Giving birth to a child has an intensity all its own. A mother’s body and mind are tested and transformed throughout the perinatal period—before, during, and after they give birth. There is a physical recovery period to follow, as well as a mental one.
When it was time for Shannon Gehrmann to go back to work as a vice president at Target after the birth of her third child, her anxiety and depression peaked. Though she had experienced postpartum mental symptoms before, she says, “this was definitely much more than that.” Upon a nurse friend’s recommendation, she sought treatment at the Mother-Baby Day Hospital at Hennepin Healthcare (formerly Hennepin County Medical Center) in downtown Minneapolis. The Day Hospital is part of a Mother-Baby Program providing mental health services for pregnant women and families with children up to 5 years of age.
In recent years, physicians and researchers have expanded their understanding of the type of mental conditions that Gehrmann was experiencing, associated with pregnancy and formerly confined to “postpartum depression.” Now, experts recognize a range of related conditions—anxiety, fatigue, obsessive-compulsive disorder, post-traumatic stress disorder, and more. One in every seven new mothers experiences such conditions, according to a 2013 study of more than 10,000 participants.
Since these symptoms can manifest before and after birth, new terminology has emerged. They are known as Perinatal Mood and Anxiety Disorders (PMADS) to many, but Hennepin Healthcare’s Dr. Helen Kim prefers PMAC: perinatal mood and anxiety conditions.
“We’ll have to kind of put it out into the universe,” Dr. Kim says. “There was an attempt to broaden the language of postpartum depression, because half of women have symptoms of anxiety. So, emphasizing ‘perinatal,’ and emphasizing ‘anxiety’—but why they came up with [PMADS]? They should’ve talked to an English major.”
Kim’s undergraduate major, by the way? English. Following a gap year after college, she entered medical school to study psychiatry, to engage with “the blend of stories, people, psychology, and what makes us human.” During her residency, at Boston’s Massachusetts General Hospital, she worked at its women’s mental health clinic and focused on perinatal psychiatry.
In November of 2020, Dr. Kim’s work with perinatal patients enters a new phase with the opening of the Redleaf Center for Family Healing. The center is an expansion of Kim’s psychiatric work with Hennepin Healthcare’s Mother-Baby Program, which has served about 560 mothers and families since 2013. “The focus was to save lives,” she says. “Because these are life-threatening illnesses.”
Beyond Postpartum Depression
Gehrmann’s bout with perinatal anxiety and depression was coupled with a nerve-wracking professional epiphany. Though she had spent more than a decade rising through the ranks at Target, she realized that it was keeping her from her newly expanded family on holidays, nights, and weekends.
“I knew that I just couldn’t and didn’t want to do it anymore,” she says. “But I had no idea what that meant for me, and I was so scared for so many reasons. [Finances], my job, and my life added to postpartum depression and just having a baby and all that stuff.”
About 20% of women with postpartum depression still experience symptoms a year after delivery, and 13% after two years, according to the New England Journal of Medicine. (To be clear, these are symptoms beyond just the “baby blues,” a condition that lasts about a week after birth and is often attributed to natural hormonal changes in the mother.)
Because perinatal mood and anxiety conditions can affect new mothers at a time of high vulnerability for their babies—during an important developmental window—the implications can be long-lasting. In the 1990s, a groundbreaking study screened enrollees in the Kaiser Permanente healthcare company, a relatively privileged, college-educated population. It found a positive correlation between an Adverse Childhood Experience (ACE)—such as abuse, neglect, or household dysfunction—and risk of depression, heart disease, cancer, diabetes, employment challenges, and substance abuse later in life. In 2018, Oprah Winfrey deemed the subject important enough to produce an in-depth report for CBS’s 60 Minutes centered on ACEs and trauma-informed care.
“Trauma is ‘too much, too soon,’ ‘too fast, too young,’ without enough adult support,” Kim explains. “Separately, you can be exposed to really hard things as a child but not have it be traumatic if you have a consistent, protective adult buffer.” Mothers experiencing PMAC may find it hard, or nearly impossible, to give that support.
Roots and Leaves
In medicine, the metaphor of a tree is often used to talk about the root cause of illness. The leaves of the tree are the presenting physical or mental symptoms, such as depression, anxiety, fatigue, migraine, or gastrointestinal problems.
“The tendency now is that we assign leaves to specialists,” Dr. Kim says. “What you end up having is people who are very compliant patients—they go to the doctors and take all the medicine—but they don’t feel well. Instead, we [at the Mother-Baby Day Hospital Program] focus on the roots of the soil, to contribute to the health of the leaves.”
