Dr. Clauda M. Gold: Health equity begins with babies, parents

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GREAT BARRINGTON — A number of years ago I worked with Susan, a new mom who was struggling terribly with feelings of depression. Her doctor had recommended medication, but she hesitated. Susan's depression lifted when her husband Tom started attending a new dads group. His newfound confidence in his ability to read his baby's cues helped to lift his own low-grade depression. In turn, he was more emotionally available to support his wife. The sense of isolation lifted for both as they began to raise their child as partners.

I thought of this story when the FDA announced, with much fanfare, a new drug specifically designed to treat postpartum depression. While such a drug might have a role to play in situations where a mother's life is in imminent danger, the steep price tag ($20-35,000 not including cost of hospitalization for the 60-hour IV infusion) serves to illuminate the inequity in access to treatment of this common condition with serious long term implications for the health of the whole family.

Peter Cooper, a world leader in postpartum depression research, shared with me that he thinks the announcement was made about 10 years too early. In Great Britain, where he and his partner Lynne Murray do much of their work, medication is rarely used to treat postpartum depression.

I spent a recent weekend with the pair as a faculty member of the University of Massachusetts Infant Parent Mental Health program, an extraordinary program where luminaries in the field meet every other month over two years to engage in three days of intimate conversations with fellows from a variety of different professions from all over the world. Lynne and Peter shared with us the latest findings from their expansive body of work that ranges from Reading, England to the poorest communities in South Africa.

Two main takeaways from the weekend were that there is no effective way to predict postpartum depression and that the only treatment with solid evidence for prevention of long term impact on child development is intensive in-home relationship-based psychotherapy, in a sense "mothering the mother."

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With no way to predict who will struggle, primary prevention inclusive of an entire population is one way to tackle this significant public health problem. That is exactly what the Hello It's Me Project aims to do.

With roots in South County, the project is coming to Pittsfield, thanks to funding from Milltown Capital, the Margaret Mahler Child Development Foundation and The John and Geraldine Weil Memorial Foundation. Using the Newborn Behavioral Observations (NBO) system as an anchor, it shines a spotlight on the tremendous capacity for connection babies have when they enter the world, each with his or her unique way of communicating, while highlighting the need to support mothers and fathers, enlisting their natural expertise during this major and often disorganizing transition to parenthood. The NBO, inspired by the work of renowned pediatrician T. Berry Brazelton, protects time to support parents in playing with their baby as families get to know their newest member. Rather than identify families "at risk," the idea is to integrate this relationship-building tool into routine care for all families.

Extensive evidence from the CDC's Adverse Childhood Experiences (ACEs) Study shows us that long-term health outcomes, both physical and emotional, have their roots in our early experience. The newborn brain makes over one million new connections per second. Spending a bit of time nurturing these tender new relationships can offer an inoculation of sorts. The days around the birth of a baby, when parents' brains are bathed in oxytocin, offers an opportune moment to get things right from the start.

If as a society we continue to support these relationships with such things as paid parental leave, access to parent support groups and quality child care, as well as quality psychotherapy for those who struggle in these early days, weeks and months, we will get everyone off on equal footing. This is where the path to health equity begins.

Claudia M. Gold, MD is a Berkshire County pediatrician and writer who specializes in early childhood mental health.


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