This article is part of State of Health, a series examining integrated care and its potential to improve Michiganders' health. It is made possible with funding from the Michigan Health Endowment Fund.

Friends and family never would have suspected that Mel Trombley was suffering from a postpartum mood disorder.

Upbeat, laid-back, and successful, Trombley had a reputation for being a winner as a former college athlete, in her career as a teacher, and in her happy marriage. In 2014, the Grand Rapids resident and her husband had their first baby, a son. Although he was a difficult baby with feeding and sleeping issues, Trombley felt great during her pregnancy and in the first four months after his birth. However, when her son was about five months old, Trombley began having onsets of panic with no rational cause.

“These were abnormal to my personality type. I am normally relaxed and optimistic. They continued and built,” she says. “At the time, I was teaching. … I loved my job. But the additional emotional stress of being a teacher and a new mom put me over the edge. I continued to have anxiety and it kept getting worse. I was breaking down and crying multiple times a day. I’d go to the staff bathroom, just sit, and be panicked and cry.”

Trombley’s case is far from uncommon. According to Dr. Maria Muzik, 20% to 25% of women are at risk for first-time onset of mental illness after they give birth. Those with a history of mental illness have a 60% to 75% risk for relapse.

Maria Muzik.

As associate professor of psychiatry and associate professor of obstetrics and gynecology at the University of Michigan (U-M), Muzik leads the U-M psychiatry department’s Zero to Thrive women and infant mental health programs. She says the best way to address new mothers’ mental health is to make screenings and referrals part of routine primary care — at the family doctor or obstetrician’s office, or when baby goes to the pediatrician for well child check-ups.

“These are natural points where moms are being seen by the medical professionals,” Muzik says. “We know this is a time when women are vulnerable for mental health issues and that preexisting conditions are exacerbated by the hormonal changes, sleep deprivation, and birth trauma.”

Finding support

Escalating episodes of panic, anxiety, and depression caused Trombley to isolate herself from friends and family, who attributed her social withdrawal to her being busy with a new baby.

“I knew I was lucky, had a great husband and baby, but I was still out of control,” she says. “It was hard for me. I’ve always been an achiever. … I was really ashamed that I could not win at this. After one of the really dark times, I realized I needed to get some help.”

With the support of counselors, medications, her husband, and the family and friends she finally confided in, Trombley was able to overcome her mental health issues. And when she and her husband decided to have a second child, they put systems in place to ensure that postpartum mood disorders would not overwhelm her again.

When her second baby arrived, Trombley signed up with MomsBloom, a nonprofit providing postpartum support to mothers of newborns in the Grand Rapids area. MomsBloom recruits, trains, and matches in-home volunteers with new moms who have reached out for help. Volunteers screen for postpartum depression and other mood disorders while also helping moms out around the house.

MomsBloom executive director Carrie Kolehouse notes that while women who have experienced mental illness in the past may be more likely to encounter postpartum mood disorders, even new moms with a clean bill of mental health need to realize they are also at risk.

“For some women, postpartum depression is instantaneous. After they give birth, a huge hormonal change can cause severe symptoms,” Kolehouse says. “For others, it might settle in as they are making difficult transitions at home or present itself as late as a year later.”

Carrie Kolehouse.

She notes that postpartum anxiety, like Trombley experienced, is also very prevalent. New moms may find themselves obsessively checking to make sure their baby is breathing, have difficulty sleeping or eating, or experience increasing irritability. Others may not feel connected to their baby or even regret having them.

“It’s difficult in our society because these feelings come with a lot of guilt and shame. Mothers don’t admit it, and this prevents them from getting the help that they need,” Kolehouse says. “In a lot of ways, our society holds parents to a higher expectation than ever before while providing less support than ever before. People feel like they have to do it all alone and something is wrong with them if they can’t. To raise children, we need to depend on other people to be there for us.”

A proactive approach

Linsey Higgins, lead maternal mental health counselor at Nature’s Playhouse in Ferndale, says some moms experience depression or anxiety during pregnancy in addition to postpartum symptoms.

Linsey Higgins.

“It’s normal to be nervous or anxious to some degree when you’re pregnant or after you have a baby. If it is a first child, there’s a lot of uncharted territory,” she says. “However, some women experience beyond what we consider typical anxiety.”

Higgins sees perinatal mood disorders robbing women of the sweet moments and joy that their newborns bring, impacting not only the mother-baby relationship but also relationships with spouses or partners. In her practice, she likes to see women early in their pregnancies — and help them create a postpartum plan as well as a birth plan, especially if mental illness has been an issue in the past. The plan may include simple household logistics or address use of medication and therapy should the need arise.

“We see women having difficulty bonding, losing interest in things they used to find enjoyable … extreme feelings of sadness, guilt or shame, that they can’t do anything right, lack of motivation, and lack of energy,” Higgins says. “Another less common reaction is anger or irritability – postpartum rage – and, in more extreme cases, thoughts of harming themselves.”

Because a pregnant woman or new mother may fear the stigma associated with visiting a psychiatrist’s office or feel hesitant to share mental health concerns with her doctor, Muzik emphasizes that simple screening tools can help primary providers meet the woman’s mental health needs, either directly at the practice or through referral.

“How easy if I get my whole physical and mental health care at my doctor’s office and don’t have to go to another location … especially for populations at higher risk who may have no transportation, no childcare, little resources, or no family support,” she says.

Muzik believes routine mental health screening is the best first step to addressing the mood disorders that put moms and babies at risk.

“We know from previous research, if a woman doesn’t get asked how she is feeling, she does not disclose. People have a tendency to under-report,” she says. “If they don’t have standard screening, physicians collude (in the under-reporting). They are not trained in mental health. They don’t want to ask. It slows them down. ‘God forbid she starts to cry! Then what do I do?’ These standard (screening) questionnaires take five minutes to fill out and two minutes to score.”

In collaboration with the Michigan Medicine Department of Psychiatry’s Michigan Child Collaborative Care Program (MC3), Zero to Thrive invites Michigan primary care providers to access psychiatry support for patients with mental health problems. Livestreamed trainings teach providers how to care for patients experiencing issues. Locally based behavioral health consultants can refer patients to resources available in their own communities. In some cases, MC3 sets up telepsychiatry consultations with Muzik and other psychiatrists involved in the program.

“It’s a dyad. The mom and the baby are a unit,” Muzik says. “This is what I breathe, what I believe in. It’s how you set the stage for thriving, for mom and the next generation. If you are taking care of the parents, you are setting up the next generation for success.”

Trombley notes that it’s important not only to have such programs and formal support structures in place, but to normalize the everyday conversation around moms’ mental health.

Mel Trombley.

“People don’t talk about how hard being a new mom is, only how great it is,” Trombley says. “As I talk about this with people, so many have said to me, ‘This happened to me too.’ I think it’s important to know it’s really prevalent and to have someone to reach out to. It doesn’t say who you are but shows you have strength to ask for help.”

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Mel Trombley and Carrie Kolehouse photos by Adam Bird. Linsey Higgins and Maria Muzik photos courtesy of the subjects.