Episode 21: The Motherhood Center of New York
Catherine Birndorf, MD, and Paige Bellenbaum, LMSW, detail the services provided by their organization, The Motherhood Center of New York, a treatment center for pregnant and new mothers experiencing mood and anxiety disorders.
Catherine Birndorf, MD
Catherine Birndorf, MD is a Reproductive Psychiatrist who is the Co-Founder and CEO of The Motherhood Center of New York, a treatment center for pregnant and new mothers experiencing mood and anxiety disorders. Dr. Birndorf is Founding Director of the Payne Whitney Women's Program at the New York-Presbyterian Hospital Weill Cornell Medical Center, where she is Clinical Associate Professor of Psychiatry and Obstetrics & Gynecology. Dr. Birndorf is a board member of Postpartum Support International, a non-profit organization for awareness, prevention and treatment of mental health issues related to childbearing worldwide. For 10 years, Dr. Birndorf was a regular mental health columnist for Self Magazine and has appeared on numerous television programs, including the Today Show, Good Morning America, MSNBC, and CNN. Her first book, The Nine Rooms of Happiness, co-authored with Lucy Danziger, was a New York Times bestseller published in 2010. She is the co-author of What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood published in April 2019.
Paige Bellenbaum, LMSW
Paige Bellenbaum, LMSW, is the Founding Director and Chief External Relations Officer of The Motherhood Center. Paige started her social work career working at a homeless shelter for families in San Francisco, where she built a multi-million Housing and Aftercare Program for families transitioning from homelessness to permanent housing. She then moved to New York City in 2000 to get her Masters of Social Work at Columbia University. After she graduated, she held executive level positions at various non-profit agencies including the Center for Family Life located in Sunset Park Brooklyn, Habitat for Humanity – New York City, and Settlement Housing Fund. Throughout her non-profit career she has worked with homeless families, victims of domestic violence and child abuse, formerly homeless single mothers, formerly incarcerated young adults and more. She Chaired the Youth and Human Services Committee of Community Board 6 in Brooklyn for 6 years, and ran for public office and was elected in 2015 as the District Leader for the 52nd Assembly District in Brooklyn which she held for three years.
After her first child was born, Paige suffered from severe postpartum depression that nearly ended her life. Once she began to heal, she became committed to fighting for education, screening and treatment for postpartum depression so that no more women would have to suffer silently. She drafted legislation in New York State that was championed by State Senator Liz Krueger, mandating education and strongly encouraging screening of all new and expecting mothers that was signed into law in 2014. Paige has been an outspoken advocate on the issue of postpartum depression, and uses her own story as a tool for change. She has appeared on the Today Show, NPR, PBS Newshour and in Women’s Health Magazine, The Wall Street Journal, and several other media outlets.
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Intro Voices [00:00:31] This is “You Matter”, a podcast for the NYU community developed by the Department of Public Safety.
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Karen Ortman [00:01:29] Today we introduce Catherine Birndorf, M.D., a reproductive psychiatrist who is the co-founder and CEO of the Motherhood Center of New York, a treatment center for pregnant and new mothers experiencing mood and anxiety disorders, and Paige Bellenbaum, L.M.S.W., the founding director and chief external relations officer of the Motherhood Center. Dr. Birndorf and Paige, thank you so much for joining us today on “You Matter”.
Paige Bellenbaum [00:01:57] Thanks for having us.
Catherine Birndorf [00:01:58] Thank you.
Karen Ortman [00:01:59] So, Paige, I'm going to turn to you first and I'm going to ask you, what exactly is the Motherhood Center and what does it do?
