Maternity care and mental health care are both lacking in our otherwise incredibly developed nation. Combine these two and you have the perfect storm for women of all races, ethnicities, educational and socioeconomic statuses to fall deep into the cracks. According to the non-profit MotherWoman, one in six postpartum women suffers from perinatal emotional complications (PEC). These PEC's can include anxiety, depression, obsessive-compulsive and post-traumatic stress symptoms and much less frequently, postpartum psychosis. MotherWoman recognizes that often women do not fit into any category, but experience a range of symptoms. However they are experienced, these types of PEC's are hard on women and their families causing loss of work, crisis in families, and potential long term disability to children.
In most women's healthcare practices, there is no routine mental health screening, and new mothers who birth in hospitals are only referred to social workers if they are gravely distressed or suspiciously detached from their newborn. What about the women who are overwhelmed with anxiety? And those who are overcome with unwanted, intrusive thoughts of harming their newborn? What about mothers who know they are on their own in this huge world with a tiny baby who is relentless in having never-ending needs? Who offers a hand to these women? Who provides support and a trained ear to listen?
Some of these women will reach out to a loved one, their provider, or a mental health professional. But unfortunately the barriers don't stop even when she reaches out for help. Some mental health clinicians don't welcome children in their practice, so childcare becomes an issue. Some women want to breastfeed and are told they need medication that is not compatible with nursing. They are incorrectly told they must stop nursing to get well. Some women don't get help. Sometimes I see them in psychiatric crisis in the hospital where I am a clinician- either feeling suicidal or after a suicide attempt.
Psychiatrists have legitimate concerns about treating a pregnant or newly postpartum woman with emotional complications. Obstetricians and midwives typically do not have experience in psychiatric concerns and may refer back to mental health experts. Pediatricians, who have frequent contact with new moms, may feel that their patient is the newborn and don't see the mother as their concern. Perhaps pediatricians do not feel they have adequate resources to help, so they don't ask.
And it doesn't stop there. When we have a pregnant or postpartum woman who is suffering, we must ensure that the infant is receiving what s/he needs. The newborn senses mom's angst and can become irritable or anxious themselves; the perfect storm then becomes the perfect tsunami. (Check out Dr. Ed Tronick's Still Face Experiment video for a disturbing look at how intensely babies respond to primary care givers' emotional states.) New moms can struggle to stay afloat with emotional tides pulling them deeper into a darkness that no one seems to understand. A woman suffering from PEC's can drown in societal expectations about the postpartum period being joyous and beautiful; about love at first sight with her baby; and how she will know intuitively how to do all things "mommy". For many moms, this just isn't the case. When mom is suffering, who can help? Where do moms turn?
In an ideal world, psychiatrists would know which medications are compatible with nursing and how to assess risks and benefits when considering medication. Obstetricians and midwives would screen all women through pregnancy and through the first postpartum year. Pediatricians would take the time to assess the family as a whole. All providers would know that isolation is a key risk factor for postpartum mothers and encourage them to increase their support systems and prioritize their self-care. We would remember as a society that it is essential to "mother the mother" and not isolate her, run her back to work before she's ready or put the full burden of childcare on her sleep-deprived shoulders. Caring for the whole woman, her mind included, would be standard. Women would be reassured that there is help available and she will get better. With the right support and care, women can speed their recovery rather than suffering in the dark for days, weeks, months and beyond. According to MotherWoman, the sooner mothers receive the proper assistance, the quicker they will recover.
How do we get there? We need more cross-training between disciplines. I was introduced to MotherWoman as a mental health clinician at a continuing education training. Before this seminar, I had sought out resources for patients struggling in the postpartum period. I don't have a newborn at home. I consider myself a savvy internet researcher, but resources are difficult, if not impossible, to locate. In one search I came across Postpartum Support International, where I was able to contact one volunteer liaison for the entire state of Connecticut. Finding help should not be this challenging!
Maternal care providers need to have referral connections just as they do for other medical specialties. Pediatricians can collaborate with family counseling resources. Mental health professionals need to be educated about the unique needs of this special population with programs by and similar to MotherWoman. Informed mental health providers can then be sensitive to a new mother's physical, hormonal, and psychosocial needs as they differ from a non-postpartum client. Education and awareness are simple concepts that could dramatically improve postpartum health and mental health and in turn family wellness. One in six postpartum women are struggling and need support. What are we waiting for?
Author's Bio: Catharine McDonald, MS, NCC, LPC works as a Senior Clinical Therapist and Access Specialist in Crisis and Behavioral Health at a community hospital. Her clinical interests include trauma, family therapy, and maternal mental health. Catharine is also active in La Leche League and Holistic Moms Network in supporting pregnant and postpartum mothers in her area. She lives in Connecticut with her husband, daughter, and their two spoiled dogs.
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