Meet Maria Carola, 2020 Mom’s 2017 Ambassador of the Year

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Over 20 2020 Mom Ambassadors were in the first class to earn their badges this Fall.

Maria was one of them and also was named 2020 Mom’s 2017 Ambassador of the Year. We want you to know what she has been up to.  You can also learn more about Maria by visiting her website www.mommamosaic.com or following her on Twitter: @mommamosaic

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What brought you to Maternal Mental Health?

I’m a mother of two.  My professional background is in psychology, public relations and documentary photography which placed me at an interesting crossroads when I was personally affected by postpartum depression. After my horrific experience falling through the cracks of the maternity care system, I knew I had to do something to help the countless women who were suffering silently as I had. Thus, as many survivors are called to do, I embarked on a larger journey to make a difference on the front lines of maternal mental health and maternity care. 

How did you become involved with  2020 Mom and the Ambassador program?

Five years ago when I was working with Wendy Davis and PSI as their PR/Marketing Chair, I heard about Joy and "The 2020 Mom Project." At the time, awareness and discussion about maternal mental health was still mostly limited to the tragedies of postpartum psychosis and the media's brutal portrayal of them. Frustrated, I remember thinking to myself, "We know what isn't working. Let’s try to identify what is working and springboard off of that." Wendy shared that Joy’s mission with 2020 Mom was exactly this — working within an existing infrastructure to identify and close the gaps in maternal mental health. When the opportunity arose to become an Ambassador for 2020 Mom, I jumped at the chance. 

Tell us about some of the projects you have been involved with.

This past spring, I was happy to participate in fundraising efforts for the NYC March for Moms team as well as raise ongoing funds for 2020 Mom via my "Wear Your Activism" Momma Mosaic tote bag campaign. The campaign was an independent fundraising campaign under the Ambassador program where I sold a tote bag, and proceeds went to 2020 Mom. What made it special is that each time a bag was purchased I provided the same bag, to a homeless woman, filled with items she needed, like personal hygiene items.  I was able to raise $210 for 2020 Mom and do good in my local community at the same time.

What are your plans as a 2020 Mom Ambassador?

Going forward, I am working to organize a diaper drive, a screening of When The Bough Breaks, and a series of fundraising events in New York City to amplify the issues and challenges surrounding motherhood in the U.S. today. 

What impacts do you see 2020 Mom and the Ambassador program having?

Today, as a doula, maternal health spokesperson and advocate, I have witnessed firsthand how the conversation is shifting towards a more open and honest dialogue about the state of maternal mental health in the U.S. Now, more than ever, we have to keep working and fighting to affect change in the field. 2020 Mom is doing important work in this regard and I am honored to be counted among their Ambassadors helping in this mission.

Delivering Moms from the Most Common Childbirth Complications: Depression and Anxiety

Bruce Spurlock, President and CEO, Cynosure Health
Joy Burkhard, MBA, Founder and Executive Director, 2020 Mom

First appeared on the California Health Care Foundation blog, July 11, 2017

Every year, half a million babies are born in California. Alarmingly, the most common complications of childbirth are the mother's depression, anxiety, or other mental health disorders. The magnitude of suffering from maternal mental health disorders dwarfs hospital-acquired infections, sexually transmitted diseases, new breast cancer diagnoses, and many other conditions that attract greater media interest, public reporting, and performance incentives and penalties.

Maternal mental health issues arise in up to one in five pregnancies. In California, as many as one in four mothers (27%) have prenatal or postpartum depression (PDF), according to a survey by the California Department of Public Health. It's worse for underserved populations affected by race, poverty, or other social factors that increase the frequency and severity of mental health conditions. Low-income mothers are 1.4 times more likely than wealthier moms to exhibit depressive symptoms before, during, or after pregnancy.

Left undetected and untreated, these conditions can lead to negative health outcomes for the mother, undermine the mother-child bond, and damage the child's long-term physical, emotional, and developmental health. And the financial cost of untreated maternal mental health conditions can be significant because of effects such as greater use of emergency care services and higher rates of absenteeism at work.

While the disorders are highly treatable, few mothers are identified by screening or diagnosis, and among those who are recognized, only 15% receive treatment. And from a cost perspective (including lost income/productivity and negative outcomes for children), untreated maternal depression costs (PDF) an estimated at $22,500 per mother, which in California totals about $2.5 billion a year.

Maternal mental health conditions can occur anytime during or after pregnancy, with onset as late as the baby's first birthday. We are not talking about either of the two ends of this spectrum — a transitory (e.g., two weeks) and less severe condition known as the "baby blues" or the rare but more extreme psychotic episodes that make national headlines. It is the much more common "middle zone" of suffering where one in five women find themselves and don't receive the care they need.

California Task Force Addresses Maternal Mental Health

In California in 2014, the California Legislature passed a resolution calling for a multistakeholder group to study, identify, and recommend solutions to address these issues. The California Endowment and the California Health Care Foundation funded a diverse task force of public health experts, clinicians, consumers, policymakers, and representatives from health plans, purchasers, state agencies, and community-based organizations. The panel included project staff from 2020 Mom, a grassroots nonprofit working to close gaps in maternal mental health in California and nationally; Cynosure Health, a national health care improvement organization; and the Central Valley Health Policy Institute, which focuses on emerging health issues in Central California. Over an 18-month period, the task force explored the barriers, models, and potential solutions that affect a half-million California mothers and their babies each year. California accounts for one in eight births in the US.

This spring, this task force released a formal report and executive summary.

Women with maternal mental health issues face herculean challenges to receiving adequate relief from their suffering. These include:

• Lack of understanding by health care providers about how to follow up with symptomatic women

• Fragmented care systems that foster inconsistent approaches to the problem by obstetricians, pediatricians, and primary care physicians

• Inadequate screening, sometimes caused by the mother's fear that her child will be taken away if the mother gives wrong answers

• Poor access to appropriate treatment

• Stigma that prevents new and expectant mothers from reaching out for help

Despite the availability of effective treatments, the health care system is tragically ill-equipped to identify and help the women who need them. The task force reviewed novel solutions that address social issues, family and generational expectations, travel limitations, and cultural sensitivities. Yet available services are often disconnected and uncoordinated across different care settings.

Two Ambitious Objectives

The task force set two bold aims for tackling this problem across vast expanses of California: By 2021, ensure that 80% of women are screened at least once during pregnancy and the postpartum period, and by 2025, increase that rate to 100%. The goals acknowledge the federal recommendations on screening and set the stage for effective treatment and symptom management. With these targets in mind, the task force developed recommendations to address barriers:

Select one of several maternal mental health screening measures developed by national organizations.

• Promote a "no wrong door" approach to screening so it can be offered by health providers of all types.

• Build capacity by expanding referral resources and telehealth consultation such as MCPAP for Moms, which operates in Massachusetts.

• Persuade insurers to develop programs offering competent maternal mental health care, including arranging specialty care as required.

• Take local action through community collaboratives that can help address social determinants.

• Combat stigma with statewide and local public awareness campaigns spearheaded by the California Department of Public Health.

Maternal mental health conditions disrupt the lives of many more women, children, families, and communities than people realize. It's likely that everyone knows many mothers — and their children — who experience unnecessary suffering from maternal mental health conditions that are treatable if we recognize and build systems to address them during the vulnerable perinatal period. Massachusetts, Maryland, and other states are doing just that. Will California step up, too?

Learn about CHCF's work with partners to develop solutions for delivering mental health care to California's mothers and expectant mothers in need.