Paige Bellenbaum [00:02:06] The Motherhood Center is a rather new development here in New York City. In my personal opinion, there should be one on every single corner but we're not quite there yet. At the Motherhood Center, we specialize in providing support and treatment to both pregnant and new mothers that are experiencing something that we call Perinatal Mood and Anxiety disorders. I'm going to refer to them as PMAD's from here on out. It's not the loveliest acronym. Someday maybe we'll change it, but it's what we've got. And what we do at the Motherhood Center is we provide clinical care and intervention to women that are experiencing PMADs symptoms. Now most people know of PMAD's as postpartum depression, so perinatal mood and anxiety disorders has really replaced that term. And the reason being is that a lot of people don't realize that these symptoms can emerge during pregnancy and postpartum. So diagnoses such as depression, anxiety, OCD, bipolar disorder and in some instances, in acute instances, postpartum psychosis. These things can happen again during pregnancy or one year postpartum. And so PMAD's really creates an umbrella to capture all of those diagnoses that happen in the perinatal period. So that's the population that we treat. And because PMAD's can impact women at different levels of acuity, anywhere from mild to moderate to very severe and acute, we offer different levels of care to meet a new or expecting mom where she's at.
Karen Ortman [00:03:38] So can I interrupt and ask one question? So what was the catalyst for the sort of the evolution of this terminology? When I was having children, it was postpartum depression. And now we have PMAD’s. So I'm just curious as to why the term changed and what the sort of reasoning behind it is.
Catherine Birndorf [00:04:09] You know, we're scratching our heads for exactly when things changed, so you raise a very good point. I think those of us in the field and particularly with some of the grassroots organizations like Postpartum Support International, where I'm a board member and Paige, we’re both very active. You know, what happened was there wasn't enough inclusion. Right. People were getting confused. When I had kids, I don’t even know, was there postpartum depression? Well, it’s been there forever but what you call it is another thing. So once we finally got the idea of PPD or postpartum depression out there, what we realized as we were treating people in the field was that not enough people were coming, could identify themselves or come for treatment because they're like, well, I'm not postpartum and I'm not depressed. I'm pregnant and anxious or I'm postpartum and anxious or pregnant and depressed. So it didn't...
Karen Ortman [00:05:09] Right, so they exhibited the symptoms of what we're calling now PMAD, they just didn't know that that's what it was.
Catherine Birndorf [00:05:17] So in an effort to be more inclusive and try and capture everything with one acronym, we got ourselves to this perinatal mood and anxiety disorders P.M.A.D. And like Paige said, we don't love it because it has the word mad in it. And right now, we're not psyched about that, right? No, we're not. But we are trying to be - trying to get as many people as we can in there so that we understand this to be a far-reaching, far-ranging class of disorders, anywhere from, like Paige said, mild, mild adjustments all the way to severe psychosis. And we want to be inclusive enough so that everyone can say, maybe I have one of those.
Karen Ortman [00:06:04] So who is at greatest risk of developing a PMAD?
Paige Bellenbaum [00:06:11] Good question. There are a couple of risk factors that women should know when they are approaching pregnancy and the postpartum period. We know that women who have a history of mental illness that have been previously diagnosed for depression or anxiety or any other disorder are at a higher risk to develop a PMAD in pregnancy or postpartum. We know that women that have it in their family genetically, if another family member is predisposed to a mental illness, that puts them at greater risk and then women that have a lot of external stressors going on. This is why we see severely higher rates of PMAD's in lower income communities because of all of the different financial and relationship and economic and housing and all of those stressors that can lean so heavily on low income women. We can see the rates be as high as 40 percent for those populations.
Karen Ortman [00:07:07] Can you describe, so PMAD covers a, it's an umbrella term for various issues. Could you speak to the least obvious condition, if you will, that a listener could be experiencing, might not recognize it as PMAD, but might perhaps benefit from talking to a medical or mental health professional to identify what could really be going on.
Catherine Birndorf [00:07:45] Yeah, that's a great question. One of the things that leaps to mind is can you sleep when the baby's sleeping? You know, can you rest? Or is your mind always racing or are you always worrying about something? Right. So what defines regular old kind of Darwinian anxiety? I mean, new parents should be anxious, right? And a pregnant person, you've never been pregnant, trying to get pregnant. All those things naturally bring up a level of anxiety that can be considered, quote, normal. What I'd say is when things are more extreme, there's greater levels of distress or there’s a level of dysfunctionality like dysfunction. You can't get to work. You're not doing your schoolwork. You're not able to complete tasks. You're not functioning in your usual way. Right. So it's a level of distress, like how bad is it?
