Driven to disrupt

Samantha Huguelet, DNP ‘12, MSN ‘02, APRN, CNS, PMH-C, was serving as a nurse on an inpatient psychiatric unit over 20 years ago when she overheard a psychiatrist say, “What are they going to do next? Train monkeys to do our jobs? She’s just a nurse.”

As it turns out, the psychiatrist was talking about a nurse who had returned to school at the University of Minnesota to become a clinical nurse specialist and was going to start treating patients.

“It was very threatening to the medical hierarchy at that point in time. I knew then if something was going to cause that much of a disruption, I wanted to be a part of it,” says Huguelet.

Huguelet did just that, earning a master’s degree in 2002 and a Doctor of Nursing Practice degree in 2012 at the University of Minnesota School of Nursing. For more than 20 years, she has served as a clinical nurse specialist in psychiatric mental health and has developed an expertise in perinatal mood and anxiety disorders, including founding a Mother Baby Program at Nystroms & Associates.

An alternative to white knuckling

After a colleague at Nystroms & Associates experienced her own bout of postpartum depression and began advocacy around the condition, the number of patients coming to the clinic with perinatal mood and anxiety disorders increased.

Huguelet, who was the only female medication provider at the time, began receiving more referrals for medication management. The general rule at the time, in the mid to late 2000s, was to take women off of everything that wasn’t a prenatal vitamin. “So people were being taken off of their antidepressants, usually pretty abruptly, and white knuckled it through their pregnancy and nursing time,” she says. “There were not established treatment guidelines, but there were little pockets of people throughout the United States who were doing this work. Finding resources really took a lot of effort.”

Around this time, Huguelet became involved with Pregnancy and Postpartum Support Minnesota, a volunteer-led group of mental health professionals focused on perinatal mental health. “We found our voice in helping to establish trainings that we took to OB providers and mental health clinics and really got the word out about awareness and treatment,” she says.

Eventually, Huguelet decided to go into private practice and opened Iris Reproductive Psychiatric Clinic focusing on perinatal mood and anxiety disorders. When she decided to return to Nystroms & Associates, she did so to establish a Mother Baby Program to help mothers learn strategies for coping with postpartum depression and anxiety, develop skills to help them bond with their child/children, and learn ways to handle stressful situations.

The program curriculum was created with the assistance of four Doctor of Nursing Practice students at the University of Minnesota as part of their practice improvement project. “My tie to the University of Minnesota has never stretched very far,” says Huguelet, who serves as preceptor for School of Nursing graduate students.

Nystroms & Associates saw its first patient in the Mother Baby intensive outpatient program in 2017. They ran the group three days a week with two providers. Now they offer daily programming including high-intensity and low-intensity groups and have 15 therapy providers and three psychiatry providers. Last year, they served 200 women, and there are plans to expand the program to North Dakota next year.

“As we’ve tracked our outcomes with depression and anxiety questionnaires at the start of treatment and at the end of treatment, we have a 53% and a 56% symptom reduction in that eight week period of time, which is better than any antidepressant can boast,” she says.

Encouraged by advancements

Huguelet continued her service with Pregnancy and Postpartum Support Minnesota for 10 years, serving as board member, education director and assistant director. She’s now on the board of directors with Postpartum Support International’s credentialing board and part of their education faculty.

She’s encouraged to see the growth in the field, noting that the first Postpartum Support International conference she attended drew 300 attendees and there were 1,300 at the conference earlier this year.

“Nationally and in Minnesota, there have been great advancements, but there still is an unmet need,” says Huguelet. “The live births in Minnesota is 65,000 a year and another 15,000 experience pregnancy loss. And about 1 out of 5 of those women have some type of a clinical perinatal mood or anxiety disorder as a result of that hormone shift. Less than 10% of those are going to seek treatment. So there are women that are suffering, getting misdiagnosed or they go to ineffective coping mechanisms.”

Those women — and the women she’s already helped — keep Huguelet focused on improving the treatment of perinatal mood and anxiety disorders.

“In graduate school, I would never have dreamed I would have the autonomy and be able to serve a patient need so great and be able to make a difference,” says Huguelet. “I see patients back for their subsequent pregnancies and their journey having adequate treatment and support makes a remarkable difference. Being a part of their journey is life changing for them and extraordinarily rewarding for me.”