The LIFTS Podcast

Dr. Jessica Liddell - Building Support for Maternal Mental Health

• Season 5 • Episode 7

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0:00 | 18:05

Guest Bio: 

Dr. Jessica Liddell is an Associate Professor at the University of Montana School of Social Work and Affiliate Faculty in the School of Public and Community Health Sciences. Her work focuses on pregnancy and childbirth, reproductive justice issues, birth justice and equity, community engagement, and making healthcare systems more equitable. Her current research focuses on the use of doulas to improve maternal and infant health outcomes in Montana. Dr. Liddell graduated from the interdisciplinary City, Culture, and Community Ph.D. program at Tulane University. She also completed a Masters in Public Health, with a focus on program design and implementation, and a Masters in Social Work, with a focus on disaster mental health at Tulane University. Originally from Logan, Utah, Dr. Liddell completed her undergraduate degree in Psychology at Reed College, in Portland, Oregon. Her experiences as a doula and as a mother inform her research and drive her passion for this work.  Here is a link to her CV: Liddell_CV_2025_August

Episode Details:

In this episode of the LIFTS Podcast, host Emily Freeman talks with Dr. Jessica Liddell, Associate Professor in the University of Montana’s School of Social Work, about her research and advocacy around perinatal mental health.

Dr. Liddell shares insights from her work in Montana and abroad — from New Zealand to Australia — exploring how culture, connection, and community all shape the postpartum experience. She discusses how doulas can be powerful allies in supporting mental health, especially in rural and tribal communities, and why genuine collaboration among providers is key to improving care across the state.

The conversation also touches on what gives her hope for the future of maternal health in Montana, the growing awareness among students and professionals, and the importance of grounding ourselves in meaningful, community-based work.

Topics in this episode include:

  • The role of doulas in supporting perinatal mental health
  • Similarities between rural Montana and rural communities abroad
  • Stigma and the “frontier mentality” around seeking help
  • Building the maternal health workforce in Montana
  • Addressing the overlap between perinatal mental health and substance use
  • Community-driven and online supports for new parents

Resources mentioned:

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Emily Freeman, HMHB-MT: 0:02

Welcome to season five of the LIFTS podcast, where we connect with parents, caregivers, providers, and advocates for Montana families in the early years of parenting. Through personal stories of lived experience and expert insights, we highlight the people and programs that are helping families thrive. I'm Emily Freeman and this is The LIFTS Podcast, A project of Healthy Mothers Healthy Babies, the Montana Coalition.

Jessica: 0:27

I'm Jessica Liddell and I am an associate professor at the University of Montana in the School of Social Work. 

Emily: 0:36

Great. Thanks for being here.

Jessica: 0:37

Yeah.

Emily: 0:37

What's the current focus of your research?

Jessica: 0:37

So I am in general, really passionate about all things maternal health, but specifically most of my research really focuses on perinatal mental health and especially looking at ways that we can support people in that postpartum time period. And I've been really excited to get to do some work, specifically looking at how doulas can be a potential support for people throughout pregnancy, during birth, but then especially in that postpartum time period when we know that a lot of folks are at risk for perinatal mood and anxiety disorders. And is your work specifically Montana focused? Yeah. So that's one thing that's really exciting is that I've actually had the opportunity to do some travel and look at what other countries are doing related to perinatal mental health and to doula care. One experience I had was doing work in New Zealand looking at postpartum care there. And even though in New Zealand, almost everyone gives birth with a midwife, which is very different than in the US where very few of us give birth with midwives. But there, when I talk to people about their postpartum care experiences. It was almost exactly the same as when I've interviewed people here in Montana. So people really told me a lot of stories about feeling that kind of, that pressure to be strong and resilient and that kind of frontier, pull yourself up by your bootstraps kind of thing. And that made it really hard and really stigmatizing if they were experiencing depression or anxiety and that that they had a lot of the same rural experiences that folks in Montana have. And so I think that there's something sort of powerful and also I guess maybe a bit sad too that, you know, women all over the world are having some of these similar experiences. I've also done some work in Australia looking at doula care. And it's kinda interesting there because they've done a really amazing job of really building up the indigenous doula workforce.

Emily: 2:23

Why was it those parts of the world that you were drawn to?

Jessica: 2:29

I guess a few things. One, it was English, so it was easy as far as, yeah. I was traveling with my five-year-old and wanted to have him in school and not have the language barrier. But also because they're not the same as the US but they're similar in some ways as far as countries that have also a history of settler colonialism, countries that have large rural populations, and countries that are at a similar kind of income setting than the us. So they're kind of a, a helpful kind of comparison, even though they're definitely different in some ways from the United States.

Emily: 2:56

And how did you find your way to this work to begin with? Why is this your area of study?