Karen Ortman [00:08:46] So there is a normal level of sort of stress associated that people experience and that's okay.
Catherine Birndorf [00:08:54] Well it's a very - yes, and it's very important to say, how could you not be, right when you're growing a person inside of you. That's kind of unusual, although very typical and common. It's distressing in some ways and anxiety provoking in others. The question is how so? How much so? And how much disruption is it causing in your life? And that's the same in the postpartum. And that's the same throughout life.
Karen Ortman [00:09:21] So you spoke of the inability to rest while the baby's sleeping because your mind's always racing. Can you give another example of a behavior or sort of experience that might warrant further sort of investigation through help?
Catherine Birndorf [00:09:38] Yeah. So if it's not level of something that you normally have that feels blown out of the water, it may be just disinterest or you find yourself kind of not being excited about anything or kind of, you're going through the motions of life or you're feeling overwhelmed in a way that is uncharacteristic of you, or you feel sad for no clear reason or hopeless or not forward looking. Things like that are not obvious and may not jump out at you. But if you're hearing this and you identify with any of those things, it's something to think about because everybody struggles with, in some ways, sleep, appetite, energy, you know, all those things are typical during pregnancy and after.
Karen Ortman [00:10:29] Depression?
Catherine Birndorf [00:10:30] No. But those things are the first three signs and symptoms of depression. And they are the first things you think of, like in the first trimester and when you're postpartum. So it's easy to be blown off by somebody, a professional who says “Oh, everybody feels that.” But what's different is if you also feel hopeless, helpless, not enjoying things. You know, just flat. And not forward looking. And in the worst case, suicidal, like having thoughts like, could I just like, get out of this? Can I return the baby? Can I escape my life? Can I give it back? Like, what the heck did I do?
Karen Ortman [00:11:12] Do you think the mental health profession and the medical profession are adequately trained to recognize a PMAD in a new mother?
Paige Bellenbaum [00:11:25] No. And it's on top of the clinical intervention and support that we provide to pregnant new moms at the motherhood center through support groups, individual therapy, medication management and our day program with an onsite nursery. We do a lot of education to the outside world as well. You know, any opportunity that we can have like this to talk about PMAD's to normalize them and try to defeat the stigma and give women permission to seek help, but also to educate providers on what to look for, what instruments to use to determine whether or not a woman is struggling with a PMAD, how to have the conversation. So many OBGYN’s and pediatricians for years and years have kind of backed off from the whole PMAD territory for a number of reasons. One, it's not their area of expertise. They're not mental health practitioners. Two, it's, you know, there hasn't typically been a lot of resources available to women. Right. So if a pediatrician or OBGYN starts to notice or has this, you know, has mom expressing discomfort or some symptoms to him or her. Where are they going to send her, right? There's only one motherhood center in the U.S. that is this model. So there's still a lot of education that needs to happen so that more providers - and this goes out to anybody who comes in contact with a new or expecting mother - doulas, lactation consultants, postpartum doulas, pelvic floor therapists, everybody should have some understanding of what to look for and then how to make a soft handoff to a referral. So that work is still being done. And you know, one thing that we're about to change this, we're working on a brochure right now. But for anybody who has had a child and has spent time in an OBGYN's office and sees all of the literature on the walls, the talks about preeclampsia, gestational diabetes, all of these things that women get tested for and learn about. Find me one practice in New York City that has a pamphlet on perinatal mood and anxiety disorders, considering the fact that they are the number one complication associated with childbirth.
Karen Ortman [00:13:34] So you brought up a point that I wanted to ask you about, which is the stigma associated with PMAD’s. Why do you think the stigma exists? Why do you think there's a reluctance to not only seek help, but to talk about it amongst a new mothers peer group? And what can we do to address this stigma and and encourage listeners who might know somebody or they themselves going through this, encourage them to seek help?
