A Conversation with Dr. Samantha Meltzer-Brody on Psychiatric Mother-Baby Care
- Kathy Morelli
- Jun 29, 2014
- 8 min read
Updated: Feb 24
In 2014, I had the opportunity to speak with Samantha Meltzer-Brody about a groundbreaking development in perinatal mental health care: the creation of the first and only psychiatric Mother-Baby inpatient unit in the United States at University of North Carolina at Chapel Hill.
Dr. Meltzer-Brody serves as Associate Professor and Director of the Perinatal Psychiatry Program at UNC and has long been a leader in reproductive psychiatry. The Mother-Baby Unit she helped develop was modeled after established programs in Europe and Australia — programs that recognize a simple but powerful truth: when a mother is hospitalized for severe psychiatric illness, the mother–infant relationship must remain part of the treatment plan.
At the time of this interview, I was continuing to deepen my own understanding of psychopharmacology in pregnancy and lactation. As a psychotherapist, I had seen firsthand how complicated medication decisions can feel for women — especially during pregnancy and postpartum. Many mothers carry understandable fears about exposure, stigma, and judgment. Over time, I have come to appreciate more fully the importance of individualized risk–benefit analysis and collaborative medical care.
In this conversation, Dr. Meltzer-Brody discusses the development of the UNC Mother-Baby Unit, the realities of inpatient perinatal psychiatric care, the role of sleep in recovery, and the ongoing challenges of stigma and breastfeeding pressure in maternal mental health treatment.
Interview with Dr. Samantha Meltzer-Brody
Q: How did you become interested in your particular niche, Reproductive/Maternal Mental Health?
Dr. Samantha Meltzer-Brody: First of all, I want to say that I love being a part of the Reproductive Mental Health field.
There are many different roles in the area of Reproductive and Maternal Mental Health, not just one. There are many different types of people needed to work in this area and fill these many different roles. I love that we all can work together, helping each other.
As far as how I became interested in Reproductive Mental Health.
My training at Duke was in one of the first women’s’ health clinics established in the early 1990s. Women’s health clinics were novel at that time. However, eventually, as more and more women were serving in the military, collaborative research was made possible through government grants to study the intersection of gynecology and obstetrics, psychiatry, chronic pain syndrome and trauma history in women. I had finished my residency fellowships in psychiatry and I was doing consultations in the women’s health clinics at Duke University.
When I began working at the University of North Carolina (UNC) at Chapel Hill, there was no formal women’s mental health program in place. The women’s mental health outpatient clinic was created at a grassroots level, beginning in the clinics on Wednesday mornings. I was fortunate as UNC Chapel Hill functions with a wonderful collaborative and interdisciplinary atmosphere, so the psychiatry program and the obstetrics program were able to dovetail nicely. In addition, the chair of the psychiatric department was Dr. David Rubino, who specialized in research in women’s reproductive mood disorders, so the time was ripe to create our interdisciplinary Perinatal Outpatient Clinic.
Q: The Mother-Baby Unit at UNC Chapel Hill is the only Maternal-Baby Psychiatric Unit in the United States.
I'd love to know more about how the idea came about to develop the Mother-Baby Unit at Chapel Hill. I’ve worked in a partial care facility for the severely mentally ill, where high-functioning individuals were mixed into groups with persons with severe and persistent mental illness.
We mental health counselors were continually baffled at how we were expected to effectively treat persons at such different ends of the spectrum in the same group. It was difficult for clinicians to serve the needs of such diverse diagnoses and also unproductive for our clients.
Is this part of the reason this mom/baby unit came about? Was it difficult to effectively treat the specific mother-baby population in a mixed unit?
SM-B: At UNC, we found there was a high demand for reproductive psychiatry in our outpatient mental health clinic. And we also found that there was a certain percentage of patients to whom we couldn’t deliver much needed proper care in our regular psychiatric unit. The Mother-baby Unit was developed to serve the needs of women experiencing severe perinatal mental illness.
As the collaborative team discovered and documented the needs of our patients, Dr. Rubino was aware of the need as well, and he brought it to the attention of hospital administration at higher levels. We were fortunate as there was a constellation of things coming together. The Vice President of the hospital was sympathetic to the issues presented. Thus, we were allotted two rooms to house a pilot program. And this pilot proved to be a very positive therapeutic experience for pour patients. And that’s how we became the only Mother-Baby inpatient unit in the United States.
At UNC, we feel it’s critical to have a unit to meet needs of mothers and babies. We feel you can’t mix all the different levels of psychiatric populations together. It turns out the funding needed was a small amount of money, all that was needed in physical changes was to do some renovations. It’s difficult for the family when a new mom becomes mentally ill and requires hospitalization. Our Mother-Baby Unit helps families through this difficulty by providing family care. It’s extremely rewarding to provide whole care that positively impacts the whole family. We are a state hospital committed to serving the population of the state. Indeed, there’s a state mandate to care for the people of the state, and we take that very seriously.
