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World Maternal Mental Health Day: Why are new mothers not getting the help they need?
By Katia Hetter
(CNN) — In many countries, up to 1 in 5 new mothers experience a mood or anxiety disorder. Unfortunately, these conditions often go undiagnosed and untreated due to lack of awareness and stigma, and everyone pays the price.
Today is World Maternal Mental Health Day, and it’s time to recognize the importance of maternal mental health. How can you tell that if you or a loved one may need help? What types of treatments are available? What can those who are pregnant or postpartum do, and how can the community around them help?
To find out more, I spoke with CNN wellness expert Dr. Leana Wen. Wen, a mother of two young kids, is an emergency physician and adjunct associate professor at the George Washington University. She previously served as Baltimore’s health commissioner and as chair of Behavioral Health Systems Baltimore, a regional nonprofit advancing mental health and substance use disorder treatment.
CNN: Why is addressing maternal mental health so important?
Dr. Leana Wen: Mental health is an essential part of overall health. By itself, mental health influences well-being and has a major impact on the physical health of both the woman and her baby.
Pregnant women with untreated mental health conditions have a higher rate of missing prenatal care. They are more likely to have depression, anxiety, psychosis and other mental health illnesses after delivery. Untreated mental health conditions also are associated with premature birth, low birth weight babies, sleeping and feeding troubles for the baby, as well as developmental and cognitive problems.
Sadly, in the United States, mental health disorders are an underlying cause of mortality in many deaths occurring during and after pregnancy. According to the US Centers for Disease Control and Prevention, 22.7% of pregnancy-related deaths were associated with a mental health condition — even more than hemorrhage (13.7%) or infection (9.2%). This is a crisis, and much more needs to be done to address it.
CNN: How common are maternal mental health conditions?
Wen: Ten percent of pregnant women and 13% of women in the postpartum period experience a mental health condition, the most common of which is depression, according to the World Health Organization. In developed countries, including the United States, the numbers go up to more than 15% during pregnancy and 19.8% after childbirth.
These numbers are staggering. Equally upsetting are the numbers that pertain to the lack of treatment. Some studies indicate that less than 15% of individuals with these conditions receive any treatment.
Imagine if were discussing any other serious medical condition. Imagine if less than 15% of people with diabetes received care for it, or if less than 15% of people with heart problems got treatment. We would not find those numbers acceptable, nor should we with treatment of mental health conditions.
CNN: A lot of postpartum women have “baby blues.” How do you distinguish between that and postpartum depression?
Wen: The “baby blues” are symptoms that most women experience after birth. They include experiencing mood swings, feeling overwhelmed, being irritable and having trouble sleeping. Generally, the baby blues occur shortly after delivery and last for days. The person has some symptoms of low mood but overall is feeling well.
The baby blues are quite different from postpartum depression. The symptoms of postpartum depression may initially resemble those of baby blues, but they are more intense and last longer — for at least two weeks and even months. Specific symptoms include continuous depressed mood, crying, overwhelming tiredness, and intense irritability and anger.
The woman may withdraw from family and friends, have less interest in activities she used to enjoy, and even experience difficulty bonding with or caring for the baby. The person may feel hopeless, worthless, and ashamed of not being a good mother. This could progress to the mother having severe anxiety and panic attacks and thoughts of harming themselves, their babies or others around them.
CNN: Are there other postpartum mental health conditions?
Wen: Yes. Postpartum depression is the most common of the mental health conditions, but there are others.
Another condition that can occur by itself or alongside postpartum depression is postpartum anxiety. It’s normal to feel anxious after becoming a new parent, but it becomes a problem when anxious feelings are out of control and take over one’s thoughts. Individuals with this condition have all-consuming worry, including with irrational fears about events that are unlikely to happen.
Other mental health conditions, like obsessive-compulsive disorder, also known as OCD, can manifest in the postpartum period. In addition, substance use is often associated with mental health diagnoses.
One more condition I want to mention is postpartum psychosis. This is the most severe form of postpartum psychiatric conditions. It is rare, occurring in approximately 1 to 2 per 1,000 women in the postpartum period. Women may become erratic and shift between depression and elation, and they can have hallucinations and delusions. This is a psychiatric emergency that requires immediate care to prevent the woman from harming herself, her baby and others.
CNN: What kinds of treatments are available?
Wen: Here is the good news. A variety of effective treatments are available to treat postpartum depression and other mental health disorders.
The two types of treatments are talk therapy and medications. Psychotherapy involves talking through concerns with a mental health professional. There are different types of psychotherapies, such as cognitive behavioral therapy. In general, they help patients to recognize and better cope with their feelings.
Health care providers also may prescribe antidepressant medications. Sometimes, a doctor will add an additional medication depending on symptoms. For instance, people with anxiety may benefit also from an antianxiety medication.
The US Food and Drug Administration has approved two medications that specifically treat postpartum depression. These drugs are used for shorter periods than antidepressants and could be a good option for some women, though insurance coverage and cost could be a barrier.
Just like any other medical condition, some women may respond better to one form of treatment than others. Some may need a combination of treatments. The length of treatment will also depend on individual circumstances.
CNN: What can pregnant and postpartum women do? And how can those around them help to improve their mental health and emotional well-being?
Wen: Good health during and after pregnancy starts well before pregnancy and giving birth. It’s crucial for women — and everyone — to seek assistance for mental health conditions. Those with preexisting mental health conditions such as depression and bipolar disorder have a much higher rate of experiencing mental health issues in the postpartum period. It is important to diagnose and treat these conditions before pregnancy.
That said, it’s also very important to recognize that postpartum depression and other mental health diagnoses in pregnancy and postpartum can occur in people who have not had mental health conditions in the past. They could occur in anyone. Just as it’s not anyone’s “fault” if they are diagnosed with diabetes or cancer, it is not someone’s “fault” if they have a mental health condition. There should be no stigma associated with the diagnosis.
People around the individual can help by being on the lookout for signs of postpartum depression. They can provide support, including encouraging treatment and offering childcare and other assistance that the person may need. Everyone should keep in mind that prompt treatment is effective and crucial to the well-being of the woman and her family.
Editor's note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the 988 Suicide & Crisis Lifeline by dialing 988 to connect with a trained counselor, or visit the 988 Lifeline website.
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