care of 70% of the covered lives in the state. This is true of obstetric and gynecologic

services as well. Many folks in the United States don’t realize that obstetrician/gynecologists

provide a good deal of the primary care for women especially under the age of fifty. And

when somebody comes in thinking about becoming pregnant or is pregnant what a great opportunity

for primary and secondary prevention. We see perinatal mental health services as being

in the forefront of this opportunity.

>>MALINA SPIRITO: Any woman who is either currently pregnant or who has delivered within

the last year is eligible for services at Center for Women’s Emotional Wellness. In

addition we’ll also work with women who are currently planning a pregnancy and have

a history of mental health challenges.

>>PATIENT 1: I guess one of my concerns though is …

>>MALINA SPIRITO: The Center for Women’s Emotional Wellness is co-located within the

Ob/Gyn department at Christiana Care Health System to make it easier for women by having

us located in the same place where their coming for their prenatal treatment, the same place

where their coming for their ultrasounds.

>>PATIENT 1: I feel better that I don’t have to tell people that I’m going to some

clinic you know?

>>MALINA SPIRITO: So many of the women that I work with really need a place where they

can sort through their challenges with regard to parenting.

>>PATIENT 1: A lot of guilt. I’m sort of petrified over the thought of my relationship

changing with my son.

>>MALINA SPIRITO: Many women are embarrassed or afraid to ask for help. They’re afraid

to admit that something is wrong. And one of the things that we really strive to do

is to just to help normalize this experience and to let them know just how widespread it

is. That in fact depression is the number one complication of childbirth and it’s

also one of the most highly treatable.

>>MEGAN O'HARA: Hi, I’m Megan.

>>MALINA SPIRITO: We see women both on the outpatient side for intake assessment and

psychotherapy as well as medication management. And we also offer inpatient consultation and

consultation services for our physicians and residents here in the Ob/Gyn department.

>>PATIENT 2: Am I doing something wrong? You know...because a mom should be able to calm

her baby down. That should be the one person that can calm her baby down.

>>MALINA SPIRITO: Our team is made up of three women of varying specialty. I’m a licensed

psychologist. And then we also have a licensed clinical social worker who also provides ongoing

outpatient therapy and inpatient consultation. And we also work with a board certified advanced

practice nurse.

>>PATIENT 2: The pregnancy was hard...

>>MALINA SPIRITO: I am a direct employee of Christiana Care Health System housed within

the department of Ob/Gyn. And I am a member of the medical-dental staff.

>>RICHARD DERMA: The idea of having set up our Center for Women’s Emotional Wellness

within the Christiana Care umbrella was very important for us because before that time

our private doctors and our doctors employed here were not actually doing the screening

for depression because we did not have the basis for referral of patients. And now we

do have a very finely integrated system.

>>MALINA SPIRITO: The on-call provider each day carriers the on-call phone. So if a provider

in the community is sitting with a woman in her office and she has concerns that this

woman needs treatment immediately she can call us on the provider line.

(Phone rings)

>>MALINA SPIRITO: Well, I’ve got some time this afternoon so is it OK if I come up to

see her in about an hour?

For any woman who we see who is a direct patient of one the Christiana Care obstetrical practices

we use the same electronic medical record which allows the Center for Women’s Emotional

Wellness to see how things are going with her obstetrical care.

>>PATIENT 2: That makes me feel a little bit better ‘cause I just….

>>MALINA SPIRITO: My experience has been that the obstetricians and gynecologists that we

work with have been really open to this model and have been extremely excited. They see

the need.

>>RICHARD DERMAN: We want to go ahead and have women and babies have the best outcome

in pregnancy. We know that if women are depressed or suffer other mental health issues they

don’t bond with their baby, they don’t breastfeed effectively, there could be long

term developmental issues that we have to address. This is just good preventive health.

It’s good healthcare. Most importantly it’s what we ought to be doing.