New moms shouldn’t have to suffer in silence

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When my son was about 2 months old, I figured I just had an extended case of the postpartum “baby blues.” It’s a right of passage of sorts for many new moms that comes with mood swings, crying, anxiety and difficulty sleeping — which seems like a particularly cruel joke.

I wish I realized earlier that it was much more. My son will be 3 years old this summer and I can’t help but feel a little sad that my anxiety had me trapped and isolated during those early days.

Hi there! My name is Hannah Fry, and I’m an enterprise reporter at the L.A. Times telling stories across California. I’m filling in for Laura Newberry. This week, I want to explore postpartum mental health and the barriers that prevent some of us from getting help.

Research tells us that about 1 in 8 new moms experience major depressive disorder with peripartum onset, more commonly referred to as postpartum depression. Experts estimate that number might be even higher because so many women don’t recognize the symptoms. Even when they do, some are reluctant to seek help out of fear they’ll be labeled bad mothers or ungrateful for their new bundle of joy.

The situation is made even more challenging by the shortage of doctors who specialize in postpartum mental health.

I’ve struggled with anxiety and sporadic panic attacks for most of my life but tried hard to hide it until I couldn’t anymore.

For months after my son was born in the summer of 2020, I felt like I was living the same day over and over. It was the height of the pandemic — long before vaccines — and my thoughts centered on being vigilant for danger, real or imagined.

I was terrified I would inadvertently expose my newborn to a deadly virus.

I obsessed over my son’s sleep to the point where I couldn’t rest for more than a few hours a night, even as he dozed soundly in the bassinet next to our bed. I worried that if I closed my eyes, I would wake up and he would be dead.

I had horrifying intrusive thoughts that flooded my brain and sent me spiraling in search of any information I could find that might keep him safe.

Every cry and sound of discomfort convinced me there was something severely wrong and I was missing it. I was afraid to leave the house alone with him, even for walks around the neighborhood.

As my return to work drew closer, my mindset wasn’t improving and I decided it was time to reach out for treatment. But it would be a long process that, honestly, wouldn’t end until my son was into his toddler years and I found a therapist who helped me deal with the root cause of my anxiety.

There’s an adage I heard from another mother once: society loves pregnant women, but once their baby is born, she’s forgotten. We’re told to embrace motherhood, fit into those pre-pregnancy jeans, maintain an Instagram-worthy home, and for many moms, also work outside the home. Don’t forget about hobbies!

It’s not a system that leaves room for vulnerability.

Early this year, I was grocery shopping when a tabloid headline caught my eye. It was questioning whether a mother who had tragically killed her children intended to do so or if she was suffering from postpartum psychosis — a rare condition that alters a new mother’s sense of reality, causing hallucinations, delusions and paranoia.

That headline stuck with me for days. Why can we only focus on mothers’ struggles after tragedy occurs? What would happen if a mother’s mental health was a less stigmatized part of postpartum health care?

What causes postpartum depression and what are the major symptoms?

You may have heard of postpartum depression, but it’s not the most accurate name for the feelings of anxiety and overwhelm that can appear during pregnancy or in the postpartum period. Medical experts have come up with a more all-encompassing term: major depressive disorder with peripartum onset.

It’s worth noting that people of many different gender identities have babies, though much of the research on this topic — and much the research we’ll go over today — focuses on cisgender women.

There’s a lot of confusion about the symptoms and warning signs. I always thought postpartum depression was characterized by overwhelming sadness and an inability to bond with my baby.

But Dr. Misty Richards, the founder and medical director of the Maternal Outpatient Mental health Services Clinic at UCLA, explained that the major symptoms of major depressive disorder with peripartum onset are anxiety and agitation or anger.

“How I think about anger or agitation is it’s really anxiety that’s mobilized,” she said. “There’s very little room for error when you’re a new mother and certainly if something goes awry for whatever reason, it’ll elicit intense rage out of proportion to the stressor. That can be a major symptom.”

This can occur because three hormones — estrogen, progesterone and allopregnanolone — spike during the third trimester of pregnancy. “Once you give birth, they just race out of your body like a Magic Mountain roller coaster ride and that physiologic drop is jolting,” she said. This is why most mothers experience postpartum “baby blues” in the first weeks after giving birth.

For some, these changes in mood extend into postpartum depression. They may have difficulty functioning day to day, lose interest in activities they enjoy and feel sadness, guilt, anxiety and fear.