Jessica: 3:02

Well, I've always been kind of what I call like a birth nerd. So, I have a master's in social work and a master's in public health. And, and both of my work during those programs was very focused on sexual and reproductive health. And then in my PhD I did I partnered with a tribe in Louisiana and looking at the experiences of indigenous women giving birth there and kind of what supports they needed, what resources, things like that. But really it was my own experience giving birth, and experiencing prenatal depression and anxiety that led me to be specifically passionate about mental health. You know, as a social work student, I kind of knew that, okay, if you're experiencing these things, you should go see a therapist. And had the experience where I reached out to a therapist and had them tell me that as soon as I saw the baby, everything was gonna be fine, and I didn't really need to be that worried about my mental health. And I of course knew that that was not right and that wasn't correct, but it really made me think, wow, you know, if this is what people are being told when they're doing what they should do and they're re reaching out for help that there's a lot of gaps that are happening. Um, I also gave birth during COVID, during the week of shutdown. And so, that also made me particularly interested in postpartum time periods specifically because I was really kind of seeing firsthand of like, wow, when you don't have community to show up with like food and do all the supports how hard that is. So that kind of really led me to being interested in both the postpartum time period and then also just thinking about like perinatal mental health when before I'd been mostly focused on birth itself as a point of intervention. Sure.

Emily: 4:29

When you look at the state of maternal health in Montana, in, rural parts of the west right now, what gives you hope? What feels promising? Are there things that feel hopeful, that feel like the needle's moving a little bit in a positive direction?

Jessica: 4:44

Yeah, I, I think so. Actually just today I was teaching some students and, and asked them how many of them knew about perinatal anxiety'cause many people are familiar with depression. And actually quite a few students raise their hands and they're all freshmen. And so I always thought, wow, okay. Like, I'm hoping that this means that there's more sort of conversation about mental health, even for people who are somewhat young and not yet kind of in their reproductive years. I also think that, the revitalization of the Montana Perinatal Mental Health Collaborative, the Maternal Health Alliance that we have in the state, I feel like there are so many great people in the state that care about maternal health, that care about this issue. And I'm really just overjoyed to see that there's a lot of organizations that are now like trying to bring all those people together so that we can make sure that we can see kinda where the gaps are and then who's filling what thing and how we can partner together. And I think that's just really beautiful. I think a lot of other states programs are very siloed and here I think that that kind of connection and desire for genuine collaboration is, is really amazing.

Emily: 5:41

And then what are some areas where you feel like you'd like to see more improvement?

Jessica: 5:46

Yeah, I think that there are still just a lot of gaps in the, especially remote communities. I think that there is still some stigma, um, even though that's starting to get broken down. I think that screening still isn't happening as much as it probably should be. But then of course there's always that counterpoint of if you screen people, but there's not like a adequate resource to refer them to. What does that sort of do for us? I think that there are also just not enough therapists, social workers, counselors with training in perinatal mental health and that's sort of, I guess is true in general. I am in school social work, so we're always trying to build up the workforce. But that there is a need for special training and that you can't just sort of do everything and then also know how to support someone who is pregnant or postpartum or you might get a therapist like me who didn't focus on perinatal mental health. And so they they gave me advice that was sort of unhelpful because they didn't have that training. Right.

Emily: 6:35

Sure.

Jessica: 6:35

Yeah.

Emily: 6:36

Say someone's listening to this and they are a therapist or on the path to maybe thinking about becoming a therapist. What types of opportunities exist? Are there programs that have been developed that are sort of responsive to this need and also cognizant of the fact that for a lot of working professionals moving to Missoula for an additional degree is not an option? Yeah.

Jessica: 6:58

Yeah, I would definitely say that I don't necessarily think that a formal, um, MSW degree is at all required to know how to support people for their perinatal mental health. I think, probably many folks are familiar with Postpartum Support International. I do sit on, the board of the Montana chapter, and they try to do pretty regular trainings related to perinatal mental health. Some of them are virtual, some of them are in person throughout the state, and we try as much as we can to try to have scholarships and things like that. I know HMHB tries in various ways to do a lot of like great education and kind of outreach to people that maybe yeah, you can't do like a big formalized class or you can't do the two day PSI training, but can attend some of these different types of things to learn. And then I think even just training doctors and what the screening tools are, right? Or training providers in general can at least let them know that they are looking for something and then go to resources like PSI or HMHB to look at like, okay, who can I refer to that has this sort of training? So, yeah.

Emily: 7:52

Yeah, and we can include links in the show notes to organizations that provide those kinds of trainings. And yeah, thinking about the importance of medical teams mm-hmm. Especially in rural areas. Exactly. Where, you don't need to be a therapist or the doctor even, but maybe it's, you know, someone at the front desk gets a training not to formally screen, but just to be aware of these issues. 