Catherine Birndorf [00:14:11] Well, the stigma, I think, comes from many places, particularly just sort of the societal expectation of what it means to be a mother. There's this myth, this mythological mother figure, right? It's been true throughout history and it's so revered and idealized that there's no room for any variation. So we all do it to each other and to ourselves. And we have to break out of that. And it's not easy. You know, from pictures on Instagram and Facebook and all these different “Look how great I'm doing!” Right. And people smiling. And it's just, we are ashamed. I mean, I think shame is the biggest culprit, which is the sense that I am bad, I am wrong, I am defective. There's guilt, too. And there are many other complicating factors. But we don't share because we're scared and embarrassed and don't want to look different. And like we don't have this thing mastered because why should you? You didn't do it before. Even if you were the queen of babysitting, it doesn't mean you're going to be good at having a kid or know what to do.
Karen Ortman [00:15:35] And even for, you know, the second and third and fourth children.
Catherine Birndorf [00:15:39] It can show up anytime.
Paige Bellenbaum [00:15:43] I would add judgment. There is such an innate fear of being judged and being revered or experienced as a failure as a mother. And I think that that fear is one of the things that keeps women's painful stories very secret and private. And also, you know, there's a real fear that women have and luckily, this experience is starting to shift a bit. But there even recently have been situations in which a woman has gone and spoken to her pediatrician or OBGYN about having scary, intrusive thoughts about harm coming to the baby. And then the police are called. Right. So women are afraid that if they share what's going on, that they're going to have their baby taken away. And, gosh, do I wish and urge people out there that have had anywhere from mild to severe symptoms of a PMAD, if you feel comfortable, I think this is the only way we're gonna change the dialogue is if we share our stories. I ran a group yesterday and there was a mom who came for the first time. She's pregnant and halfway through it she's like, I just have to say, I'm amazed. I thought I was the only person that was going through this. I feel so much better knowing that everybody in this room is struggling, too. And that in itself is - there's hope in that, right, that we're not alone, that one in five women experience a perinatal mood and anxiety disorder.
Oatile Ramsey [00:17:10] Right. We talked a lot about the condition itself. And I was wondering if we could shift the conversation a little bit towards treatment. And I guess this question can go either way, but I think Dr. Birndorff, I was wondering what treatments would be available for PMAD’s?
Catherine Birndorf [00:17:31] Well, good news. There are many and they're highly effective. And these are almost, you know, invariably super treatable. So tons of hope. The biggest issue as we've been talking about is how do you recognize it? How do you bring it to medical attention and how do you, you know, not be ashamed to ask. But treatment, once you can get there, if you can find it. I mean, which is partly why the Motherhood Center exists, why we built it, is really effective. And it's very straightforward. It's in fact, not so different from treatment of any other kinds of mental health disorders, which is, you know, support and talk therapies. And those come in various forms; individual, group, couples, family, mother-baby, you know, come in many different forms. And if that is not working or is not enough, which is often the case with a moderate to severe PMAD, then we bring in medication. And again, I spend most of my time talking with women who are thinking about getting pregnant, who are pregnant or who are postpartum, who have a history of illness and are on a medication or have been off their medication, but are thinking, oh my gosh, what's going to happen to me? Will I have a relapse or can I come off this medication? Because should I be on this in pregnancy? Is that okay? Is it good for the baby? Is it bad for the baby? What about breastfeeding? So that's what my academic specialty has been about for the last 20 years. And what I love to do, because women find themselves in these very precarious places where they're at odds with like, if I'm going to be well, what's it going to mean for the baby? And you're not at odds with the baby, but that's the experience. So it's a really - I love having these conversations because you can really help women empower them to make choices that they thought they didn't have. And there are many choices to make. Because primarily, I would say essentially all of the antidepressant medications, which are primary treatments for both anxiety disorders and depression, are considered relatively safe in pregnancy. Boom. Right. Like, that's what so good, you know? It's like a news headline every time. And when I started doing this in the 90s, there were very few articles out there. There was limited data. And now there are tens and thousands, tens of thousands of articles with decent data sets looking at these medications and pregnancy. There’ll be people in work, you know, are they going to cause birth defects, are they going to cause other complications with the baby or they can affect the baby long term. And what about breastfeeding? So all of that stuff, these medications, because mental illness is marginalized, right. Like if it's a physical illness, as if there's a difference, like you have a seizure disorder or you have diabetes or high blood pressure, no one's taking you off your medication. It's not a discussion. It's a no brainer. But with psychiatric illness, “Oh, you have depression. You'll be okay, right? You can get through a pregnancy, right?”
