Best Practices: The Motherhood Center

Juliette Rodé
Oct 23, 2018 · 9 min read

A space for women to find the support and care they need before, during, and after pregnancy.

Having a child can be an exhilarating experience, but also a complex and difficult one. A recently founded boon to new mothers, The Motherhood Center is unique in the nation as a standalone clinical treatment facility. It was established to address the perinatal mental health issues that arise for new and expecting moms, and serves as a rare resource that spans the range of need from acute psychiatric symptoms to those who simply need a new mom support group. Chief Executive Officer/Medical Director Catherine Birndorf and Chief External Relations Officer Paige Bellenbaum spoke with Capsule about the beginnings of the center, and how it has filled a crucial need in the city and facilitated much-needed dialogue around the prevalence of perinatal mood and anxiety disorder (PMADs) otherwise known as postpartum depression.

Why is it so difficult to talk about the changes that motherhood brings?
Paige: You know, in New York, nearly everyone is a transplant, so few people have family support. Having a baby is by definition an isolating experience — you are home alone, often. Plus, there is so much expectation to live up to: “Isn’t this the happiest time of your life?” We’re told we have to love this experience and feel one way about it. The more we send those messages as a society, the less mothers want to talk about their actual experience. It’s that discrepancy that prompts a big part of that isolation.

Catherine: Becoming a mother is one of the biggest, if not the biggest, life changes for a woman. It’s billed as being blissful, natural, even easy. The message is that if that’s not your experience, then something must be wrong with you. No one talks about how hard the transition is. And there’s not a lot of room for moms to be anything less than perfect. That is tremendous pressure from society as well from ourselves.

Tell us about the onboarding process at the clinic.

Catherine: Evaluation is the first step, which we do first via a brief phone screen. We’ll get a sense of the woman’s symptoms (these can include depression, anxiety, OCD, intense irritability, feeling overwhelmed and more) and sometimes get her in the same day, depending on how urgent it is. Typically, we make a collaborative clinical decision about the level of care needed after doing a thorough in-person consultation. We treat women who have been in inpatient psychiatric facilities, and we also help women who simply need the base of a weekly new mom support group.

In addition, we offer services like psychotherapy or medication management on a weekly or monthly basis. The most unique part of treatment at our center is a day program, which is an intermediate level of care, somewhere between outpatient and inpatient. It is a step up for those who need therapy more than once or twice a week, and can be a step down for those exiting an inpatient program.

It meets five hours a day, five days a week, and is centered around a two-to-four week curriculum. You bring your baby (or your pregnant self), and we have a staffed nursery on site so you can get a break. A lot of the therapeutic work is around the mother-baby relationship, and using a group-based model, we have built out a curriculum that focuses on the universal experiences of becoming a mother that is often made worse by mental illness. We employ different therapeutic modalities including IPT (interpersonal therapy) CBT (cognitive behavioral therapy), DBT (dialectical behavioral therapy) as well as art therapy, mindfulness, and mediation groups.

We also offer continuing care to graduates of the Day Program, including a once-a-week support group so they can brush up on the skills they learned while in the Day Program. For women currently in the Day Program, we offer a partner support groups every Friday. We engage parents and other family members of the new mom, so that everyone understands what is going on. We also have a whole other realm of offerings for new and expecting parents including birth preparation, breastfeeding support, parenting, and healthy relationship classes.

While we are one of a dozen Day Programs in the country that treat pregnant and new moms, we are the only center that is not hospital-based. We decided to be free-standing, “agnostic” (in this case meaning to not affiliate with any one hospital,) so there wouldn’t be institutional barriers. We’ve created a space that feels like a giant living room, homey and comfortable, warm and welcoming. And being on our own allows us certain freedoms — to be creative and nimble, and to pivot easily so that we can refine our programming to quickly meet the needs of our moms and families.

What words or phrases can we equip the supporters of new mothers with to help them understand what is going on?

Catherine: One of the words that we use often is “permission.” Permission to feel any or many ways about being a mother. You can have one or ten feelings at the same time. You can both love your baby and also wish you never had the baby.

This is called being a human being; we are not defined by one feeling. And there is no right way to feel. Basically, the main message is: you are allowed to have all your feelings. That is such a relief for women to hear.

You could also use the word “ambivalence” here. Motherhood is an exercise in ambivalence — having mixed feelings, and learning to live with that — even if women struggle to admit this to themselves. Finally the word “loss”: Loss of one’s former self and previous identity. It’s a shift from what was to what is, and you’ve picked up another person along the way. Having a child is an irreversible act. You can get divorced or move towns but you can’t undo the experience of having a child.

One door closes and many doors open — but you are fundamentally changed. That identity change is fundamental part of the experience.