“It’s not the overall amount of hormone that matters. It’s the physiologic change that can leave a woman feeling just vulnerable and uniquely sensitive,” Richards said. “The women that tend to struggle the most are ones that are exquisitely sensitive to hormonal shifts, and you can look back historically to their menstrual cycle to kind of litmus test that.”

Research shows that a history of mood disorders like depression or bipolar disorder, a history of physical or sexual abuse, stressful life events, poverty and complications during pregnancy can up a woman’s risk for depression after she gives birth. Researchers have also found that African American and Hispanic women are more likely to suffer from postpartum depression.

Darby Saxbe, a clinical psychologist and professor of psychology at USC, explained that mental health problems, including those that occur during pregnancy postpartum, are caused by a combination of factors that can include genetics, environment and stress.

“In the postpartum period, women might be distressed because they are not getting enough support, or because their expectations of motherhood might not match their new reality. Sleep deprivation and isolation are common after the birth of a child, and both can contribute to mental health problems,” she explained.

What are the barriers to getting help?

At first, I was reluctant to pursue treatment because I had internalized this idea that I could tough it out. I reasoned that it was normal for the transition to parenthood to be difficult. I also foolishly thought it was selfish to seek care and that I was taking the focus off my baby.

Richards told me this is not unusual.

“A lot of women just suffer in silence and rationalize,” Richards said. “They tell themselves ‘This is OK, it’s gonna get better. This happens to everyone. I’m just having a bad week and next week will be better.’ But you’re not enjoying the things you want to enjoy. You’re not appreciating the world in color.”

Stigma plays a big role in preventing mothers from seeking help, Saxbe said.

“Many women believe that they should be delighted with their new baby and are reluctant to share that they are struggling. They might feel like bad mothers because they are not enjoying every interaction with their infant,” Saxbe said.

In 2019, California legislators passed a law requiring licensed health providers who work with pregnant or postpartum people to screen for mental health conditions. This typically comes in the form of a questionnaire. It’s a step in the right direction, experts say, but it isn’t perfect.

The healthcare providers doing the screening are usually not trained to provide the mental health treatment a new mother might need. There’s also a shortage of licensed mental health providers that specialize in peripartum conditions and few take insurance. This is in part because it’s challenging to get reimbursed from insurance companies, Richards said.

Out-of-pocket costs for a therapist can reach up to $300 an hour. The cost of a reproductive psychiatrist can be even higher, up to $800 per hour.

“Access to care is a crisis right now because people can’t afford to pay what is being offered,” Richards said.

So what can we do?

While these issues require systemic changes, there are some steps you can take to make your experience easier in the short term.

During pregnancy, Saxbe suggests searching for integrated perinatal healthcare practices where psychologists, psychiatrists or social workers are embedded with OB-GYN care. These kinds of offices can offer patients more options should an issue arise.

Building a support system and a network of new moms during pregnancy can also go a long way to preventing isolation after birth.

“At the most basic level, new moms should focus on sleep, social support and self-care,” Saxbe said. “Mothers are often expected to be martyrs, but there is no shame in handing the new baby off to a friend or family member for a few hours in order to catch up on sleep.”

If you find yourself struggling, Richards said the first step is to share what you’re going through with someone else, ideally your OB-GYN. They can make referrals to a specialist, if needed, and can help you navigate the often complex web of resources.

If that’s uncomfortable for you, Richards suggests leaning on a partner or friend who can go to the appointment with you and help explain.

There’s also resources like Hello Alma to help find therapists and groups like Maternal Mental Health Now with information for new parents.

“The No. 1 message is do not suffer in silence,” Richards said.

If what you learned today from these experts spoke to you or you’d like to tell us about your own experiences, please email us and let us know if it is OK to share your thoughts with the larger Group Therapy community. The email [email protected] gets right to our team. As always, find us on Instagram at @latimesforyourmind, where we’ll continue this conversation.

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More perspectives on today’s topic & other resources

Life in the Throes of Postpartum Depression. In this New York Times article, four new mothers share their experiences as they struggle with postpartum depression. Their stories give a glimpse into how symptoms can manifest and how they got help.

Green space could help lower mothers’ risks. This recent study conducted by a UC Irvine research team determined that exposure to green space and tree coverage was associated with a decreased risk of postpartum depression.

Other interesting stuff

Homes for residents with mental illnesses are closing across California. “Advocates have sounded the alarm for almost two decades about how these licensed facilities, which provide 24/7 care and support for Californians with serious mental illnesses, are vital to solving California’s homelessness crisis — but for years, lawmakers did little to curb the closures,” writes Jaclyn Cosgrove for The Times.