Oatile Ramsey [00:20:46] Sorry, I do sort of have a question about that, because there is that big concern amongst a lot of people of what medications to take, what dose? What's safe and what's not safe. So if one if you kind of elaborate on, one, what medications should people be looking for, what to expect? And then when would it be safe to take them during the period?
Catherine Birndorf [00:21:08] Great questions. So what I would say is - it used to not be a quick answer, but the quick answer is, if you have illness, and you are well on a medication, chances are you should stay on that and stay well, because the mom being well is the best thing for the developing fetus and for the infant and for the child and for the family. That's a huge generalisation. So let me go back for a second and say, as I said before, the anti-depressants, right, the SSRIs, selective serotonin reuptake inhibitors, which started with Prozac, fluoxetine, then Zoloft, sertraline, Celexa, which is citalopram, lexapro, escitalopram, Paxil, Paroxetine. And then we go into the SNRIs like Effexor and Cymbalta. Right. Looking at that category of medication, the SRIs as a whole, we have no evidence to suggest that these are unsafe in pregnancy for women to take. OK, that said, we do not pass these medications out lightly. We don't just think, oh, you have a mild to moderate depression, stay on it, because if you can be off of it, I always start my conversations with women who are in my office by saying, “What would life be like for you off this medication?” How much, you know, symptomatology is there when you come off, how ill do you get? And if they're like, you know, it's mild, my anxiety’s mild or my depression’s mild, you might be able to - you might choose the symptoms, mild symptoms over the medication.
Karen Ortman [00:22:51] I think it's great that you involve the patient in that conversation.
Catherine Birndorf [00:22:55] We have to.
Karen Ortman [00:22:57] Why - would you agree that that might not have always been the case?
Catherine Birndorf [00:23:00] Oh, for sure. And I don't - I didn't mean to be flip saying that. I don't see it any other way but a collaborative process.
Karen Ortman [00:23:07] It's kind of a different sort of philosophy in or approach to women who are suffering.
Catherine Birndorf [00:23:15] Absolutely. But if they're not included in their care - And I get it, you're right. I mean, I always think, everybody must do it this way. But you’re right. They don't. And I was very fortunate to have come from a medical, though it was Western traditional medicine, you know, the place where I was trained was very - it was all about collaborative care and the patient was the center.
Karen Ortman [00:23:36] As they should be.
Catherine Birndorf [00:23:37] As they should be. And we're providing information. That's how I've practiced my whole career. And I can't make that decision. I can give you my advice, my professional opinion. And in the end, you have to make the choice. And your choice may be very different than the one I make. I have severely ill women who've had multiple, you know, manic episodes who when they're off their lithium or their Lamictal or their antipsychotic medications, you know, for many reasons they get sick and they still opt because they feel like they have to try. They have to prove to themselves that being on this medication is the better choice than being off and potentially being hospitalized. Okay. I'll go on that ride with you. I'll give you my opinion. I think you might very well be sick and we might next meet in the hospital. But that's OK - if that's what you have to do, I gotta do it with you. I don't know. But, so I hope an easy way to understand this is mild to moderate illness. And this is ACOG, the American Congress of OBGYNs. So there's a body of experts in literature out there that says mild to moderate illness, if you can use psychotherapies, talk therapies, non-medication treatments, that would be the way to go. But once things are moderate to severe, medications are most likely indicated and you should go for it.