Jessica: 8:18

I think we have also a big missed opportunity with pediatricians and kind of everyone in those offices, and I think that's starting to change, but so much of the focus is generally then on like, how's baby doing? Right. Which of course is what they focus on. But so I think making it more standardized that we also ask parents how they're doing at those meetings.'Cause we know that a lot of people go in maybe for that one visit postpartum maybe, but that's all that they're getting. Whereas they will bring their kids to their checkups, so, yeah.

Emily: 8:44

Yeah. Well, and to your point about, you know, you screen, but then what is the resource to direct them to? Are there telehealth opportunities? Are there support groups? What do we do in really rural areas? Mm-hmm. Especially areas that are healthcare deserts to begin with. Mm-hmm. Um, what's available for a mom?

Jessica: 9:02

Yeah, I mean that is sort of the, the question, right? I think that telehealth works great for some folks and definitely again, PSI and I know other organizations have like online support groups. Um, and those are helpful for some people. Some people actually like that flexibility of being able to do something that is online and they can be moving around the house and with the baby, things like that. For other people, they're hungry for that human connection. Right? Sure. That being said, I think that we sort of have an ethical obligation that yes, it can be hard to screen someone, but simply by not knowing about the problem, putting our head in the sand, we're not helping things either.'cause even if at least the provider knows, okay, I need to keep extra attention on this person, or the person themselves know like, oh, okay, this isn't actually normal. Like this isn't just the baby blues. Like I'm actually like potentially clinically diagnosable. Right? Um, I think that that can actually, in and of itself, that knowledge can be maybe validating and really powerful. It can also like help the person, if they have a partner, the partner know, okay, my, my partner's struggling. Right? But I think it also really underscores why we do need like community driven interventions because we can try to make more therapists, we can try to do more screening. We need, like communities themselves to really come up with local supports for new parents. It's just, it's hard to be a new parent out there, right? So I think that we need to have a multilevel approach because there's no one kind of silver bullet that's gonna address all of this.

Emily: 10:18

Yeah. And so you do a lot of work with doulas and studying the effects of having doulas. Why are doulas important in Montana? Why are they valuable for Montana's rural and tribal communities in particular?

Jessica: 10:32

Yeah. I think in part it's because we don't have as much of a robust maternal healthcare system and doulas are kind of one way that we can address some of that gap. I'm also very cognizant though, and I'm trained as a doulas myself, that you can't, doulas can't fix everything. Right, right. However, I think that often doulas are from their communities and they are so important, especially. For people who are vulnerable to make sure that they have their voices heard in the birth space to make sure that they don't feel stigmatized if they are struggling with certain thoughts. I think that like you just really can't overstate the value of having a consistent person with you throughout your birth experience? I think obs try as much as they can, especially in rural areas. And sometimes it's not an ob it's just sort of the general doc. If it's really rural they have multiple patients and they're getting called in and out of different things. Right. And so the fact that the doula is there with you for basically the whole birth, as long as it doesn't go on for too many days. And that they, they're the one going into your house afterwards for postpartum check. I mean, they can really see what's happening. That kind of really like, you know, feet on the ground, really seeing what's happening in your space, in your home is really valuable. I would say not all doulas are currently trained specifically in mental health. I think a lot of trainings are now teaching doulas to do the basic screenings'cause they're very easy to do and then giving them resources about who to refer to. But, in some of my interviews with doulas that kind of specialized training in mental health is what a lot of them are really hungry for. Mm-hmm. Because they acknowledge that they get a teaser of it in some of their trainings, but it's not the focus. And of course it's hard because we're not, we don't wanna make doulas also therapists, we Right. Because they, they're doulas and that their primary scope. But I think it is an opportunity for doulas to provide additional kind of just knowledge, information kind of de-stigmatize things like that, even though they're not being a formal kind of therapist or anything like that. One thing that I'm really excited to look more into as well is there's kind of preliminary research that is suggesting that having a doula in and of itself, separate from if a doula has additional mental health training, might actually help reduce or mitigate perinatal mental health because we know that if you have a doula, you're less likely to have maybe a lot of birth interventions or you're more likely to feel empowered during the birth or you are less likely to feel pressure to keep breastfeeding if it's not working for you. Right. So all these things we know are associated with mental health doulas can impact. So even if we aren't training doulas to do perinatal mental health therapy, right. Just having a doula in and of itself, I think is actually something that's powerful to mitigate and reduce uh, PMADS.

