When Robin learned she was pregnant, she and her partner were ecstatic. They chatted about names, discussed colors for the baby’s room, and planned maternity photos.
But the joy of pregnancy was overshadowed by a frightening delivery. Robin was ultimately diagnosed with both postpartum depression and post-traumatic stress disorder; she was exhausted, overwhelmed, and angry, and she even fantasized about escaping from her family.
Fortunately, Robin’s obstetrician’s office routinely screened for mental health issues during pregnancy and postpartum, and Robin quickly recovered with help from family and trained mental health professionals. In fact, most maternal mental health conditions, such as postpartum depression or anxiety, are temporary and treatable; the proven path to wellness may include a combination of self-care, social support, therapy, and medication.
However, nearly 20% of women experiencing postpartum depression have thoughts of harming themselves, and suicide is one of the leading causes of death for women in the first year following pregnancy (Metz, et al., 2016). Some studies even indicate that suicide is the number one cause of death for women in the first year postpartum (Davis, et al, 2019).
Mental health concerns – primarily anxiety and depression – are the most common complication of pregnancy and childbirth, affecting one in five women in the general population. Women of color, those who live in poverty, and military mothers are at even greater risk. The COVID-19 pandemic has exacerbated these issues with a recent study showing that women pregnant during the pandemic have rates of anxiety and depression that are triple pre-pandemic rates (Davenport, et al, 2020).
Our healthcare system provides many opportunities to talk with childbearing women about their mental health. On average, a woman will visit a healthcare provider 25 times in the two-year timeframe from conception to their child’s first birthday. This offers ample opportunity for providers to discuss and screen for mental health issues and to teach their patients how to safeguard their mental health. Family members also come in contact with health providers and discuss their concerns and observations.
Starting these conversations early in pregnancy normalizes a healthy discourse on the importance of mental health and develops trust between a woman and her obstetrician, which can later help her feel more comfortable speaking up if she is feeling anxious or depressed. Recognizing the importance of discussing and screening for mental health issues, the American College of Obstetrics and Gynecology recently updated their recommendations to include screening for anxiety and depression each trimester during pregnancy and talking with new mothers two to three weeks postpartum, rather than waiting for the standard six-week postpartum visit, specifically to evaluate the mother’s mental health.
All healthcare providers who work with childbearing women should be prepared to discuss and screen for mental health issues: obstetric and midwifery providers and their staff, hospital nursing staff, and affiliated health professionals such as doulas and lactation consultants. Medical professionals working in the emergency room should also be trained on these matters as the majority of new mothers who die by suicide visit an ER within one month prior to taking their lives (Goldman-Mellor, 2019).
Should it become evident at any point that a woman needs intervention, providers also need to know how to equip her with resources for recovery. An excellent resource is Postpartum Support International (PSI), which has volunteers in every state to help pregnant women, new mothers, and their families find help. PSI offers a helpline in both English and Spanish, a directory of providers, information on finding local or international assistance, online support groups, peer mentoring, the option to chat with an expert, and resources for dads, partners, and family members. All services to mothers and families are free. There may be other resources available in your local community: check at your hospital or doctor’s office for information about support groups or mental health providers who specialize in treating women during pregnancy or postpartum.
However, it isn’t just medical professionals who need to reach out to pregnant women and new moms. We all should. Ask your pregnant friend how she is feeling. Ask the new mom in your life how she is doing. Suicide can be prevented and prevention starts with asking with compassion, listening with empathy, and being ready to step up to help when someone is in need. Melissa found healing because she had people in her life who were willing and able to do exactly this, but countless more women still need help.
About the Authors
Adrienne Griffen, MPP, is the Executive Director of Maternal Mental Health Leadership Alliance (www.mmhla.org), a national nonprofit focused on maternal mental health policy. Adrienne has lived experience with postpartum depression and anxiety, is a graduate of the United States Naval Academy, and holds a masters in Public Policy from Harvard University.
Amy Stuart is a contributing author with Postpartum Support International, a resource for parents and caregivers with perinatal mood and anxiety disorders, and has personal experience with postpartum depression. She is a graduate of Arizona State University, where she majored in justice studies and also studied English and history.
Davenport, M. H., Meyer, S., Meah, V. L., Strynadka, M. C., & Khurana, R. (2020). Moms are Not OK: COVID-19 and Maternal Mental Health. Frontiers in Global Women's Health.
Davis, N., Goodman, D., & Smoots, A. (2019). Pregnancy-Related Deaths: Data From 14 U.S. Maternal Mortality Review Committees, 2008-2017. Center for Disease Control and Prevention.
Goldman-Mellor, S. & Margerison, C. (2019). Maternal Drug-Related Death and Suicide Are Leading Causes of Postpartum Death in California. American Journal of Obstetrics & Gynecology.
Metz, T. D., Rovner, P., Hoffman, C. M., Allshouse, A. A., Beckwith, K. M., & Binswangerm, I. A. (2016). Maternal Deaths From Suicide and Overdose in Colorado, 2004-2012. Obstetrics and Gynecology.