Oatile Ramsey [00:25:00] I'm glad there's a shift in how we treat mental illness in society in general and you've spoken to it before, but it is something that's still relatively new. Where should people be going for treatment? What specific types of medical professionals should they be seeking out for treatment?
Catherine Birndorf [00:25:21] You've got to go for somebody who listens and who hears you. So- sorry, Paige-
Paige Bellenbaum [00:25:27] Or else, I mean, you'd want to come to us. If you're in New York City. Absolutely. Because we are really the only game in town that again covers this full spectrum of illness based on different interventions. You know, not everybody lives in New York City. And so unfortunately, in most other corners of the US, people don't have access to clinicians that specialize in treating PMADs. I do think that's important. But again, it's not everywhere. Right. Luckily, there's more and more training available to therapists and psychiatrists to be able to use appropriate interventions with pregnant and new moms. But, if possible to, look for a reproductive psychiatrist like Catherine, who specializes in meds and pregnancy and postpartum, to look for a clinician who has some training and expertise working with women experiencing PMAD's because although, as I will quote Catherine, these diagnoses are virtually the same as at any other time during life. It just happened to fall in the perinatal period. There are nuances and there are different types of symptoms that can transpire like anger and rage, which is something that's so common that women experiencing depression and anxiety have in the perinatal period. It's very helpful to be seen by somebody who has experience in treating these diagnoses.
Karen Ortman [00:26:52] Paige, can anybody outside of New York City contact your organization if they have questions about maybe the quality of resources in the Northwestern part of the country? Or if they just have questions because they listen to this podcast and they want to talk to experts in the area.
Paige Bellenbaum [00:27:18] Absolutely, yes. I mean, we get calls and e-mail inquiries from Africa, and Asia, and Australia, all over the world saying, I heard about your program, you know, are you coming to my country soon? We can help to the best of our ability. Really, the organization that does that for a living, as Catherine mentioned earlier, is Postpartum Support International. They've been around since the mid-80s. And their whole reason for existing is to be able to connect women across the world with treatment providers in their community so they can get the help that they need. So PSI, it's www.postpartum.net, is a place that will be able to cater to everybody around the world.
Karen Ortman [00:28:06] And do you have a 1-800 number for your organization? In the event somebody wants to reach out?
Paige Bellenbaum [00:28:11] Well, we have a 212 number, and it's very simple. All you have to do is call one of our care coordinators, we’ll speak to you on the phone, understand what you're experiencing and try to get you in to get evaluated. And it's 212-335-0034. I did just want to add one thing about something that we offer at the Motherhood Center that's really different. And I alluded to it in the beginning. It's called our day program and in clinical terms, it's a partial hospitalization program that's licensed by the New York State Department of Health and Mental Health. What's different about this program is that it's an intermediate level of care between inpatient, which is really the most acute intervention for a woman who has acute depression, is suicidal, perhaps experiencing postpartum psychosis, and outpatient treatment. It's in between. So women in our day program, they're with us five hours a day, five days a week. We have an onsite nursery and new moms are strongly encouraged to bring their baby because we do a lot of dyadic intervention. So that's therapy, an intervention between mom and baby. So often women with PMADs have these attachment issues. They're having a really difficult time bonding with their baby or they can't back off their baby. They're so anxious that something is going to happen. So a lot of the work there is on the dyad, women participate in therapeutic support groups throughout the day, expressive therapies like art therapy, they're all followed by an individual therapist, a reproductive psychiatrist. We do a lot of family work. It's so important to include and involve partners and other family members in this new or expecting mom's treatment. And we do partner support, too, because, you know, women are having a really difficult time with this transition and their partners are struggling at making sense of it, knowing how to support the woman in their life that's going through this and also looking for a community to connect to and say this is really hard. Like I don't know what to do. I have no one to talk to. I can't talk to anyone at work. So we really try to make sure that we're including the entire family into mom’s-
Karen Ortman [00:30:25] What a great organization.
