UConn Health Opens Perinatal Mental Health Clinic

An integrated team of obstetric and mental health specialists is helping patients recognize and treat depression, anxiety and other conditions that can emerge during pregnancy and the first year after childbirth. Pregnancy and the arrival of a new baby are often portrayed as joyful milestones. But for many patients, this period also brings significant emotional, physical, and psychological challenges that can be difficult to recognize and even harder to discuss. A new Perinatal Mental Health Clinic at UConn Health is working to change that conversation. Opened July 1, the clinic brings together specialists in obstetrics and gynecology, psychiatry, psychology, and social work to identify patients who may be struggling and connect them with individualized care. The integrated model allows patients to receive mental health support in a familiar OB/GYN setting while their providers communicate closely about every aspect of their care. "Perinatal mental health is a medical condition," says Dr. Dyanne Tappin, a UConn Health OB/GYN who helped develop the clinic. "It doesn't mean there is anything wrong with you. It means there is a condition we need to address so you can be in the best possible state for yourself, your baby and your family." What Is Perinatal Mental Health? The perinatal period generally includes pregnancy and the first year after childbirth. Although the term "postpartum" is more familiar, mental health symptoms can begin during pregnancy, emerge after delivery or represent a worsening of a condition that existed before pregnancy. These conditions can include: Depression Anxiety and panic disorders Obsessive-compulsive disorder, or OCD Post-traumatic stress disorder Bipolar disorder Postpartum psychosis, a rare but serious psychiatric emergency Some patients enter pregnancy with a history of depression, anxiety, trauma, or another mental health condition that has been stable for years. The hormonal, physical and emotional changes of pregnancy and later the demands of caring for an infant can cause symptoms to return or intensify. Others experience depression or anxiety for the first time during pregnancy or after giving birth. "There are hormonal changes, but it is much more complicated than hormones alone," says Dr. Feier Liu, a UConn Health psychiatrist with the clinic. "Pregnancy can be physically uncomfortable, and some patients experience significant nausea, vomiting and disrupted sleep. After delivery, there may be continued sleep deprivation, questions about how much support someone has at home, financial stress, relationship stress and the pressure of returning to work." These stressors can accumulate quickly, says UConn Health psychologist Dr. Traci Cipriano. "You can think of it as a basket of stressors," Cipriano says. "If someone is sleep-deprived, has a history of depression, lacks support, is experiencing relationship or financial stress, or has a baby with medical challenges, eventually that basket can overflow." Baby Blues or Something More? Emotional changes in the days following childbirth are common. Often referred to as the "baby blues," they can include tearfulness, irritability, feeling overwhelmed and difficulty sleeping. These feelings are generally temporary and do not prevent someone from caring for themselves or their baby. Symptoms that are intense, persist, or interfere with daily functioning may indicate a more serious condition. Warning signs can include: Persistent sadness, hopelessness or frequent crying Severe anxiety or racing thoughts Feeling worthless or like an inadequate parent Withdrawing from family and friends Difficulty bonding with the baby Significant changes in appetite Being unable to sleep even when the baby is sleeping Feeling unable to manage everyday responsibilities Intrusive, frightening thoughts Thoughts of self-harm, suicide or harming the baby Confusion, hallucinations, delusions or a loss of contact with reality "It is normal to have some anxiety when you are caring for a new baby," Cipriano says. "The question is whether that anxiety is interfering with your ability to function. Are you unable to relax? Are your worries taking over? Are you isolating yourself, feeling hopeless or unable to be present?" Sleep can be an especially important indicator. While interrupted sleep is expected with a newborn, being unable to sleep when there is an opportunity to rest may signal that something more is happening. "Perinatal mental health conditions exist on a spectrum," Liu says. "We want people to recognize when their symptoms are affecting their ability to eat, sleep, care for themselves, care for their baby or function in their daily lives and to know that help is available." Anyone experiencing thoughts of suicide or harming themselves or someone else, hallucinations, delusions, severe confusion or other signs of psychosis should seek emergency assistance immediately by calling 911 or going to the nearest emergency department. The 988 Suicide & Crisis Lifeline also provides confidential support by call, text or chat. Care Built Around Each Patient Patients receiving