When mothers of newborns need support, Susan Doub takes the wheel. She's a Novant Health counselor running new support services, launched in August, for postpartum depression.

Every month, the program processes about 250 patient referrals, all new mothers from across the Novant Health system who have scored high on the Edinburgh Postnatal Depression Scale, a screening tool that indicates whether a parent may be struggling with depression, anxiety or thoughts of self-harm.

Postpartum depression is a condition where a new mother may experience extreme sadness, a sense of disconnection and a lack of desire to care for herself and her baby as a result of hormonal fluctuations.

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New mothers are encouraged to fill out screening forms during visits with Novant Health physicians – most often, pediatricians provide a screening form when a mother sets up a medical visit for her baby. Historically, a new mother who scored high on the Edinburgh scale needed to follow up on her own if she wanted support. Now, Doub is the one picking up the phone to call each new mother and refer her to the right services.

“They’re overwhelmed already. They aren’t getting sleep. They don’t have time to eat, much less make a phone call and get connected to somebody,” Doub said. Too often, these new mothers with postpartum depression are struggling in secret. So she makes the call. (It’s part of an overall effort at Novant Health to take on disparities in maternal health. You can read more about this below.)

The first call after screening

The Edinburgh screenings get routed directly to Doub.

“I’m speaking to moms of all cultures and backgrounds and trying to meet them where they are,” she said. “If needed, I’m here to take extra time with women whose cultures are about not sharing or about being stoic in their emotional struggles after childbirth.

“What’s important in this first connection is to shift the focus from the baby and let the mom know I care how she’s doing. I’m concerned about her as a mom, as a person, as a woman.”

One of Doub’s goals is to know when to read between the lines of what a woman is saying about her well-being and how to pick up on social and cultural cues. “You need to be willing to dig a little deeper and go a little further with certain people to make sure they understand the questions and feel comfortable sharing their answers," she said.

Based on each new mother’s needs, this unbiased process ensures Doub can refer her for support. That could mean connecting the mother with an OB-GYN who can provide medication, or it could mean connecting her with a therapist, or a postpartum support group, or even a food pantry. Doub also provides connections to international support services, such as Spanish-speaking support groups and therapists.

“We want mom to be healthy and to be the very best she can be, and to have pride in the experience of giving all that she can to motherhood,” Doub said. “It’s not all about wearing yourself out and feeling you have to do it all and be it all. It’s about experiencing motherhood in the moment. You can’t do that when you're struggling with anxiety and depression.”

Before she hangs up the phone, Doub tells the mother: “I am here for you for the first year of this baby’s life. If you need mental health or emotional support, if you have a question, if you need someone to talk to for five minutes about a meltdown or about lactation, I am here for you.”

She doesn’t give up

Doub isn’t just passionate about this work, she’s persistent. If a new mother doesn’t answer or respond to the first call, Doub will call again. Still no response? she will send a MyChart message with her name and information.

The job still isn’t done once a referral is made. If a mom has difficulty scheduling an appointment, Doub makes the calls herself. “I’m not willing to let people fall through the cracks,” she said.

Doub has been doing therapeutic work for 32 years, with a background in inpatient, intensive outpatient and pregnancy center programming. She is also a grandmother and a mother of three, and has experienced symptoms of postpartum depression herself. “I see how much pain some of these women are going through and they feel like they’re the only ones, or that they need to go through it in isolation,” Doub said. “They’re doing their best to hold it together, but they don’t have to do it alone.”

That’s why the mother’s OB-GYN and pediatrician are looped in about the referral, so they can follow up with the new mother during her next appointment. With this complete system of care – from screening, to postpartum support services, to next steps and follow-ups – these mothers no longer have to do this alone.

Doub’s advice: “Be honest when you complete surveys on postpartum depression. And talk to your pediatrician and to your obstetrician because they are well-versed in symptoms and what treatment is available; they can point you in the right direction. They are the ones that will get you connected to me.”

Battling disparities in maternal health and pediatrics

These new postpartum depression support services fit into a broader, multi-year effort at Novant Health to reduce disparities in maternal and infant health.

Among the other steps in 2023, Novant Health launched a training program for doctors and other advanced clinicians in pediatrics and obstetrics to ensure they’re equipped to recognize biases that might prevent certain patients, often people of color, from receiving the best care.

In 2021, 1 in 6 infants in North Carolina was born to a woman receiving inadequate prenatal care. Research indicates that babies of mothers who don’t receive prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get adequate care.

Nationally, Black women are three to four times more likely to die than white women and have the highest rates of maternal mortality, independent of income, age and education. Additionally, infant mortality, fetal death and stillbirths occur at a higher rate in Black children. The drastic disparities centered on the maternal and infant health experience are a central focus of Novant Health’s strategic approach.