Telehealth can alleviate barriers to care for postpartum depression

By Aleksandra Vujicic

After two unsuccessful pregnancies, Lonicera Jiang decided to try in-vitro fertilization. But the fear of losing another baby, along with anxiety over the fertility treatment process, took such a toll on her mental health that a nurse midwife recommended she get help from the Women’s Wellness and Counseling (WWC) Service at University of Iowa Hospitals & Clinics. 

The center worked with Jiang through her pregnancy and the delivery of her daughter. Her anxiety didn’t suddenly vanish, so the therapy sessions continued—until Jiang’s increasingly busy schedule made it impossible to attend regular appointments. With her husband working six to seven days a week, and Jiang’s hands full with an 8-month-old and a very active 5-year-old, even sneaking in a few minutes to talk about her experience for this story wasn’t easy and had to be scheduled, quietly, during nap time.

For a busy mom like Jiang, in order to tend to her own health needs as well as care for a new baby, having a way to connect with her therapist without traveling to an appointment would be a relief. WWC is working to make that possible.

“Many women who seek services at our clinic have a hard time bringing a fragile newborn with them to an appointment at the hospital, or they might say, ‘my baby’s sick and I can’t come in today,’" says Stacey Pawlak, PhD, UI clinical assistant professor of psychiatry, who regularly gets calls from new moms asking for therapy and guidance over the phone. “We’re hoping a new telehealth program may be able to help.”

Pawlak, who is Jiang’s psychologist, directs the WWC Service, which provides care for women who have mental health concerns related to pregnancy, childbirth, or reproductive health. It is the only specialized therapy and medication management program for postpartum women in Iowa and one of only 34 programs across the country. Some patients travel two to three hours from their homes to receive care in the clinic.

To increase access to this specialized care, Pawlak and colleague Hristina Koleva, MD, clinical associate professor of psychiatry, are piloting a postpartum telehealth program for women diagnosed with depression or anxiety. The virtual service is funded by the Department of Psychiatry and aims to help women who need therapy or medication but may not be able to come to the clinic consistently. Patients will be able to connect with a care provider through a secure video call in the comfort of their homes.

The pilot program will initially enroll women with significant barriers to receiving care, such as mothers who live far away from the clinic or have a baby with a medical condition that complicates child care. Eventually, Pawlak and Koleva hope to expand the program to accommodate more mothers who may live nearby but still struggle to leave their home and baby for an appointment.

15% diagnosed with postpartum depression

Postpartum depression is diagnosed in roughly 15% of new mothers, according to the National Institute of Mental Health. Abbey Hardy-Fairbanks, MD, OB-GYN clinical associate professor and medical director of the Women’s Health Clinic at UI Hospitals & Clinics, says mood disorders are “incredibly prevalent” among her patients and she frequently refers them to WWC. The clinic she runs now calls all new moms two weeks after delivery to check on their mood. 

“Postpartum depression is debilitating,” Hardy-Fairbanks says. “You’re kind of alone, you’re home, and it’s really hard. There’s nothing else in the state like Women’s Wellness and Counseling. Having a place to send people for help is hugely important, and if you don’t have a collaborative way to get the patient the help they need, your outcomes are not going to be as good.”

Although doctors typically screen for depression and other mood disorders during and after pregnancy, many women choose not to seek follow-up care after they’re diagnosed.

“The no-show rates are fairly high due to difficulty finding day care and other logistical issues,” Pawlak says. “These barriers can be addressed, and telehealth is fitting for a patient population like this.”

A 2017 Indiana University School of Medicine study by Nerissa S. Bauer and colleagues, published in Frontiers in Pediatrics, found that less than half of postpartum women who were diagnosed with a mood disorder actually sought treatment. Only 37 percent showed up for an appointment with a mental health provider. Many of these mothers might not have the time, transportation, or appropriate child care to attend appointments in a clinic, especially if they live hours away.

“It’s hard to develop a therapeutic relationship when you can’t come as frequently as you need to because you live so far away,” Hardy-Fairbanks says. “The ability to have a telemedicine option would be huge.”

The yearlong pilot program started in October 2019 with a limited number of patients. Koleva and Pawlak hope to collect data before, during, and after treatment to demonstrate the program’s effectiveness in improving mood and reducing symptoms. The ultimate goal is to expand the program to reach more patients after the trial period.

“I’m a fan of a hybrid approach, where we see the patients face-to-face and can also follow up virtually,” Koleva says.