Paige Bellenbaum [00:30:27] We like it.
Karen Ortman [00:30:29] I love it. I want everyone to know about it.
Paige Bellenbaum [00:30:32] Thank you.
Oatile Ramsey [00:30:33] You sort of just mentioned, sort of, the struggles family and friends might have on both and trying to really connect with this issue. And I'm wondering what role they can play in this? How can they identify if it's happening and then once they do, what are the next steps?
Paige Bellenbaum [00:30:53] It was very important to me when we opened up the Motherhood Center that our icon be a life preserver. For me, having gone through severe postpartum depression and anxiety myself when my son was born, I felt like - and it's so interesting hearing these stories of women that come in for treatment over and over again. I feel like I'm drowning. I feel like I'm stuck in a tidal wave. These references to the power of water and being stuck. I felt like I was drowning and I couldn't paddle fast enough to keep my head above water before I went under. And I kept feeling like, somebody, just throw me a life preserver, like, I can't do this by myself. And so many women that are in the bowels of this experience, they don't have the ability to pick up the phone and say, I need help. Right. It's so critically important that family members, especially partners, have some sense of awareness of what symptoms to look for, because a lot of times it's the partner that needs to say, you're not well. I see you and I know that you need help. And I'm going to make this call for you. I'm going to look into treatment options for you and see if we can't figure out a place for you to get help. In a perfect world, before any couple is discharged from the hospital, they would be taught all about what PMADs are and what symptoms to look for with a partner right there or another family member. Because mom doesn't always know. I was a licensed social worker. It happened to me. I had no idea what was going on. So family members are almost even more important, the need to inform them because they're the ones that can jump in and help.
Oatile Ramsey [00:32:39] Given all the stigmas we mentioned before and even the lack of awareness. Do you run into circumstances where perhaps people try to refuse treatment or maybe don't know that they need it? So let's say the family is trying to help and maybe they're just not receptive. And in that case, what would you advise?
Catherine Birndorf[00:32:59] It happens all the time. You know, no one really wants to hear, if they haven't come up with it themselves or if they aren't reaching out for help. It's hard to tell someone that they're not well. And family members don't want to upset people. You know, just, It's gonna be OK. It'll go away on its own. So a lot of this gets missed. It goes untreated, undiagnosed, untreated. And just, you know, festers, because it can take years to have a recovery on your own. And often women will get pregnant with a second, and they're still unwell. So we're talking perinatal. But the truth is, some people were depressed and anxious before they ever got pregnant or thought about it. And then they didn’t get treatment. And now they're raising this little baby not well. They're not well. And they never get treatment. And then they have another kid and it just compounds itself. So people really are scared, as Paige said. They're scared if you tell, someone will take your child, think you're defective, a bad mother. Families don't want to believe it. Often we find that the education is essential because, I always say as a physician, it’s a medical illness. Would you not treat something that your cardiologist told you had to be treated? Like, this isn't an option. But it's hard and there's a lot of refusal and we try very hard, as Paige said, with a soft handoff, with a soft touch. We should try not to clobber people over the heads with this and and get the word out there. But it's really hard to convince. And culturally, there are a lot of differences. So certain cultures don't identify or don't allow, you know, until there's like a flagrant problem, they'll keep it within. Right. So you won't see someone till they're psychotic and they've been ill for years. And it's so heartbreaking. It just - we're doing everything, getting the word out there. And maybe if there's a member of a family who's more, you know, out there learning, who can bring it back. I mean, you figure out whatever ways you can in to try and help the person suffering.
Oatile Ramsey [00:35:17] That's why a conversation like this is so important. Just all the work you do. As we try and create more awareness and tackle this issue a little bit more head on, both here in the United States and it sounds like across different parts of the globe, I’m wondering what recommendations you might have to improve education, screening and treatment of PMADs.
