-located treatments and take a mom–baby approach, as they work to bolster the resilience and overcome stress in mothers and their infants, benefiting two generations at once. They engage in cross-disciplinary and trainee educational efforts and hope to impact more dispersed communities with telehealth consultation in the future.

Fatima was 25 years old when she came to the obstetric (OB) clinic in the second trimester of her second pregnancy (her first daughter is 7 years old), having been diagnosed with genital herpes (HSV-2), which she contracted from her husband. She felt betrayed and shared that she thought her husband might have been unfaithful, and they subsequently separated. She had few friends or supports in the United States, and her extended family was living in Pakistan. She worried about carrying her child to term with her recent HSV-2 diagnosis. While excited about her baby boy, she felt concerned that he would remind her of her husband, making it difficult to bond with him. On several occasions, she expressed ambivalence about the pregnancy to OB providers, who were concerned about her mental health, given her prior diagnosis of bipolar disorder and current depressive symptoms. Thus, she was referred to the integrated mental health team. Upon assessment, she did not meet criteria for a past manic/hypomanic episode, though she did meet for major depressive disorder and prior posttraumatic stress disorder with residual symptoms. She struggled with mood dysregulation and emotional lability, engaging quite differently with providers during appointments that were only 1 week apart, and her symptoms were often associated with the amount of contact with her estranged husband between visits. Multiple discussions occurred between Fatima, her mental health and OB providers, and the OB social worker regarding her ambivalence and demoralization about the pregnancy in the context of the relationship with her estranged husband. Her feelings toward her male baby, her depressive symptoms, and her reticence about taking psychotropic medications were all areas of concern. Motivational interviewing and close follow-up with her psychiatrist and therapist in a team approach occurred throughout her pregnancy. Her psychotherapist provided ongoing psychoeducation about Fatima’s symptoms and engaged in collaborative care with OB providers, thereby creating a supportive environment within the clinic. During psychotherapy sessions spanning from pregnancy into the postpartum period, Fatima was able to talk about her feelings about her baby, with whom she was increasingly beginning to connect.

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