This week is Maternal Mental Health Week. Maternal mental health refers to a mother's mental health during pregnancy and postpartum. According to the Cleveland Clinic, up to 15% of mothers experience postpartum depression (PPD) and/or anxiety (PPA.) (Source) Many do not know that you can actually have the same symptoms and diagnosis during pregnancy as well. The Mayo Clinic sites that 7% of pregnant women experience depression. (Source) This can be true even when the pregnancy is planned and wanted with mothers who have never experienced depression before. Hormone changes are a huge factor in these illnesses. Around 20% of women will experience a maternal mental health issue. (Source) If 1 in 5 women deal with this, WHY are they not talking about? Many women will share their "birth stories" which may include graphic details about things like mucus plugs and hemorrhoids, but do not share their experience with PPD/PPA. There are several reasons for this. I think the three of the most obvious to me are 1) Mother's don't always recognize what is happening. 2) When they do realize something is wrong, they may fear judgment from others as "crazy" or incapable of taking care of their children. 3) Treatment options aren't always easy to find and access.
I had PPA during and after my second pregnancy and PPA and PPD after my third pregnancy. During the second pregnancy, I knew I was more anxious than normal. So, I had discussed with my primary care provider starting an anxiety medication immediately upon the birth of my baby, which meant I would not be breastfeeding. (Though, many agree it may be safe to do so with certain anxiety medications, so discuss this with your doctor.) Fast forward to the birth of my second son. After, I was completely harassed and shamed by the staff for not breastfeeding, they handed me the postpartum questionnaire. I thought well, I already explained to them I have anxiety and need medication, I will answer this truthfully. Maybe they will understand why I am not breastfeeding. The next day a woman came in the room and after telling my mom to leave, she said, "I think you know why I am here." UM NO, I did not. Then she told me I scored very low on my questionnaire and she had a few questions to ask me. Then, she proceeded to ask me what public assistance programs I was on and to list what drugs I had a problem with. (Neither question was at all applicable to me.) Never did she ask me how I was feeling or anything like that. She finally asked me if I had a plan, and when I said yes, she just said OK and handed me some literature. I was completely offended and had no interest in doing that again. So, when my 6 week check up came and I got the same questionnaire, I just filled in what I knew I should say. Luckily, I had already started medication and that helped some. It took me about 3 months or more to realize...I still don't think I'm 100%. All my doctor could do was refer me to a psychiatrist for a different medication, which I didn't want. So I had to research on my own and I tried mind/body therapy. It helped some as well, and by the time my son was 1 I felt almost normal again. Think, what if I would have just suffered for an ENTIRE YEAR!
With this experience, I thought I would be prepared for PPA after the birth of my third son. WRONG! This time I got PPD too! This is a story for another article, but even though I experienced PPA before, I was now sure I would never be better. And, I wasn't on medication because this time I was persuaded to breastfeed. Luckily, I sought out a therapist who knew a lot of different ways to handle my situation and encouraged me to get back on medication, gave me some great tips, and most of all gave me the confidence that this could turn around. Funny my OB who I told about my PPD/PPA, never followed up on my condition after my 6 week appointment. She did however have a nurse call me and to ask why I didn't take my postnatal glucose test. Your brain should be treated the same as your pancreas!
But, the point here is two fold. 1) Mother's need to talk about their experiences so other women don't feel like they are the only ones because clearly they are not. That other women have recovered. And, so they can recognize the symptoms in themselves so they can seek treatment. 2) Make treatment options more accessible. Handing someone a questionnaire or a pamphlet is not enough. Nurses and doctors need to speak to women about the range of treatment options available in case they are against taking medication while breastfeeding or are wary of talking to a therapist. I know my insurance only offered me male therapists, none of whom were specialists in maternal mental health. I didn't have to google treatments for Gestational Diabetes. I was given a nutritionist, a diabetic nurse and an endocrinologist in addition to a myriad of information. (Again with the pancreas over the brain!)
For more information about PPD/PPA these sites are very helpful!
If you live in Southern California, message me for some local resources.
Remember, from the outside you may have no idea the struggles someone is going through. I was just starting to recover in this picture. Be kind to all mothers!
Talk About It!