Paige Bellenbaum [00:35:39] I mean, screening should be mandatory. It shouldn't be a question. There are a number of states that have regulated mandatory screening, not all of them. New York is not one of them. I worked on legislation to originally mandate screening. But our governor at the time, who is still our governor, decided that he didn't want to tell the medical community how to do their job. So the language became strongly encouraged. New York should have mandatory screening. And that helps, right? It's not the perfect scenario, because oftentimes a lot of women are not honest on their screen for reasons that we've discussed today, fear of having the baby taken away, fear of judgment. But there are very effective instruments out there, and it should be universally mandatory, not only just once, at the six week postpartum visit for a new mom, which really is part of our medical model for a new mom, you know, you see your OBGYN more and more and more up until the delivery. And then six weeks later. And then that's it. There needs to be screening routinely throughout pregnancy. And also, pediatricians need to screen, too, because after the baby comes, they're the ones that are seeing mom more frequently. So we need to mandate screening. And again, you know, I really do believe that we have the ability to start a movement and really create a dialogue around normalization if we talk about our own experiences. And I understand for all the reasons that we've listed today around the fear of judgment and guilt and shame, it's a hard thing to share. But, you know, I will tell this story, which I tell very often, and Catherine's going to have to suffer through with me. But when I was at my worst and I hadn't been out of the house in weeks or bathed or anything, and my son was, I don't know, two months old, and I was like, I have to go outside. And I made it to the park. And I sat down on a bench and I saw all these women that appeared to be engaging with their babies and smiling and having that attachment, and I just wanted to hand him off to anybody who walked by me. I felt like I'd made the biggest mistake in my life. And this woman starts walking towards the bench and she's beautiful and she has her hair done and her makeup and she's got her size two jeans back on. And I'm like, please don't sit next to me. I really don't want to talk to you right now. She has this beautiful baby. And sure enough, she comes and sits down next to me. And they’re cooing at each other and smiling. And she looks over at me and she says, “Isn't this the greatest thing that ever happened to you?” And I looked at her and I said, “No, this is the hardest thing I've ever done. And a lot of the time, I wish I never did it.” And her smile started to fade and she started to cry. And she said, “Thank you so much for saying that. I feel the same way.” Now, if we can, those of us that have experienced any of these symptoms from mild to acute, the more that we can give women permission to struggle, the more we create a movement in solidarity. And we make this a real thing. And we start to chisel away at the stigma and make it normal and common so that more women go and get the treatment that they need to feel better.
Karen Ortman [00:39:03] Thank you so much for sharing your story. I think that's so important for people to hear, particularly from somebody in a position like yours who is trying desperately to get people educated about PMADs. I so appreciate both of you being here today. And for you being so honest and sharing your story. So thank you so much. I know you're going to help a lot of people who are listening. Both of you.
Oatile Ramsey [00:39:42] Before we come to a close, I was wondering if there's anything you might have wanted to say that we might not have touched on yet, anything that comes to mind.
Catherine Birndorf [00:39:54] It will feel better. I think one important thing is just a message of hope, and I say this to almost every patient. You will feel better. With help, you can feel better again. Almost invariably. You know, you can't guarantee anything in this world, these days particularly. But if you get help, you will feel better. And it's real. And we hold that hope for people when they can't. But if you can get to treatment, if you can identify it and get to treatment, you can feel better.
Oatile Ramsey [00:40:28] Thank you. I think that's great.
Karen Ortman [00:40:33] Inspiring.
Oatile Ramsey [00:40:36] Thank you both. Thank you to our guests, Dr. Birndorf, Paige, and to all of our listeners for joining us on today's episode of “You Matter”.
Karen Ortman [00:40:48] If any information presented today was triggering or disturbing, please feel free to contact the Wellness Exchange at 212-443-9999. You can also get in touch with NYU’s Department of Public Safety and their Victim Services Unit by calling 212-998-2222.
Oatile Ramsey [00:41:06] Please share, like, and subscribe to “You Matter” on Apple podcasts, Google Play or Spotify.