A Journey Back From Postpartum Depression

In a small, tidy office on Chapala Street, a young Latina mother still recovering from postpartum depression (PPD) recalled the voices that once told her to walk into the ocean with her children and never come back. “Just go, go … at the beach,” said Danielle Vasquez. “Just go in with the kids.” Like most mothers with PPD, Vasquez (not her real name) didn’t realize she had a common and treatable disorder. She thought she was either on her way to being crazy or already fully there. She slept a lot and stayed in her room, too afraid to leave the house or to drive. Even the sound of her two school-aged children playing was difficult to tolerate. “I was feeling like I was worth this much,” said Vasquez, holding her thumb and forefinger a half inch apart.

Vasquez and her children could have been the subjects of a tragic news story. Instead, intervention from a child abuse prevention program operated by CALM (Child Abuse Listening and Mediation) helped this pretty, dark-eyed woman pull her life and her family’s life back from the precipice. CALM is the acclaimed Santa Barbara nonprofit devoted to preventing, assessing, and treating child abuse here since 1970. It began when a resident named Claire Miles became so troubled by a fatal case of child abuse that she installed a dedicated phone line in her home for stressed-out parents to call for support.

The program that helped Vasquez is called Great Beginnings and its best feature is its efficacy. It actually works. Studying their records, the Santa Barbara County Department of Child Welfare Services (CWS) found that despite the additional risk factors for abuse and neglect in Great Beginnings’ clients, the department hasn’t opened a single case involving one of these families since 2001. Also noteworthy is the fact that there is a lower incidence of reports to CWS from this group of families than from the regular population. At its core, Great Beginnings is a home visitation program, augmented throughout the years by other services, like access to therapists, an in-house psychiatrist, a nurse practitioner, a child development specialist, and the only known PPD support group for monolingual Spanish-speaking moms in California.

As CALM discovered, the PPD support group in particular is meeting an urgent need; between 10 and 13 percent of new mothers — irrespective of economic strata or race — experience postpartum depression. Only a fraction of them discuss their symptoms with a health professional. In Santa Barbara, there is the popular Postpartum Education for Parents (PEP), which includes mother-to-mother support groups and 24-hour counseling via its PEP Warmline. But it caters mainly to middle-class, English-speaking, Caucasian moms.

Vasquez was fortunate in that when her son was born, a Cottage Hospital social worker picked up on her depression and referred her name to Great Beginnings. There, her name was passed along to social worker/home-visitor Genevieve Soto-Berry. Soto-Berry oozes love and support as naturally as she takes in breath. After being assigned to Vasquez’s case, Soto-Berry immediately began calling her on the phone. The new mother was screening her calls and deleting 99 percent of her messages. Still, something about Soto-Berry’s messages — perhaps the sincerity in her voice — made Vasquez want to leave them on the tape. Then one night, feeling particularly bad, Vasquez decided to call Soto-Berry on her cell.

“Poor thing — she just talked about everything, her fears. I mean, she thought she was going crazy and didn’t know why,” Soto-Berry said. “I said, ‘Let me come over. I need to meet you.’” Over the phone, Soto-Berry made a verbal contract with Vasquez that she wouldn’t harm herself or her kids until they met the following morning. Once together, Soto-Berry explained that Vasquez was not, in fact, going crazy, but she did have severe PPD and needed treatment before it got worse. At that first meeting, Vasquez agreed to sign a written contract that she wouldn’t hurt herself as long as she and Soto-Berry were working together. During the next 18 months, they remained in close contact, speaking at least everyday and seeing each other at weekly visits. Soto-Berry’s priority was getting Vasquez help for the voices. She brought her to see CALM’s resident psychiatrist and then connected her with a therapist.

It was four months before Vasquez began to feel better and a year before the PPD support group for monolingual Spanish speaking moms began meeting. Vasquez joined this first group and loved it so much that her life began to revolve around the weekly meetings. “It was like, you put everything in a bottle and then once you get there, you get better. You feel better because you talk,” she said. Great Beginnings originated from a collaborative study between UCSB, the Santa Barbara County Department of Public Health, and CALM. Building on the successful Hawaii-based “Healthy Families” home visitation program, the three parties chose 17 families with risk factors for child abuse and neglect and randomly assigned them to two separate groups. One group received home-visits, while the other received just what was available to every other family in the county. After a year, the group receiving home visits had significantly fewer problems: Moms were less likely to have shaken their babies, were less stressed, less depressed, and had better support networks than moms who weren’t visited.

With those results in hand, CALM won a grant from the State Office of Child Abuse and Prevention for a pilot study. Of the 17 other counties awarded the same grant, Great Beginnings outperformed them all, said CALM Associate Director Deborah Holmes, LCSW.

Researchers are learning more and more about the effects of maternal depression on babies and children, said Holmes. Not only are depressed moms more likely to abuse and neglect their children, according to the National Institute of Child Health and Human Development, their infants are often less securely attached than those of non-depressed moms. Depressed moms miss their babies’ cues, for example. If enough cues are missed during the course of some months, the baby will shut down out of hopelessness. Untreated maternal depression is now recognized as a massive public health issue.

Great Beginnings’ three full-time home visitors make about 150 visits per month to clients countywide. They become their clients’ advocate, mentor, and parenting coach; working to promote attachment, they sometimes act as the baby’s interpreter — pointing out cues the mom may be missing.

Vasquez knows she’s not 100 percent well, but she is grateful for all that she’s overcome so far. Soto-Berry said Vasquez now reaches out to the newer moms in the PPD support group, saying, “Have you tried this?”

And it’s easier for her to be with her kids now, too. “Before, when my kids were laughing or playing, it was pain for me, ’cause I couldn’t stand the noise,” she said. “Now it’s like they’re laughing and I’m laughing with them.”

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