30 Jan Maternal Mental Health: What Every Care Provider Should Know
A couple of questions to consider:
First, what percentage of the population would you guess are mothers?
Second, what proportion of the population is deeply impacted by a relationship with a mother figure?
I don’t think it’s an exaggeration to state that pretty much every single patient or client who walks through our doors belongs to one or both of those groups. That being the case, mothers’ mental health should be important to all of us, right? Are you aware that 11 -25% of mothers will develop a mental health condition, most commonly major depression and/or an anxiety disorder, in the year following the birth of each child?
It is not surprising that so many mothers in our society struggle with the transition to parenthood. New mothers face a degree of change that rivals any other in our lifetimes. When a woman becomes a mother, every moment of her day (and night!) is altered. Whether breastfeeding or not, a mother’s adjustment to parenthood includes significant physical as well as psychological changes. Hormonal shifts, altered body size and shape, sleep deprivation and the adjustment to breastfeeding (or weaning) takes a toll on mothers’ sense of themselves and their degree of control over their life. In modern life, many mothers do not have significant family or community support through this transition.
This degree of change in a woman’s daily life after becoming a mother is without a doubt more stressful than any other life transition we face. And yet, new mothers are expected to be ecstatic at their new life and to treasure every moment lest it disappear too quickly. Our culture tells mothers that becoming a parent should be joyful and that they should feel grateful and loving. Is it any wonder new mothers’ sanity is tested during this time?
When mothers suffer from a mental health condition, the consequences for the entire family are significant
Maternal depression is shown to cause developmental delays and attachment injuries in children and can impact the child’s physical and mental health for an entire lifetime. Mental health difficulties in mothers can also lead to marital strife or even divorce, further harming children and the whole family. And most importantly, maternal depression all too frequently results in suicide. In fact, suicide is the most common cause of death, after childbirth itself, during the first year of motherhood.
Clearly, proper diagnosis and effective treatment of mothers is of paramount importance, and postpartum mental health conditions can be effectively treated. Most mothers recover relatively quickly when they receive an accurate diagnosis and proper treatment. As a therapist who specializes in maternal mental health, I have a steady flow of clients who “graduate” treatment and much fewer who discover more complex, long-term issues they want to explore and stay in treatment longer than a year.
Most care providers don’t receive any training in how to assess and treat new moms
Despite the importance of maternal mental health, most therapists know very little about this area and it is grossly underrepresented in the professional literature. It is also lacking in the topics we cover at our professional conferences and, most importantly, during the training we receive as therapists, doctors and nurses. This fact strikes me every time I look over a psychotherapy conference brochure or continuing education booklet.
To the best of my knowledge, not a single clinical psychology graduate program in the U.S. provides specialized training to psychotherapists wanting to work with this population. My own graduate program at JFK University, while very valuable, didn’t provide even a weekend workshop on issues relating specifically to motherhood or perinatal mental health complications. My understanding is that Obstetricians and Nurses don’t receive training specific to mental health assessment either.
Every pregnant woman is screened for gestational diabetes, which affects only about 9% of pregnancies. However, the most common complication of childbirth is a mental health condition. It is also the one most likely, after the birth itself, to result in the death of the mother. And yet, this condition is still not routinely screened in many obstetrical practices, nor by most pediatricians who encounter mothers many times during the first postpartum year. The American College of Obstetricians and Gynecologists only formally adopted a recommendation to screen pregnant and new mothers for Postpartum Depression in May of 2015. And while the American Academy of Pediatrics has generally recommended postpartum depression screening at well-child visits since 2010, most pediatricians still do not routinely screen mothers.
Does training specific to perinatal or maternal mental health really matter?
The short answer is yes. Pregnant and postpartum mothers have specific concerns regarding the use of antidepressants and anxiety medications which require their mental health and medical providers to be knowledgeable enough to support them in these decisions. In addition, mothers may present quite differently than providers would expect. They often appear fine, because they are hiding their shameful thoughts and feelings and do not present as “depressed.”
Perinatal depression is more likely to involve high anxiety or panic, often with scary thoughts, as well as irritability, anger and insomnia, rather than sadness and lethargy. It is also more likely to present with unusual physical symptoms. Even clients who have experienced depression in the past tell me that their postpartum depression is quite different, and they did not identify their feelings as a mental health condition. Instead, many mothers believe that they are failing at parenting or that they were not “cut out” to be a mother. A phrase that resonates for many of my clients is “I didn’t think I was depressed, I just thought motherhood sucks and I’m terrible at it.”
Furthermore, the presence of a baby and the demands of motherhood make living with and recovering from depression and anxiety disorders a far more complicated process. Mothers who are depressed experience great shame at not feeling joy during this time. They are often reluctant to talk about their feelings with anyone who isn’t knowledgeable about these conditions and able to normalize their thoughts and feelings.
Care providers who are not adequately trained can add to the trauma mothers already experience
Care providers who are untrained in the assessment of perinatal mood and anxiety disorders are unprepared for the symptoms experienced by many mothers. Upsetting thoughts and feelings are actually commonplace with postpartum depression and anxiety. This lack of knowledge among their care providers can add layers of trauma and self-blame to these already-struggling new mothers. Providers who aren’t familiar with common symptoms often add to anxiety by over-pathologizing negative or violent thoughts about the baby. Intrusive thoughts about harming the baby are very common during this time and require careful assessment by a trained provider to determine whether they are related to anxiety or obsessive symptoms, or may be indicative of postpartum psychosis, which requires immediate hospitalization.
In my own personal experience, the lack of general training among mental health and medical providers delayed my recovery by several months when I developed postpartum anxiety after the birth of my second child. My therapist, a specialist in anxiety disorders, did not recognize the signs when I developed postpartum panic attacks, which presented somatically. I diagnosed myself with a postpartum mental health condition after being admitted to a psychiatric inpatient unit. Neither my doctor nor my therapist had considered the possibility.
What can we do to help?
As care providers serving new mothers, it is important for us all to be aware of issues relating to maternal mental health, to become informed about these conditions, and to advocate for increased education through our training programs and professional conferences. We all need to be able to recognize the signs and understand the importance of appropriate diagnosis and treatment. Every client who walks through our doors and the generations that follow them will benefit from understanding and care for the mothers in our communities.
Meri Levy is a Licensed Marriage and Family Therapist and Administrative Director of BAPTI. Meri has worked with mothers adjusting to parenthood for the past seventeen years. After an early career in public policy and the birth of her first two children (and her own experience with postpartum anxiety), she founded a resource center and became a lactation educator and support group leader before pursuing licensure as a Marriage and Family Therapist, going through BAPTI’s intern training program. Her practice specializes in treating perinatal mood and anxiety disorders, as well as working with mothers at various stages of parenting. She is also a volunteer peer consultation group facilitator with Postpartum Support International. Her website is http://merilevy.com. Meri is offering a training on February 26 for care providers on the basics of Maternal Mental Health. To find out more or to register, visit https://www.ticketbase.com/events/maternal