Emily: 12:59

Yeah. Sometimes it's just that simple formula of another trusted human who says Exactly, I see you and you got this, mm-hmm, whatever this looks like and I believe in you. So this work can get heavy. How do you keep yourself grounded or feeling positive and hopeful? How do you keep yourself grounded and strong?

Jessica: 13:19

Yeah, I think a few things. I think for me, I mean, the fact that it is heavy and hard is actually what's kind of motivating.'cause it means it's important, right? Mm-hmm. And I feel so privileged that I have a job that I feel like really matters, right? Like I cannot imagine clocking into a job where, yeah, it doesn't matter, you're not passionate about it. Like I find that, because it's important that is motivating. I also get a lot of inspiration from the colleagues that I work with, the professionals who are in the field doing the work. Just seeing their energy and passion for this is always just, just really validating. It's like, wow, other people care about this thing that I also care about. Right. I think it would be much harder if you were just talking to a wall and trying to tell people that mental health matters during, pregnancy, you know. Also then, yeah, I try I, I love a costume. I'm from New Orleans, so love costuming, things like that. I also recently started doing stained glass. Um, you know, I hang out with my 5-year-old who is a great source of inspiration. I think it's about the mixture of having the work feeling meaningful and that being motivational, and then of course, knowing when it's time to to do other things. So, yeah.

Emily: 14:20

Yeah. Well, that's great. And it, it does feel like there are exciting changes happening. Yes. And it must be encouraging to see that, to be able to look at like the last legislative session and say exactly what happened around doulas. And I could see that being very motivating.

Jessica: 14:36

Yeah. I feel like, um, both in Montana we're seeing this, but also nationally. It's just, it's really exciting just to see how finally people are starting to care about maternal mental health and even just acknowledging that it's a leading contributor to maternal morbidity and mortality. So I just feel like both in the state, both nationally and even globally, like people are finally starting to talk about this and I, yeah. I think it's a really exciting time to be doing this work, and I'm excited to see what happens.

Emily: 15:01

Yeah. Anything that you wish I had asked you or any final things that you wanna share?

Jessica: 15:07

I mean, I think that there's also sort of a need to think about how mental health also is interconnected with a lot of other things, like substance use disorders, right? Mm-hmm. And I think that's something I'd love to see more improvement on. And that, I think that we still sort of keep those a bit siloed. Like substance use disorder is separate from mental health and of course substance use disorders is a mental health disorder. Right? So, um, I think that that's something that we know we have high rates of in Montana and I think that those fears are still a bit siloed and I'd like to see more connection. Yeah. So that's another area to have some improvement in, I think. Yeah.

Emily: 15:38

Are you familiar with the recovery doula program?

Jessica: 15:40

Yeah. Yeah. I evaluate that program and have created some modules for it. So yes. Very excited for the work they're doing and to continue. 

Emily: 15:48

And that is, it is encouraging to see a little bit of change there where people aren't necessarily siloing those things so much. Exactly. Seeing like they are interconnected mm-hmm. And totally addressing them in a combined way rather than as two separate pieces of someone. Exactly. Yeah.

Jessica: 16:04

Yeah.

Emily: 16:05

I think the other interesting thing about maternal mental health work is that there's so many ways to get involved, you know? Mm-hmm. Yeah. And it's so important. Yeah.

Jessica: 16:13

One thing I found has been kinda interesting too, just being a parent here in Missoula is even like the hyper-focused sort of like Facebook groups and different social media groups that are like a support space for people. I think that that's something too that it's still local so it feels personable. You know some of the people's names, but it doesn't necessarily have to involve going somewhere once a week for a meeting'cause that maybe isn't possible. Right? But I found that that's actually been kind of helpful for mental health support too. So again, you can dream big. But also dream really small and even just if, maybe you can't start a regular weekly group, but you can make just like an online group support thing that's very local so it feels personal.

Emily: 16:46

Yeah, absolutely. Like a small community-based Facebook group that's just for moms or for parents. Exactly. Mm-hmm. And maybe all you need to do is set it up exactly and just sit back and enjoy watching the space that you've created with minimal effort'cause if you need it, someone else needs it too. Exactly. Yeah. All right. Well, thank you so much for your time.

Jessica: 17:07

Yeah.

Emily Freeman: 17:11

The LIFTS Podcast is a project of Healthy Mothers, Healthy Babies The Montana Coalition, a nonprofit dedicated to improving the health, safety, and wellbeing of Montana families in the zero to three years of parenting. Visit us at hmhb-mt.org to learn more about who we are and what we do. Views and opinions expressed in these interviews do not necessarily represent HMHB as an organization. If you have feedback on the podcast or an idea for a future guest or episode, we'd love to hear from you. Take our LIFTS podcast listener survey at hmhb-mt.org/survey or email us at stories@hmbmt.org. Thanks for listening.