Maternal depression is getting more attention — but still not enough
Untreated, it can harm mothers and their children
Adapted from a story by The Washington Post’s Michael Alison Chandler.
Shelane Gaydos was expecting her fourth child when she learned that her baby’s heart had stopped beating during a routine 12-week ultrasound.
Devastated, she blamed herself, worried aloud that she had let her husband down, and told her sister that she felt like a failure. She took time off work as a police officer and stopped sleeping. Two weeks after the doctor’s appointment, she ended her life.
Her family and friends have spent the past two years trying to understand what happened to the 35-year-old woman they knew to be ambitious, passionate and fiercely dedicated to her children.
“It was natural, of course, that she would be depressed,” said her mother, Joanne Bryant, who is now helping to raise her three grandchildren. “We did not know to what degree.”
Gaydos’s family believes her death was the result of postpartum psychosis, a rare illness that can cause delusions and paranoia. They have become advocates for raising awareness about the range of mental-health issues — often referred to in somewhat misleading shorthand as postpartum depression — that can affect expectant or new mothers.
“Postpartum depression is where breast cancer was 30 years ago: We whispered about it,” said Adrienne Griffen, founder and executive director of Postpartum Support Virginia. “This is the next generation’s issue. ”
“Baby blues” and maternal depression are two different things, although they share many of the same symptoms.
Maternal depression is longer lasting and more severe. Symptoms can include:
- Anxiety
- Sleeplessness
- Extreme worry about the baby
- Feelings of hopelessness
- Recurrent “intrusive thoughts” about hurting themselves or the baby
Untreated maternal depression can harm mothers as well as their children. Studies show that it can lead to delays in their cognitive and emotional development. Severe depression during pregnancy is associated with health risks, including pre-eclampsia and preterm delivery.
Mental health disorders are the most common complication of pregnancy, but maternal health remains vastly underdiagnosed and undertreated. Only 15 percent of women affected seek professional help.
In recent years, advocates say, there has been new progress in understanding and treating an illness that half a million U.S. women experience each year. Medical providers are screening for depression more routinely, and lawmakers are beginning to look for solutions for expanding treatment options.
Last November, Congress passed the Bringing Postpartum Depression Out of the Shadows Act as part of a large medical research funding bill to provide federal grants to states to create programs that screen and treat women for maternal depression. The bill had broad bipartisan support, but funding for the grants is now in question. Last week, the House approved just $1 million of the $5 million originally allocated. The Senate has yet to vote.
Rep. Katherine M. Clark (D-Mass.), who introduced the bill, said many women struggle silently through what is supposed to be “the happiest time of their lives.”
“Moms have a lot of guilt about how they feel, so they don’t seek treatment,” she said. “We want to reduce the stigma and increase awareness that this is highly treatable.”
Hormonal shifts and stress
Women are more likely to attempt suicide during the first year after childbirth than during any other time in their lives, and they tend to choose more lethal means.
These mood disorders are triggered by fluctuating hormones, including estrogen and progesterone, that ramp up during pregnancy and then drop off sharply after birth. Another significant hormonal shift occurs when women stop breast-feeding.
Researchers are trying to understand what predisposes some women to be more sensitive to these hormonal fluctuations, while others are not. So far, they have discovered that environmental stressors play a role.
The prevalence of depression is far higher for women who are poor or in abusive relationships or for women whose babies are born premature or disabled.
The stress of having a child is also exacerbated by unrealistic societal expectations, advocates say, and a poor social safety net that offers no federal paid leave program for new mothers.
“Women are supposed to have a full-time job, breast-feed, fit into a Size 6, go back to work a week after their baby is born, and do it all themselves, not to mention without sleeping,” said Jamie Zahlaway Belsito, advocacy chair of the National Coalition for Maternal Mental Health.
The screening process
In 2015, the American Congress of Obstetricians and Gynecologists (ACOG) recommended that women be screened at least once for depression during pregnancy and again in the postnatal period.
Last year, the U.S. Preventive Services Task Force, an influential federal panel, made a similar recommendation. In 2010, the American Academy of Pediatrics recommended that pediatricians screen mothers for postpartum depression at well-baby visits during the first six months.
Despite the push, many women are still not being screened, mental-health advocates say, which is why some recommend screenings happen more frequently.
At the Children’s National Health system, Lenore Jarvis, a pediatric emergency room doctor, noticed a pattern: Worried mothers were coming to the emergency room with babies who didn’t have a clear medical problem.
Jarvis would examine the baby and report back that everything was fine, but she needed to dig deeper.
She launched a pilot study to give depression screenings to mothers whose visits were not urgent and to provide resources to help those who needed it. The study found that 27 percent scored positive, and 7 percent reported having suicidal thoughts. More than half of the women who screened positive said they had never been screened before.
Lack of training
Many obstetricians or pediatricians lack specialized training on how to respond to maternal mental-health concerns, and they do not know where to refer mothers for help. The ACOG is developing training materials to help obstetricians, and it published a technical document to advise doctors who want to prescribe medications to pregnant or lactating women.
A statewide program in Massachusetts makes a perinatal psychiatrist available full time to consult by phone with pediatricians and obstetricians or other caregivers who need advice to treat mothers.
Treatment options can include individual or group therapy, medication, home visits by a nurse or social worker, or simply a follow-up phone call.
For help, visit the Postpartum Support International website at postpartum.net or call 1–800–944–4773.
