A couple of years ago after having her second baby, Jana Kogon barely slept.
The Atlanta mom’s mind kept racing with thoughts of all the bad things that could happen. Her fears all revolved around her children, she said.
“‘What if your eye starts to bleed and then I have to take you to the hospital,’ that’s where all my thoughts went constantly,” she said. “What if, what if, what if, what if, what if, what if, what if, what if, what if.”
It was still early in the pandemic. And, at first, Kogon pegged her feelings of depression and anxiety on everything happening with COVID-19 and being isolated at home with a baby and a 2-year old.
But over time her symptoms grew worse.
“Like, I thought someone put an AirTag on my car in Kroger and was following me home. So I asked my husband, I called him on the way home and said, ‘Someone’s following me home from Kroger. They followed me around the whole grocery store. Can you wait outside with a gun?’ And he did,” Kogon said, “but he knew something was off at that point.”
Georgia’s maternal mortality rate is among the worst in the United States. Families want change. Policymakers and advocates are pushing solutions. We’re exploring the complex factors behind the crisis and what’s being done to address it.
Her husband urged her to seek help at her OB-GYN’s office, where Kogon got a referral to a specialist via telehealth.
By then, she said she knew she needed the help.
“I was like, you know what? I’m just going to tell them the truth because I know that these are not normal thoughts I’m having,” she said. “Before with my anxiety, I could hide it. But once you have the hormones surging, it just takes over.”
The therapist she saw was part of an Emory University program called PEACE for Moms.
PEACE – the name is an acronym for Perinatal Psychiatry, Education and Community Engagement – is a program that helps medical professionals connect their pregnant and postpartum patients with mental health providers. Its specialists consult directly with doctors, nurses, midwives and other clinicians across the state whose patients may be experiencing a pregnancy-related mental health crisis.
“There are so many reasons that individuals harm themselves and bad things happen,” said PEACE for Moms director Dr. Toby Goldsmith, who’s also an assistant professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine.
Diagnosis and treatment are critical when a woman is experiencing psychiatric symptoms during pregnancy or the postpartum period, according to Goldsmith.
Her program helps assess patients and determines how to get them the support that they need, including a video or phone appointment.
As of last fall, PEACE for Moms completed more than 500 consultations with providers around the state.
Dekalb-Gwinnett OB/GYN nurse practitioner Megan Elliott in Peachtree Corners is one of them.
Elliott said it’s typical for most patients to experience some hormone-related mental health changes during pregnancy and after childbirth. But for patients whose symptoms are more severe, she said it is reassuring to be able to contact PEACE for Moms’ triage service.
“I’m not a mental health nurse practitioner; I do have some basic understanding of antidepressants and different screenings that we can use and things like that. And I do know how to find resources,” she said. “Some of it is maybe a little bit outside of my scope.”
“There’s a huge element of stigma amongst those who are suffering.”
-Emory University’s PEACE for Moms program director Dr. Toby Goldsmith
Dr. Goldsmith said that is PEACE for Moms’ goal — to help patients by also helping their medical providers.
The program also offers trainings to Georgia providers in how to assess new parents’ mental health.
“There’s a huge element of stigma amongst those who are suffering,” Goldsmith said. “There’s an element of fear, in that individuals are often afraid that someone is going to take their child away from them because they’re on medication, or because they have to go to the hospital.”
Nationwide in 2020, the CDC identified mental health conditions as the number-one cause of maternal mortality. Georgia has one of the worst rates of maternal mortality in the nation, with Black Georgians dying related to pregnancy at almost three times the rate of white Georgians. In 2022, mental health conditions were the leading cause of pregnancy-related deaths in Georgia according to the state Department of Public Health.
Mental health conditions can impact a woman’s health and well-being over time, too.
“It’s not necessarily just suicides and accidental overdoses, but it’s someone who has got depression, who’s so apathetic they’re unable to take care of their hypertension or their diabetes,” Goldsmith said. “And things like that can contribute to morbidity and mortality.”
A new mom’s mental health conditions can also impact her baby.
Research has shown that anxiety, stress and depression can interfere with breastfeeding and with the parent-baby bonding that is critical for child development.
Timely mental health care lacking in Georgia
Georgia has made a commitment to improve maternal health. The most recent Georgia Maternal Mortality Review Committee analysis determined 87% of overall pregnancy-related deaths to be preventable.
Its ongoing initiatives include implementing the Georgia Perinatal Quality Collaborative at all birthing facilities statewide, with particular emphasis on preventing hemorrhage, severe hypertension and cardiac conditions — top causes of pregnancy-related death in Georgia.
To help more at-risk women access maternal health and mental health care, Gov. Brian Kemp recently extended Georgia’s pregnancy-related Medicaid program for low-income women up to a year after giving birth.
Georgia has also expanded maternal home visiting programs to 50 counties. As part of the state-funded programs, home-visiting workers regularly meet with pregnant and postpartum women to make sure they are up to date with their medical appointments.
They also keep tabs on women’s mental health — and connect them to any additional services they may need, including referrals to a therapist, if they show signs of pregnancy-related depression or psychosis.
Despite these and other investments, timely mental health care can be hard to come by in Georgia.
“It’s access, not having the providers, it’s the cost in terms of reimbursements.”
-State Sen. Kim Jackson on mental health care barriers in Georgia
Most Georgia counties lack enough mental health professionals, according to the Federal Office of Rural Health Policy. And even if a provider is available, they might be unaffordable or not be covered by health insurance.
A state law was supposed to fix this problem.
The 2022 Mental Health Parity Act requires insurers to cover mental health conditions on par with physical health conditions.
At a recent policy discussion near the Georgia Capitol, Democratic State Sen. Kim Jackson said the state needs to do more to enforce the parity law and invest more toward growing the mental health workforce, especially outside the Atlanta metropolitan area.
“It’s access, not having the providers, it’s the cost in terms of reimbursements,” Jackson said. “It’s also, fundamentally we still live in a place where there’s stigma around getting mental health care services in the first place.”
In the U.S., most pregnant and postpartum patients are regularly screened for mental health conditions at their OB-GYN appointments and at their infants’ regular pediatrician visits.
Still, many pregnancy and postpartum mood disorders and other mental health conditions go undiagnosed and untreated, according to the American College of Obstetricians and Gynecologists.
In Georgia, many women live in areas without access to mental health clinicians, for instance. Or, they — or their medical providers — may not recognize their mental health symptoms as serious.
Atlanta mom Jana Kogon considers herself one of the fortunate ones. She got a diagnosis.
Hers included postpartum anxiety and obsessive-compulsive disorder, or OCD.
Kogon said a combination of antidepressant medication and therapy dramatically eased her symptoms. She still experiences some anxiety sometimes, she said, but it’s nothing like it used to be.
”I was present and I had not been before and I didn’t realize it,” she said. “I got through my day without thinking someone was following me or thinking someone was after my kids. I didn’t feel like I had to go watch them in the window of their classroom.”
Now, Kogon urges anyone who is struggling with their mental health during or after pregnancy to reach out for help.
“I feel like there’s a stigma around mental health and taking medication. But I cannot even describe to you how much it changed me once I started taking the medication,” she said. “Like, oh my gosh, is this what it feels like to feel normal?”
She acknowledges that talking openly about mental health disorders can be scary.
And it can be tough to find the right treatment. But the benefits, she said, are worth it for the whole family.
WABE is part of the Mental Health Parity Collaborative, a group of newsrooms covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center and newsrooms in select states across the country.
