Mothers need more than medicine; they need psychological and social support, too. And finding better ways to provide that support can help the mental health of even more Americans.
I suspect most people don’t realize how the United States’ failure to properly address pregnancy-related illness and death is a mental health story. It took until 2019 for all U.S. states to include pregnancy status on death certificates, and the Centers for Disease Control and Prevention relies on local committees sifting through records and interviews to figure out when mental illness causes a pregnancy-related death.
We know that about half a million women struggle with postpartum depression annually. Postpartum anxiety, panic, post-traumatic stress and obsessive-compulsive disorder grip even more. And in 36 states between 2017 and 2019, suicide, overdoses and other mental health conditions, including depressive disorder, caused 23 percent of pregnancy-related death — more than any physical cause.
In one sense, a new treatment is just what’s needed to sound the alarm. It’s also a reminder that many anti-depressants are safe to use while breastfeeding — important intel when more than half of pregnant women with known depression aren’t treated for it in the United States. But no single solution is enough. The problem of unaddressed mental illness among new mothers is a systemic one, and none of us are unaffected.
“The worry is people will say, ‘Well, we have a pill to fix it, now we can ignore it,’” Mary Kimmel, the medical director of NC Maternal Mental Health Matters, told me.
We can’t let that happen. The biggest challenge is access to care. The newly approved anti-depressant, Zurzuvae, might be priced for the privileged. There’s a severe shortage of mental health providers in the United States, and about 7 million women don’t live within reach of an obstetric provider or birth center. This is particularly catastrophic for Black mothers, who die at three times the rate of White mothers.
There is fortunate news, however: You don’t have to be a professional caregiver to help bend this curve. And better news: Collective care that helps new mothers also fights the mental health crisis in the United States, where loneliness and isolation are an epidemic and nearly 50,000 people died by suicide last year.
Think of it this way: Maternal health has a powerful butterfly effect. That’s because secure attachment is a cornerstone of mental health. All of us — every single human — is shaped in part by how we attached to our primary caregiver as infants. How consistently and sensitively our physical and emotional needs were met when we were most vulnerable affects how we learn, socialize and manage emotions. In turn, that affects our relationships with partners, children, friends, colleagues and strangers.
Secure attachment is much more likely to form if a new caregiver is rested and healthy. Sleep guards against illness, especially as the overwhelm of a baby collides with the stress of hormonal changes, a traumatic birth, poverty, racism, or a personal or family history of abuse or psychiatric disorders. It’s common for new parents to feel some anxiety, anger or grief. But if this persists beyond two weeks, depression, obsessive compulsive disorder and even psychosis can settle in for months or years — with ripple effects that span generations.
So, helping new moms is in some ways selfish. A mother’s well-being can influence her baby’s. In time, as that infant grows into a colleague or a neighbor, their well-being can influence yours. This isn’t conjecture, by the way. Studies show a mother’s untreated postpartum illness puts her child at higher risk of attention deficit/hyperactivity disorder and her partner more likely to develop depression. Plus, Americans lose money: Untreated pregnancy-related mood and anxiety disorders cost about $14 billion in lost productivity and medical expenses in 2017.
In other words: If we wanted to do just one thing to help improve our culture’s mental health, we would do everything we can to support new mothers.
So let’s do it. Medication, of course, can be a good thing, but experts say a team approach is vital. Friends, neighbors and colleagues need to pitch in. Drive mom to appointments. Clean and cook for her. If insurance doesn’t pay for doulas — which can reduce the trauma of labor that exacerbate mental health challenges — then demand that it does. If helping others doesn’t appeal, help yourself: Learning more about attachment theory can change how you interact with the world.
Oh, and one more thing. New parents aren’t even guaranteed paid leave in the United States, let alone postpartum checkups. Can we finally change that?
I hope so, but Americans are wasting precious time waiting for the government and health-care industry to fix all these problems. Let’s not wait to start addressing this desperate need; if you know a new mom, let the small acts of kindness flow.
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