In Kim’s case, focusing on the root means addressing the trauma or dysfunction a parent may have grown up with. By emphasizing sleep, gut health, nutrition, purpose, and exercise, Kim says she and her colleagues can improve the overall mental health of new mothers, at a critical time in their babies’ lives.
“[The Mother-Baby Program] helped us look into ‘This is what was missing for me,’ or ‘This is what I grew up believing, and is this really true?’” Gehrmann says. “And it taught you to question some of that and reframe your truth, how you look at yourself, and how you go about things. It was really eye-opening.”
Proper development profoundly depends on the baby’s access to an adult who can help organize the baby’s emotions, look after wellbeing, and provide comfort. Mothers bring their own past experiences to parenting, and if they didn’t receive the comfort they needed as a child, they may be unable to provide the same for their baby.
“We are hardwired as humans to have two basic drives: to explore and to seek connection,” Dr. Kim explains. “The role of the parent is to be the secure base from which children can explore, and the safe haven to return to.”
By helping parents learn to support their children, Dr. Kim’s work focuses on preventing future trauma, with a combination of “downstream” and “upstream” medicine.
“Downstream medicine is for people who have already had the heart attack or the car accident,” she says. “It’s hands-on, intensive medical intervention. We are a downstream center for moms, because we didn’t prevent the episode that brought them to us. But we are upstream for the baby. We are preventing the impact of trauma for babies, with mothers learning to be a better buffer and to be more responsive to babies.”
The Redleaf Difference
The Redleaf Center for Family Healing—which officially had its groundbreaking in November—was started by Dr. Kim; Dr. Diana Cutts, Hennepin Healthcare’s interim chief of pediatrics; and Jesse Kuendig, a licensed social worker and co-founder of the Mother-Baby Program. In collaboration with Olivia Mastry, founder of Collective Action Lab—a Twin Cities-based organization focused on social change—they created a place to serve mothers and families during an exciting yet demanding time in life.
As a “family healing center,” it focuses on the health of the mother—to strengthen the family unit and provide stability for the baby—while also involving fathers.
“In the Mother-Baby Program, when moms come, the fathers are usually there for a session or two,” Kim says. “In that experience, we learn that they are struggling. There’s not a lot of robust programming for fathers, and they have their own stigma attached to seeking our help or acknowledging vulnerability. We want to expand our clinical programming to include more therapy for dads and more parent-child therapy.”
The unique therapy model, called “Circle of Security,” is based on research on attachment tendencies in children and how parents can best support the needs of the child. It involves elements of cognitive behavioral therapy and emotion regulation skills, taught to mothers of varying backgrounds in groups of seven or eight, with a focus on the overall strength of the mother-baby bond.
“One mother might have severe financial struggles and not be able to pay bills or get food, and one might be completely opposite in that regard but have no partner or supporting family,” Gehrmann says. “So it brings a very diverse group together that are united on that one front. If we all supported each other, regardless of differences, like that group of moms supported each other throughout that four weeks—if we did that in the world, oh my gosh, I can’t even imagine.”
She says the experience helped her dig deep into her own values, to better understand the stress of that time. She stayed home with her kids for a while and spent time refocusing her life. Eventually, Gehrmann and her husband quit their jobs and opened the Goddard School of Woodbury, where they see their children every day.
The Redleaf Center retains Hennepin’s Mother-Baby Day Hospital program, where women can receive treatment and counseling for 20 hours a week. Women with children less than a year old are encouraged to bring their babies. A Perinatal Outpatient Program is six hours a week, with further-specialized groups, such as for teen or immigrant moms.
The Center will be able to work with about 1,000 families each year, and feature a drop-in daycare for patients, to make appointments more accessible. Syl Jones, a fellow in narrative medicine, will teach patients to tell their own stories as a way to heal. The space will have a teaching kitchen and a large room for yoga, meditation, and mindfulness. Dr. Kim also hopes to launch a trauma-informed Innovation Network, to test pilot programs such as drop-in parenting support for new parents who might not seek out resources otherwise.
The Redleaf Center is named for philanthropists Lynne and Andrew Redleaf. They donated $10 million to the project, and Lynne’s two children were born at Hennepin County Medical Center. Inspired by the Mother-Baby Program’s work to improve the lives of family and children, the Redleafs are now responsible for the largest gift Hennepin Healthcare has ever received—though it’s only the first step in a capital campaign goal to raise $20 million more. The center also received $2.25 million from the Pohlad family.
“It’s a hospital that really needs philanthropy,” Dr. Kim says. “So many programs fill a critical need but are not funded by the county. All of Minnesota needs a thriving Hennepin Healthcare. Ultimately, my hope with the Redleaf Center is that we are making children visible. The children that we have right now and the children that we were.”