Ashley Pauline has a lot to be thankful for this season.
There are her healthy twins, Landon and Madison. And, just as important, are the people who helped bring the now 2-year-olds into the world — and helped Pauline, 34, of Hazleton, deal with the emotional aftermath of their premature birth and intensive care needs after they were born.
For Pauline, becoming a mother was an uphill battle. She went through fertility treatments for two years. When she finally became pregnant with twins, it was everything she’d wanted — but soon more challenges arose.
Pauline was hospitalized at 22 weeks. On Nov. 19, 2022, at 26 weeks and four days, she gave birth to her twins at Lehigh Valley Hospital-Cedar Crest.
Another challenge — one she’d never anticipated and couldn’t have prepared for — began. For 78 days, Pauline drove one hour and 15 minutes each way every day to see her children in the Natal Intensive Care Unit at LVH-Cedar Crest. Her husband made a similar trip after work, until baby Landon came home.
For 40 more days she’d made the same trip, with little Landon in tow, until Madison came home on March 15, 2023.
That’s when, she said, postpartum depression hit.
“I didn’t know where to begin. You’re up every three hours feeding a newborn and then driving to Allentown the next morning to take care of your premature baby who is still on oxygen while taking care of the baby that is with you. I was definitely spiraling at that point,” Pauline said.
However, through the whole process, she said she was helped by social workers, NICU nurses and by Melissa Aylesworth of LVHN’s Women Adjusting to Various Emotional States program.
The WAVES program helped her get into counseling, find support groups, get on a medication that helped treat her anxiety and depression, and helped her feel like she wasn’t alone and someone was listening.
“They expressed to me how important it was to get help and realize that I wasn’t doing it alone because I definitely had my ups and downs,” Pauline said. “I didn’t know where to start. I knew I had all these feelings, all these things that I was afraid of and had anxiety about but I didn’t know where to put them and I didn’t know what to do with them.”
Improving moms’ mental health
Aylesworth, physician assistant and clinical lead of the WAVES program, said it was started by herself and two LVHN nurses — Christina Felten and Kayla Smith — in August 2022, with the goal of helping women with mental health during pregnancy and postpartum care.
Pregnancy and childbirth do not have to be as challenging as Pauline’s for mothers to experience postpartum depression, anxiety or other mental health struggles, she said. The program is open to all women who are pregnant or within their first 12 months of motherhood.
Aylesworth said WAVES was partially based on a similar program started by Kaiser Permanente, as well as other LVHN institutes and original ideas from the founders. For perinatal mental health, the treatment plan has three points: mental health therapy, medication management, and finding and practicing forms of self-care, such as from exercise, meditation or other means.
LVHN’s OBGYN program has embedded behavioral health therapists with specialized training in caring for women with peripartum and postpartum mental health conditions. If patients have more complex mental health needs they will be referred to LVHN’s psychiatry department.
Aylesworth added that they also provide patients with educational materials to help them with anything from self care to their pregnancy and postpartum plans.
Pauline said before she was referred to the WAVES program it felt like she was trapped in a bubble and no one understood her, but she connected with Aylesworth immediately. Often it was like she knew what Pauline needed without it even needing to be said. And she was available anytime Pauline needed her.
‘I felt very guilty’
Pauline said because of how badly she wanted to become a mother, she felt depression and anxiety when baby Landon finally came home — followed by guilt.
“I was used to this new reality of two babies in the NICU, then I had Landon come home and I just felt like I hit rock bottom,” Pauline said. “Because now I’m taking care of one child while half my heart is still up there in Allentown. How do I put all my effort and all of my attention with my child at home when I’m not fully here? I couldn’t navigate that.
“I felt very guilty, I was feeling like I should be ecstatic that my son is home and I’m sitting here blubbering, crying like an absolute mess not enjoying this. It was really a big thing for Melissa to listen to me and validate how I was feeling and then help me process.”
Pauline said medication, counseling and daily support from Aylesworth helped her mentally prepare herself for Madison to come home and successfully make that transition before returning to work as a court stenographer several months later.
Aylesworth said some patients don’t need medication, and others like Pauline benefit from taking it. She said part of her job is helping patients determine if medication is the right choice for them and explaining the options available to them.
Many mothers are concerned about how medications for depression and anxiety, such as selective serotonin reuptake inhibitors, can affect their children. These medications can cross the placenta in utero and through milk when breastfeeding and the most common side effect is that babies may be mildly irritable and/or jittery after delivery, though this goes away.
“The vast majority, not all, but the vast majority of medications for anxiety and depression are considered to be safe in pregnancy. There’s a lot of misinformation, a lot of fear in patients with regard to taking medications, because, of course, they care about their pregnancy and their breastfeeding status and want to make sure that they’re doing what’s right for their children,” Aylesworth said. “The benefit of taking medication in many circumstances outweighs the potential risks of the medication, largely due to the risks that poorly controlled anxiety and depression can have on a pregnancy and on fetal development.”
The known potential effects of untreated depression on pregnancy include premature birth, low birth weight and the fetus growing at a significantly slowed rate. Poorly handled maternal depression can even affect a child’s cognitive development outside of the womb, increasing the risk of certain mental health issues and disorders. Untreated maternal anxiety may also affect a fetus’s growth, size and risk of cognitive and psychiatric disorders later in life as well as affecting the blood flow from the mother to the baby.
Aylesworth added that the irritability and jitteriness babies sometimes experience when the mother has taken SSRIs can also occur when a mother has untreated or undertreated depression or anxiety.
Aylesworth said from the start of WAVES in 2022 up to June the program received 2,518 referrals including from the Pocono, Schuylkill and Hazleton regions of LVHN’s coverage area. They’ve worked with first-time mothers, mothers who had their first child before the WAVES program who want help with postpartum depression for their second or third children, and some mothers are even in their second round in the program.
Pauline said she doesn’t see a counselor anymore — she doesn’t need it. For her, speaking up about her experience and talking to other mothers with premature babies is a sort of therapy. She said everything that the WAVES program did for her and all the connections she made are still with her.
“The nurses became my family. I still talk to a lot of the nurses,” she said. “They’re still involved in our children’s lives. Everybody as a whole got us through all of that and really made me feel validated.”
