Help for postpartum mood disorders can be hard to come by

Words can’t describe the pandemonium that follows a child’s birth, but I’ll try anyway. After my first daughter was born, I felt like a giant had picked up my life, shaken it hard, martini-style, and returned it to the ground. The familiar objects in my life were all still there, but nothing seemed to be the same.

The day we came home from the hospital as a family of three, my husband and I plunged headfirst into profound elation and profound exhaustion, often changing by the minute. We worried. We snipped at each other. We marveled at this new, beautiful person. The experience, as new parents the world over know, was intense.

The first week home, my body took a bruising. I was recovering from the wildness that is childbirth. I was insanely thirsty and hungry. I was struggling to both breastfeed and pump every two hours, in an effort to boost my milk supply. And against this backdrop, my levels of estrogen and progesterone, after climbing to great heights during pregnancy, had fallen off a cliff.

Massive reconfigurations were taking place, both in life and in my body. And at times, I felt like the whole thing could go south at any point. After talking to other new mothers, I now realize that almost everyone has a version of this same story. Childbirth and caring for a newborn is really, really hard, in many different ways.

That fraught time can be particularly dangerous for postpartum mood disorders such as depression and anxiety. Unsurprisingly, most women experience mood disturbances in the aftermath of a baby. For the majority, symptoms are mild and ease up with time. But for an estimated 10 to 15 percent of women in industrialized countries and 20 to 40 percent of women in developing countries, symptoms of depression will be troublesome and persistent. And these estimates account for only depression — not anxiety, OCD or other disorders postpartum women sometimes experience.

As a clinical psychologist, Betty-Shannon Prevatt of North Carolina State University in Raleigh saw firsthand how hard the transition to motherhood was for many women. She set out to study why women with postpartum mood disorders often don’t get the help they need.

Along with her colleague Sarah Desmarais, Prevatt surveyed 211 women who had given birth in the previous three years. The researchers asked the women about potential symptoms of mood disorders, whether they had received treatment and, if not, factors that may have kept them from doing so.

I found the results, published August 1 in Maternal and Child Health Journal, shocking. At the time of the survey, 51 percent of the women felt they currently met the criteria for a postpartum mood disorder. That self-report isn’t the same as a diagnosis from a doctor, nor is it indicative of women’s rate overall. But still, the number is high. “I was absolutely surprised,” Prevatt says. The number was especially notable because these are women who would presumably have a good shot at getting help — they are primarily white, married, well-educated and middle class.

The follow-up number is even more worrisome: Twenty percent of the women who self-reported that they were struggling didn’t report their struggles to their health care provider. The two biggest roadblocks to getting help were time constraints (no shock there) and stigma.
A new mother can have trouble finding time to take a shower, let alone to make a doctor’s appointment, call insurance companies, find someone to watch the baby and all the other tasks that go into seeking help. Paid maternity leave policies might help alleviate some of this pressure for women who need to go back to work quickly, the authors write. Strong social support can help, too.

Overcoming stigma is another huge challenge. “Women fear judgment that they are not a good mother … and often feel embarrassed,” Prevatt says.

That has to change. Women ought to be able to seek the help they need without fear or shame. There’s a push among some providers to use a universal screening tool, to ask every postpartum woman about her mental health. But these new results hint that even a universal screen wouldn’t catch women who are ashamed of their illness. For providers to better catch that population, women need to know that they’re experiencing something that’s quite common, and often treatable. “The more we can normalize the wide range of emotions that follow childbirth, the easier it will be for women to disclose how they are truly feeling,” Prevatt says.

The postpartum time can be grueling, even for people lucky enough to not have to deal with a mood disorder. The best we can do is to try and take care of new moms who are giving their all to take care of their baby.