Dr. Jessica Gaulton
“I truly believe that all new mothers should have a touch point with somebody that they trust, and who is checking in on them and making sure that their mental health is addressed in a confidential way. Every single mom and dad or partner, non-birthing parent, and every provider should be educated. Most women suffer in silence until either they somehow get out of it, they find some resources, or in the worst case there are really tragic outcomes.”
Dr. Jessica Gaulton has 10+ years of clinical experience and is a board-certified Neonatologist and Pediatrician. Her expertise lies at the intersection of maternal and newborn health, design thinking, and innovation. Jess is also a mother of two and personally experienced postpartum depression, which inspired her to start FamilyWell Health. Dr. Gaulton is currently a practicing Neonatologist at Beth Israel Deaconess Medical Center / Harvard Medical School in Boston, MA. She completed her Neonatology Fellowship at the Children’s Hospital of Philadelphia, as well as a Fellowship in Innovation and Design at the Penn Medicine Center for Health Care Innovation. She received her medical degree from the Johns Hopkins School of Medicine, a Master of Public Health from the Harvard School of Public Health, and completed Pediatric Residency at Boston Children’s Hospital / Harvard Medical School.
This blog is made possible by a sponsorship from Sage Therapeutics. All content on this page has been curated by the Mass. PPD Fund without input from Sage Therapeutics, Inc.
March 2023 | Interviewed and edited by Jessie Colbert, Executive Director, Mass. PPD Fund
We were lucky to connect recently with Dr. Jessica Gaulton, a Neonatologist, Pediatrician, and Founder of FamilyWell Health, an innovative new model integrating mental health support into obstetric care using virtual peer support. When she was postpartum, Dr. Gaulton pushed through breastfeeding challenges, anxiety, and then finally a deep depression, until another doctor helped her reach out for help. Her extensive experience on both sides of the healthcare system taught her why new moms are unlikely to speak up about mental health challenges, and why screening alone doesn’t work – and she found a solution.
Can you share what your life was like when you had your first child?
At the time I had [my first baby] Addie, my husband and I were living in Boston. I had just finished my pediatric residency, and my husband, who’s also a physician, was finishing his in anesthesia. I actually had her two months before I moved to Philadelphia for a NICU fellowship. I moved [on my own first] before my husband was done with his residency. I didn't know anybody in the city. I just remember moving into this empty house with a two-month-old, and feeling very lonely and isolated.
She was such a hard baby – I can’t even tell you how hard she was! She had a lot of difficulty breastfeeding. She just screamed her head off for the first several weeks of her life. In retrospect, I realized she was hungry. And I was so insistent on exclusive breastfeeding. I’m a pediatrician - I have to do this, right? Lots of pressure that I'm putting on myself.
When we were still in Boston, I was very fortunate to have a lactation consultant that I found through my pediatrician’s office. I remember she showed up on my doorstep – she’s this very old lady, sort of hunched over, with a big heavy bag. I opened the door and I just started crying. I’m like, I don't know what I'm doing. She won't latch. She's starving. She somehow miraculously got her to latch, and helped her get enough nutrients to start gaining weight. She was just a wonderful, wonderful person who supported me in those early first few weeks.
When we moved to Philly I didn't have that support. I just remember, like, we had no furniture, I was sleeping on a mattress on the floor. And I started getting fevers, I had mastitis. I didn’t know who to reach out to lactation-wise. Being a female physician, I felt like, I’ve got to do this on my own. I take care of babies!
Before you had Addie, did you ever think about the support you might need as a new mom?
I didn't ever take care of myself. One of the most important things that I've learned is that you truly have to take care of your own mental health first before you're able to take care of your baby. When I'm talking to parents in the hospital, I say, Look, it is okay to care of yourself first. You have to! So no, that did not cross my mind. 100% of my focus was like, How do I get my baby fed? How do I take care of her? And none of the focus was on me. That was definitely a mistake.
Can you tell more about your mental health challenges after Addie was born? When did they start?
They actually started the night that I got home from the hospital with her. I started having these really intense nightmares that felt real, like about accidentally dropping her when I'm walking down the stairs. Another example was I would be at a grocery store pushing her along in the cart, and then I would leave the grocery store without her. I’d get home and be like, Oh my gosh, I forgot my baby at the grocery store! And then during the daytime when I was just doing routine things around the house, these same thoughts would just pop into my head repeatedly. I was like, What is wrong with me?!
It wasn't until later when I learned about intrusive thoughts, that this is actually a normal phenomenon in the postpartum period.
It was a downward spiral from there. Intense anxiety, panic attacks – full-blown panic attacks like the walls caving in on me – and then lack of sleep that sort of spiraled into me going into a depression. I think the depression probably didn't hit me until she was a couple months old. But at the time I didn't recognize my symptoms at all.
