Moms Helping Moms: Peer-to-Peer Push Aims to Ease Maternal Depression (and Save Money)
Crystal McAuley’s first pregnancy was not an easy one. She had severe pelvic pain and complications, and doctors tried to induce delivery at 39 weeks. But her labor failed to progress, her son Fitzgerald’s heart rate dropped, and she ended up having an emergency cesarean section at a hospital in Napa, California in 2014.
Though Fitz, as she calls him, was healthy, McAuley went through a “pretty severe” postpartum depression — but didn’t process the trauma she went through. “As a society, we’re told: ‘You survived the birth, your baby is healthy, you should be grateful,’” she says. “The message is: ‘Move on.’”
The next year, she became pregnant again, and though she was physically healthy, her anxiety and depression returned. Unable to focus, things spiraled down, she says, and she took leave from her job in the wine industry and went home with instructions to rest. Her doctors and health professionals “didn’t understand the nuances of maternal mental health and didn’t recognize that my first birth trauma was something I needed to process,” she says.
She gutted it out and son number two, Franklin, was born healthy, but McAuley’s depression lingered. “I suffered for a long time and kept feeling like I needed to give purpose to the pain,” she says. She began volunteering with a nonprofit policy group, 2020 Mom, and traveled to Sacramento to lobby for a bill, AB 2193, that requires health plans and doctors to address the mental health needs of pregnant women.
After the bill passed, McAuley started a peer support group for women who are pregnant or recently gave birth — the MomSquad, sponsored by Napa Moms, a volunteer organization. The group hosts drop-in gatherings Friday mornings; between sessions McAuley calls or texts to connect with women who need extra support. Her colleague, social worker Jenny Shully, provides clinical expertise.
McAuley’s own battles with maternal depression and her willingness to reach out and talk straight help her forge connections, as do the trainings she received in maternal mental health. “Because of my lived experience, I can normalize what these women are going through, or what they might go through,” McAuley says. “I can help them identify risk factors and help them with the red flags.”
The training earned her a certificate, she says, but it has no practical or official value. That’s because California is one of only two states in the country that has failed to set up an official program to certify peer support specialists — people who are trained to use their personal experience with mental health challenges to help others.
On Aug. 31, California legislators — on a nearly unanimous, bipartisan vote — passed a bill, SB 803, to establish a statewide certification process for peer support specialists and sent it to Governor Gavin Newsom. It would allow counties in California to train and certify peers and bill the federal Medicaid program for part of the cost of their services. Newsom voiced support for an expanded role for peers when he ran for governor in 2018 but last year vetoed similar legislation. He has until the end of September to sign or veto the legislation.
Terra Jane Albee was in the late stages of a pregnancy last year when she heard about the Mom Squad. She hesitated, uncomfortable with the idea of meeting people she didn’t know. But eventually she and a friend decided to check it out together — with a plan to discreetly escape if they didn’t like it. Albee says she’s glad she went, and that she returned the following week.
In those two meetings, she forged a connection with McAuley and some of the other mothers — connections that helped her when she couldn’t produce breast milk, felt like a failure and sunk into the very depression she had feared because of her personal and family history.
“I texted Crystal any time of day, and she was there for me,” Albee says. “Without her and the group, I would have been a lot more lonely, a lot more lost.”
Albee says she feels fortunate because she has a husband, friends and a support system — something that isn’t true for several of the women who took part in the Mom Squad meetings.
“There was a lot of postpartum depression, a lot of anxiety and a lot of people who really had no support,” Albee remembers. “Some days it would get really dark and sad in there because people would share their hard feelings. But we had support and community — and someone who’s actually checking in on you, making sure you’re okay.”
With the women who are having a hard time, McAuley texts frequently with messages like this: “When we saw you on Friday, you were in the midst of a sleep regression with your infant and worried about your husband’s job. I just want to see how everything’s going.” Or this: “If you haven’t slept for three days, this might be a good time for you to get professional help. We can help connect you.”
One in seven US women who are pregnant or recently gave birth suffer from mood and anxiety disorders — with low-income women experiencing them at much greater rates. A cost model released last year by researchers at Mathematica, a research consultancy, estimates that the failure to treat perinatal mood and anxiety disorders cost about $14.2 billion over five years due to lost productivity from absenteeism and unemployment and from the medical costs of preterm birth or extra maternal health expenditures.
McAuley says women like her, armed with personal experience and some inexpensive training, could do a lot to reduce these costs if counties and health agencies had more incentive and funding to hire them. The federal Centers for Medicare and Medicaid Services will provide partial reimbursement for peer support specialists — but only in states that have established a process for certifying their training.
“If we were able to say, hey, you can get certified by the state, and get compensated for this work, it would be easier to find people willing to fulfill the role,” McAuley says. “If we have more peers who are trained in the nuances of maternal mental health and are certified and recognized by the state, more people would know about the other resources that exist. It just builds a wider safety net for everyone.”