Keep in mind that our Mother-baby Unit is a psychiatric care unit, not a luxury suite. To be admitted, the patient must meet the criteria for a psychiatric inpatient hospitalization, such as suicidal ideation, a heightened bipolar episode or postpartum psychosis. Most of our patients are not psychotic but do have suicidal ideation. The average length of stay (LOS) is seven days. Compare this average LOS in the US to the average LOS in a Mother-baby Unit in Australia of 21 days.
When a mother comes to stay with us, it’s required that a family member, such as the grandmother or father comes with the mother to assist in her care, as someone must come and help care for the baby.
Babies don’t stay overnight as the health insurance companies in the United States won’t pay for babies to stay overnight. But we work as best we can with the family, in order to preserve the mother’s sleep time for her mental health and also preserve the healthy attachment with her infant. Sleep is especially important when a person is suffering from a mental illness.
In the units, we have bassinets and breast pumps available for the patients and their babies. The nurses’ interaction with the babies vary.
Our treatment plans focus on several psychosocial areas of concern. We focus on maternal mood, impaired mother-baby attachment issues, the relationship with the partner and on improving what the partner and family understands about what has happened. To serve these needs, we run several targeted groups: a maternal mental health group, a mother-infant attachment group and a partner group for fathers. But the treatment is individualized; it’s tailored to meet the needs of the family. Due to the typical short length of stay allowed by insurance companies in psychiatric units in the United States, the emphasis is on teaching self-help skills and tools to the patient and family. Such skills and tools are mindfulness, breathing, trigger identification, and post-discharge planning.
Q: Stigma and Fear of Seeking Treatment
There is so much stigma around the diagnosis of mental illness and perhaps more so around perinatal mental illness. Research shows that individuals suffer from both externalized and internalized stigma around a diagnosis of mental illness, much more so than a physical medical condition. So, there’s already stigma about depression and anxiety….it’s already difficult to come forward and then even more so for women to come forward about how they feel, as new mothers and with a baby. There’s shame associated with not coping and also fear about having the baby taken away.
Do you believe there is unconscious stigma around mental illness? Have you seen this phenomena in your work?
SM-B: Stigma is a huge and well documented issue in perinatal mood disorders. It’s very hard and terrifying for people to admit to having a mental illness. There are so many fears around hurting the baby. It’s documented that actual harm to the baby is quite rare, but when it happens, of course it’s a tragedy and the media sadly sensationalizes the event.
Plus there is enormous personal shame. Research and clinical experience indicate this shame around feeling emotionally ill and then being diagnosed with a mental illness is exaggerated during the perinatal period. New mothers can feel so insecure and inadequate in their new roles. The stigma, shame and guilt issues are important and need to be part of the therapeutic sessions.
Q: There is so much contradictory information about how hormones, breastfeeding, formula feeding can affect a woman’s self-esteem and mood. Some studies suggest that breastfeeding is protective of depression, yet clinically, some women feel better when they choose to discontinue breastfeeding.
In layman terms, what are your thoughts about the relationship between breastfeeding and postpartum mood disorders? What are some of your guidelines for clinicians to follow regarding the choice of infant feeding method for a woman and her family?
SM-B: At the Mother-Baby Unit at UNC, we’d love to educate organizations that support new moms that women have psychiatric needs. We’d love to educate and influence breastfeeding groups with information about the unique needs of the specific population of women with mood disorders. Our feeling is that setting up breastfeeding as an all-or-nothing construct is a set up for feelings of failure for new moms and can lead to exacerbation of psychiatric symptoms.
We’d love to see the prescription for sleep as a recognized treatment for new moms. And define successful breastfeeding to include one bottle nighty so that mom can sleep. It’s important for the mom’s brain health.
We also want to emphasize that mothering is not a competitive sport.
Our goal is a healthy mother and a healthy baby. Whether or not a woman breastfeeds shouldn’t be colored by judgment of right versus wrong or success versus failure. We need to keep in mind that the baby must be fed, even when the mother is suffering from a severe perinatal mental illness.
One thing we do know is that sleep deprivation exacerbates depression anxiety and mood disorders. So we try to help women who wish to breastfeed increase the odds of successful lactation without sleep deprivation. We encourage women and families who wish to breastfeed to continue but also set up some guidelines to help the mothers heal mentally and emotionally. We don’t see breastfeeding as an all or nothing activity.
At UNC, we say that there can be a combination of breastfeeding and formula feeding in order to support the needs of both mom and baby. We feel that breastfeeding has many benefits and that it’s not an all or nothing equation. We want to enable women to continue to breastfeed but also help them succeed at mothering, in a way that’s realistic and healthy for them.
Dr. Meltzer-Brody, thank you so very much for your time! You’ve shared enlightened information and guidelines for perinatal clinicians and expanded the definition of mothering to be more inclusive. I look forward to seeing you this June at UNC!
Closing Paragraph
The development of specialized psychiatric Mother-Baby care reflects a larger truth in perinatal mental health: mothers deserve treatment that protects both their lives and their relationships. Severe mood disorders in pregnancy and postpartum are real, treatable medical conditions — not moral failings. When care is collaborative, individualized, and grounded in both science and compassion, families can stabilize and move forward. My hope is that conversations like this continue to expand access, reduce stigma, and remind mothers that seeking help is an act of strength.
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