prenatal and postpartum care at UConn Health are screened for depression, and providers can refer those who may benefit from additional evaluation to the Perinatal Mental Health Clinic. Tappin and Dr. Shannon DeGroff, also an OB/GYN, conduct the initial intake. In addition to repeating depression screening when appropriate, they may assess patients for anxiety, bipolar disorder, and trauma. Most importantly, they take the time to talk with patients about what they are experiencing and what kind of support they want. "As important as screening is, it is only one piece of the puzzle," Tappin says. "We need to sit down and ask, 'How are you really doing? What is happening in your life, and what is causing these stressors?' Those conversations help us understand what each patient needs." Following the intake, the team develops an individualized treatment plan. Some patients may want psychotherapy, some may benefit from medication management, and others may need a combination of services. Those needs may also change over time. Cipriano provides the psychotherapy component, helping patients manage anxiety and overwhelming emotions, remain grounded, identify sources of support, and find realistic ways to care for themselves. "There can be this expectation that someone has to be a certain kind of 'perfect' mother," Cipriano says. "Patients may compare themselves with what they see on social media or with what their own mothers were able to do, even though their circumstances may be completely different. Therapy can help them talk through those expectations and recognize that asking for support is not a failure." Liu works with patients who may benefit from medication, discussing the potential risks and benefits so they can make informed decisions. Treatment is never one-size-fits-all. When a medication has helped a patient in the past, the team may consider continuing it rather than introducing something new. For patients who have not previously taken medication, the choice depends on their diagnosis, symptoms, medical history, and personal preferences. "No medication is 100% risk-free, so we talk honestly about the potential risks of treatment," Liu says. "But we also discuss the risks of leaving a significant mental health condition untreated. Our goal is to give patients the information they need to make the decision that is right for them." Untreated perinatal mental health conditions can affect both physical and emotional well-being. They may contribute to pregnancy complications and can interfere with recovery, infant bonding, feeding, and relationships with partners and other family members. Tappin stresses that this information is not intended to make patients feel guilty or pressured. Instead, it helps them understand that caring for their mental health is an important part of caring for their pregnancy and family. "You have to care for yourself, too," Tappin says. "We are here to help, and this is a journey we take with you." Bringing Care Together Locating mental health services within the OB/GYN practice is a central part of the clinic's design. Patients begin with an in-person intake and may later use telehealth when appropriate and more convenient. The shared setting also allows members of the care team to consult with one another quickly. If Liu suspects that a medical concern may be contributing to a patient's anxiety, for example, she can speak directly with an OB/GYN colleague rather than sending the patient elsewhere to navigate another referral independently. "It creates a collaborative and cohesive approach," Cipriano says. "Patients are not being told to call several different people in different locations and hope someone can see them. The goal is an integrated experience with better communication among providers." The response since the clinic opened has demonstrated the need. The team received over 50 referrals since opening in July. UConn Health has also developed relationships with community providers and organizations, so patients can be connected with appropriate resources as the program grows. Those partnerships include the Hispanic Health Council, the Family Wellness Center and Postpartum Support International. A recent community baby shower organized with these groups brought together nearly 50 families for education and support focused on perinatal mental health. For Tappin, the clinic represents an important shift in how health care providers approach pregnancy and postpartum care. "As OB/GYNs, we recognize that we do not have all the answers, and we should not put that pressure on ourselves," she says. "But we can partner with psychiatry, psychology, social work and community organizations to provide better care." Above all, the team wants patients and families to know that perinatal mental health conditions are common, treatable, and nothing to hide. "There is often an idealized image of what a mother should be, and some women feel they are not enough if they need help," Liu says. "This is an incredibly challenging time. We need to come together as a community, understand what patients are experiencing and give them the support they deserve."