I pushed through the postpartum period in the NICU fellowship, but I started to really feel like something was wrong. I am not able to focus, I'm not able to function at a level that that I'm used to functioning at, and everything makes me cry. I realized that when I got into a depression, I would isolate myself even more. And I had paranoid thoughts, like, People don't care about me, they don’t want to help me. I was worried about the stigma, and I certainly did not want to tell anyone at work, even though I'm sure that they knew.
Then I got pregnant again. I had my second baby, Will, 18 months later. That was not a planned pregnancy. I was probably deeply depressed and just kept pushing through somehow. I'm a very resilient person. My husband was starting his fellowship in anesthesia critical care, and his fellowship was even more intense. I couldn't really put words to [the depression], honestly, and I didn't think that he would understand or be able to empathize. And also, I literally never saw him. It was really hard.
What allowed you to finally speak up and ask for help?
About six months after Will was born, I just hit a wall. I was like, I can't do this anymore. I had thoughts like, I'm not good enough to be a mom, my kids would be better off without me. I couldn't see a way out. One of the female physicians that I worked with, she was my attending, I said to her, I need to talk to somebody. I just need to have somebody that understands that I’m struggling. I need help. And she put me in touch with a female physician who had mentored a lot of young female physicians. I swear, she is the reason why I'm here doing this work.
She just mentored me through it. She sort of gave me the keys. At the time, I was pumping around the clock and it was horrible. This was a big source of my anxiety and depression. I put so much pressure on myself to breastfeed both babies. I wouldn't do that again, and I wouldn't recommend it. She’s like, Jessica, it's okay to let go of something. And you should let go of something. Either take a break from the fellowship and just focus on being a mom, or stop pumping. And that’s okay. So I stopped pumping. And I started seeing a therapist. Eventually, I got an SSRI that made the world of difference. For me, that plus therapy helped me get out of that difficult time. And it was truly that peer mentorship – that is the foundation of what we do at FamilyWell – that helped me take those initial steps.
Looking back, what do you wish you had known? What do you wish others around you had known or done?
I truly believe that all new mothers should have a touch point with somebody that they trust, and who is checking in on them in the postpartum period and making sure that their emotional mental health is addressed in a confidential way. Someone to lean on at all hours, because the hardest times in my postpartum period were in the middle of the night, trying to breastfeed while the whole world was asleep. Oh god, I would dread those nights! I would have panic attacks thinking about going into the night.
And then having a system in place where, through that trusted source, you're being screened for anxiety and depression regularly, and are getting education around what it is. Every single mom and dad or partner, non-birthing parent, and every provider should be educated on what perinatal mood and anxiety disorders are, what the warning signs are, what the resources are. And if you have any of those warnings, they’re addressing it right away. Most women suffer in silence until either they somehow get out of it, they find some resources, or in the worst case there are really tragic outcomes.
Can you talk about how you turned your challenging experience into action with FamilyWell?
The foundation of FamilyWell was built on this idea that there is a lack of trust between new moms and their medical providers, and in the healthcare system in general. I felt that! I didn’t ever think of my OB as a person that I would turn to emotionally. And I had really great medical care. So the fundamental piece that we wanted to address was building that trust. We built a peer texting platform, and we piloted it in the Medicaid population at a hospital outside of Philadelphia. And basically, our idea was: will moms text us about their emotional health, and can we bridge that trust through peer mentorship?
I recruited a group of [peer coach] moms who were just mostly laypeople. We provided them with some basic mental health training, and set up a texting platform where our patients in the postpartum period could text anytime and get emotional support. And we also proactively screened them and pushed out educational information in the form of very short podcasts and PDF files, all by text. We found that women are very willing to share their emotional health with people they've never met, because our coaches are moms with shared experiences, and they're reaching out in an empathetic way. We validated that and had very, very high engagement. And it was very popular with the obstetricians at that hospital, so they advocated for it to be offered to all new OB patients.
Then as we started screening them, we realized that it's really hard to find a therapist. And we also found that a lot of women just didn't want a therapist, they weren't ready emotionally to accept that they needed that. So we started building our own behavioral health services within FamilyWell, and now we're at a point where we're integrating those services into OB practices. The thing that I think will be really important is building that trust between patients and their medical providers. I’m hoping that we can bridge that through peer mentorship. We’re building out a workforce of perinatal-trained health coaches, because there are so few therapists and psychiatrists in this field. I'm hoping that will help get women back into the healthcare system when they need it. Because that's where the services are, but it's just very hard for people to access.
Do you think of yourself as a “survivor”? How do you understand your experience now?
I don't like to say that I'm a survivor because I don't want to label myself as a victim. I went through what I went through, just like so many women in our country. I'm very fortunate to be able to have overcome that period in my life. A lot of people say, Jess, you have so much energy! And I'm like, That's because I have this really deep passion to be able to help other women avoid this situation that I was in. I’m harnessing that energy towards helping others.