New mothers shouldn’t suffer in silence

USUALLY THE BIRTH of a child is anticipated with wonder and joy. When something goes wrong, our expectations shatter into jagged pieces that cut deep. How could this happen? That was the question when Duxbury mother Lindsay Clancy allegedly took the life of her children during a postpartum episode. It was the question again when Ariana Sutton, a Norton woman newly delivered of twins, took her own life.

Let me be clear: I never examined or even met either woman. But as a clinician and an advocate working to improve maternal mental health, I am acutely familiar with the question: How could this happen? The Centers for Disease Control and Prevention recognizes that mental health disorders are the leading cause of pregnancy-related death in the United States, including through suicide and substance abuse disorder. Postpartum depression is the number-one occurring complication of childbirth, affecting at least one in five mothers. Postpartum psychosis is less common but is the most serious postpartum mental illness. The tragedies set in motion by these disorders occur far too often. Massachusetts stands out for its willingness to ask another question: What can be done?

Illinois became the first state to make provision for taking maternal mental health into consideration when trying pregnant or newly parenting women for crimes. The Massachusetts Legislature is considering a bill that will be even more beneficial by also proactively connecting women to a network of support and treatment. Passing An Act Relative to the Health and Well-Being of New Mothers and Infants  will help families thrive by creating a digital resource that will connect women to information and to professionals expert in perinatal health.

The important thing to remember about perinatal mental health, encompassing pregnancy and the first year after birth, is that even severe disorders are temporary and treatable. Because society idealizes motherhood, there is little space to talk about it when women have real struggles. Women suffer – quite literally – in silence. Some even die because they do not feel they can ask for help.

The single most effective thing anyone can do to improve maternal mental health is to talk about it, to acknowledge that the feelings and thoughts a woman may encounter during pregnancy and new motherhood are often uncomfortable, sad, and downright ugly. Symptoms of perinatal mental health disorders are real, they are frightening, and they can carry risk. But they will also be transitory, with the help of informed care and treatment.

After my firstborn, people marveled that I lost the baby weight in only three weeks. My impulse was to break out in tears and tell them, “That’s because I’m too anxious and sad to eat!” Instead, I stayed silent and tried to smile. Despite being a therapist who specializes in depression and anxiety, I did not recognize my own postpartum symptoms.

I thought, wrongly, that I failed at motherhood, that I had made a terrible mistake, that life was hopeless. That was the depression talking. Never once in my years of training was the issue of perinatal mental health introduced. Given how common maternal mental health challenges are, every mental health provider must have a basic understanding. And every gynecologist, midwife, or other clinician supporting women’s physical health must know enough to talk about these challenges and refer patients to specialists if the need arises.

My organization, Postpartum Support International, maintains an online directory of clinicians with expertise in perinatal mental health. I wish it were larger. The ranks of professionals who understand why and how to support mothers must grow. The involvement of the public sector in what is clearly a public health crisis is also essential. The CDC has committed funding to study maternal mental health disorders, risk, and mortality, and develop strategies for effective support. Massachusetts could become a model with its digital resource in connecting women to help, where they live.

The Commonwealth would do well to take perinatal mental health into account in criminal cases. This is a matter of justice. It will do better still to prevent tragedies by connecting families to the care that they need and ending the deadly silence around this all-too-common problem.

Massachusetts is justly proud of its world-class medical resources. But the greatest doctors in the world do no good to women who don’t know where to find them – or are too ashamed to even ask for help. No family should ever have to trade their joy for mourning because of an absolutely treatable problem.  The bill dealing with the health and well-being of new mothers and infants should become law and serve as a model for other states. I can say it no better than this: It will save lives.

Wendy N. Davis is executive director of Postpartum Support International.