The U.S. must better recognize and treat new mothers in need of help.
After Rihanna revealed during her Super Bowl appearance that she is pregnant with her second child, fans responded on social media with an outpouring of congratulatory comments. And last week, when 48-year-old rap star Da Brat revealed her pregnancy on Instagram, the comments section was ablaze with positive reactions.
But not every pregnancy and birth are met with such public jubilation.
In the months after I had my baby in December of 2021, I didn’t sleep well and was prone to crying spells, petrified that my baby would stop breathing or die at any moment. She wasn’t afflicted with any disorders that could give a basis to my fears, but that didn’t stop me from constantly worrying. I was a Ph.D.-holding, self-sufficient, independent female; I didn’t want to admit that I had postpartum depression—to myself or anyone. As a mother, I understood it would be best for my baby if I was mentally healthy. But, the need to be mentally fit quickly turned into denial.
The problem was exacerbated by the blurry line between categories of postpartum mental health issues. A myriad of factors play a role in whether a new mother will face struggles. A mother can suffer from postpartum anxiety, but not necessarily depression. And postpartum depression can sometimes be written off altogether as “Baby Blues.” Some women experience dysphoric milk rejection reflex, which could appear as a short depressive episode only after producing breast milk. Some women go through postpartum psychosis, a condition in which the mother’s sense of reality is distorted, and could potentially lead to harming themselves and their baby.
Once I was able to admit to myself I wasn’t okay, I didn’t go directly to my healthcare provider. Instead, I asked other mothers I trusted, searched forums and online support groups. Many of these women confessed to having quietly suffered through similar issues after giving birth.
Postpartum depression is one of the most common disorders after labor. According to the Centers for Disease Control, one in 10 women reported symptoms suggesting they were or had undergone a depressive episode beyond two weeks after birth.
And the actual number is likely a lot higher: The information reported by the CDC is based on data obtained through the Pregnancy Risk Assessment Monitoring System (PRAMS), developed in the late ’80s between the CDC and local health departments with the aim to “reduce infant morbidity and mortality by influencing maternal behaviors.” (If you have given birth within the United States, you may have been randomly chosen to participate in the PRAMS research initiative.) The initiative’s direct aim was not to study postpartum mental health issues, but they have obtained enough information to write statistically relevant reports. However, data collection hasn’t been entirely consistent or rigorous. In Texas, for example, PRAMS has no data because the required 50-55 percent response rate has not been met since 2016.
The current postpartum mental health assessment relies on self-reporting. During my experience in Austin answering a widely-used short questionnaire called the Edinburgh Postnatal Depression Scale, I found the survey was not complex. It doesn’t take much thinking to know what to answer, meaning many issues remain undetected.
Shame, guilt and pride can all lead to a woman not reporting their struggles—affecting not just their mental health, but their physical well-being. The body that just went through the ordeal of birth does not recover quickly or easily.
Even when new mothers are honest with the clinical team, there is often no real follow-through beyond asking the new mother to see a mental health professional. It seems unlikely that a new mother who barely has the strength to make it through the day, may go through the extra steps needed to see a mental healthcare specialist.
Because the root of postpartum issues can be unfocused, varied and case-dependent, healthcare professionals need to improve monitoring and treatment strategies, rather than prevention.
Since many of the issues with identification are due to the straightforward self-reporting nature of the questions, it may be beneficial to expand questionaries. Reporting could also include questions directed at family members living with the new mother. Or perhaps, with the aim to attempt an objective assessment, a visit to a women’s mental health professional postpartum could be implemented as standard practice.
It is crucial to focus finding other modalities of treatment besides a healthcare professional visit—particularly important given the recent limited availability of psychiatric personnel. A 2021 research article suggests that brief home visitations by master’s level social workers may improve the mental health of women with postpartum depression as much as psychiatric visits. There is also evidence that social support can help ameliorate and the intensity and even prevent the onset of postpartum depression symptoms.
Too many new mothers suffer from mental health issues which remain undetected—though the signs are there.
It is imperative that the U.S. review and revise its approach to maternal mental health to recognize and treat these mothers in need of help.
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