Paige: One of the most common personality types we see at the center is “type A” — those women who are ambitious, run companies, are high-performing, and have a lot of balls in the air. They may think they are going to A+ the motherhood thing, and then they learn from day one that they can’t control this experience like they can their professional lives. The discrepancy between expectations and reality can hit hard.

We have had these mothers say to us, “All the things that have served me so well as an ambitious career person are the things that least serve me in the motherhood experience!” We like to talk about the concept of surrender, not in the sense of waving a white flag, but rather in terms of surrendering yourself into the situation — if you cannot get your two month-old to sleep, you can either feel completely frustrated and angry, or you can surrender into the idea that this is what babies do, and that this will change over time and there are other ways I can spend the energy.

How did the Motherhood center begin?

Paige: I struggled with severe postpartum depression and anxiety with my first child. It began when I was pregnant, but I didn’t recognize it at the time. When my son came, the anxiety and depression that followed spiked significantly. I dragged myself up to the Payne Whitney Women’s Program, of which Catherine is the founding director. We didn’t realize until much later that she was on my evaluation team at the time. When I got better, I got angry, as I like to say. I was enraged that nobody was talking about postpartum depression. I talked to one of my dear friends, who is a state senator, and we began drafting legislation about requiring mental health screening and education.

Catherine was (and is) one of the leading and best perinatal psychiatrists in the nation. I actually didn’t remember that she had been on my evaluation team at the Payne Whitney clinic! We invited her to collaborate with us. The legislation didn’t pass the first time around, but in 2014 — in a slightly watered down way — it was signed into law. In the winter of 2015, I was asked by the Mayor’s office to share my story in conjunction with the launch of the most robust mental health initiative in the country, ThriveNYC, led by first lady Chirlane McCray. Catherine was there and she plucked me off the stage and asked me if I wanted to work with her. The answer was obvious!

Catherine: I am a reproductive psychiatrist, which means I psychiatrically treat women during their reproductive years, from menses to menopause — as well as before, during and after pregnancy. I couldn’t decide between psychiatry or Ob-Gyn, so I chose the interface between the two! In the 90s, people, including most medical professionals, weren’t very up to speed about postpartum depression — I had to seek out a lot of information and education on my own.

After I finished training in the late 1990’s, and then apprenticed with a reproductive psychiatrist in Chicago, I came back to NYC and founded the Payne Whitney Women’s Program in 2002. There were only a handful of programs — like Massachusetts General Hospital, Emory in Atlanta, UCLA, Northwestern and University of Illinois in Chicago — that were addressing this kind of thing. After visiting most of them, and finding mentorship, I created the program at Cornell to train psychiatric and medical residents to treat women who couldn’t get this kind of specialized care.

Much of what we did at my program was to help women make the difficult decision about if and what you do when pregnant or postpartum and in need of psychiatric medication. Then around 2015, I met Paige (again!), and she had created legislation and was speaking about her personal story for the rollout of ThriveNYC. I had recently begun collaborating with a business person who had approached me as an expert in the field in an effort to get into this particular healthcare space.

His initial idea was around postpartum sleep, and we considered modeling our center after an Australian program, a sort of “sleep school,” that focuses on the crucial role of sleep in new motherhood. I wasn’t sure we were ready for that in the US, so we shifted the focus to the perinatal day program (which originated up at Women and Infants Hospital in Rhode Island) that now forms the base of our treatment program. We opened doors at The Motherhood Center in March 2017.

Vital Signs:

Best patient amenity:

The kitchen that we encourage all our patients to use, to make themselves tea and snacks, and feel at home. We also have tampons, pads, and diapers in the bathroom!

Things you do to keep balanced during the week:

Paige: My lovely 85 lb pitbull rescue, who is so excited to see me that she nearly pees on the floor when I come home at night.

Catherine:I walk to work if I can. I’ve also become a podcast junkie — I like The Daily, and I really dig How I Built This. Also, my dirty little secret is that I bank sleep on the weekends to recharge for the week.

Places to eat in the area:

Paige: I think we keep the nearby Pret a Manger in business. We are literally there so often we get free coffee. I went and told the regional manager whose visit happened to coincide with us being there that this is the best Pret in the city and that everyone there deserves a raise.

Catherine: Vezzo’s Pizza is really good thin crust nearby.

Learn more about The Motherhood Center here!

Know an innovative practice in NYC? We’d love to hear, introduce us here!

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Juliette Rodé

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Interviewing spectacular physicians in NYC for Capsule’s Best Practices blog

Hello, Dear - the Capsule Blog

Capsule is a newer, better, kinder, smarter pharmacy - here to make your life simpler and healthier.