We’ve witnessed a robust conversation surrounding perinatal mental health following this tragedy, as Lindsay Clancy’s youngest child was eight-months-old. Social media posts and local media coverage reference perinatal mental health as a possible cause of these events. While we do not wish to speculate, nor are we familiar with the Clancy family’s situation, Moms Mental Health Initiative supports responsible discussions on perinatal mental health conditions. Furthermore, perinatal mental health is grossly under-supported and deserves more attention, education and resources.
What is Perinatal Mental Health?
Perinatal mental health conditions impact 1 in 5 mothers. “Perinatal” references the period of time from pregnancy through approximately 18 months postpartum, and is a high-risk time for mental health. While postpartum/perinatal depression is most commonly known, other conditions include perinatal anxiety, perinatal obsessive compulsive disorder, post traumatic stress disorder and, in the most severe cases, postpartum psychosis.
Postpartum psychosis is an extremely rare manifestation of a perinatal mental health condition that separates a mother from reality and may include delusions and hallucinations (visual and auditory). This psychotic state makes her judgment irrational, believing these thoughts to be true (she doesn’t think anything is “wrong”). 70-100% of mothers experience intrusive thoughts- scary thoughts that may include harming themselves or their child. In these cases, a mother is not psychotic but rational in her judgment – she will feel embarrassed or terrified of these thoughts. Postpartum psychosis does not always lead to harm but is a psychiatric emergency in which the person deserves and needs immediate specialized treatment.
Perinatal mental health conditions may worsen if not treated and are the leading cause of death among perinatal women.
A Message to Moms: You Are Not Alone
To any mothers witnessing this discussion, suffering in silence, please know you are not alone. There is hope and there is help. In Southeast Wisconsin, Moms Mental Health Initiative connects moms to qualified providers with knowledge and experience with perinatal mental health conditions. Outside of the area, Postpartum Support International provides excellent resources.
I hate you. I hate you for SO many reasons. I hate you for creeping up on me at a time in my life that was supposed to be filled with joy. I hate the what-ifs and the images you played, re-played and then played again in my mind. I hate how you tried to convince me that I was capable of horrific, gut-wrenching things. I hate that you made me feel that it was best to avoid my children. I hate the way you berated me with intrusive thoughts each one more graphic and terrifying than the last. I hate that you made me want to avoid certain activities and places therefore depriving my kids of experiences they deserved to have. I hate that, because of you, I missed out on so much with my babies. But most of all, I hate that you told me that the only way they would be safe was without me.
I hate that no one even told me you existed. This fact made it so easy for you to convince me that there was something wrong with me…that I was some sort of monster that didn’t even deserve to be a mother. I hate the way you made me view myself. How you stripped me of what little self-compassion I had and made me feel worthless and unlovable.
I hate that you made me feel trapped…that you made me feel like a prisoner in my own mind. I hate that some days you made me wonder if I would ever be well. If there was any end to the agony I was in…if there was any other way out…
But that was before. Through treatment, medication and time, I’ve learned to see you less as an enemy and think of your more as a friend. Because, the reality is that, you’ve made it your mission to protect me, and those I love most. Despite the fact that your warning signals may misfire, I have learned to appreciate the motivation behind them. For your own good (and mine), I’ve learned to challenge you and your screams. I have practiced letting your alarm blare incessantly in my head, in an effort to show you that there’s no real need to be afraid. And in some odd way, I need to thank you. I need to thank you for showing me that I had strength I didn’t know I possessed. For allowing me to find courage to speak out and advocate for other moms who might have a friend like you. But please know that you can rest now. I’ve got this.
With recent news of the FDA’s approval of Zulessro (brexanolone), a new drug to treat postpartum depression (PPD), there has been a plethora of responses both positive and negative. Zulresso currently comes in the form of an injection through intravenous use and requires 60 hours of inpatient stay at a certified medical center. Although not an ideal form of treatment, it has promising results. As a two time survivor of postpartum depression and anxiety and a maternal mental health advocate in the greater Milwaukee area, I think this is a big win in the world of maternal mental health and here’s why: Zulresso is the FIRST MEDICATION SPECIFICALLY DEVELOPED AND DESIGNED FOR POSTPARTUM DEPRESSION. In all of the years that Moms have been suffering, there has never been any researched treatment that addresses the complexity of this form of depression. So many of us have been fighting an uphill battle to give PPD and its treatment options legitimacy because frankly, much of our culture, community and medical community, do not think it is a legitimate disease.
We know that PPD and other Perinatal Mood and Anxiety Disorders (PMADs) are the number one complication of childbirth (as common as 1 in 7). We also know that suicide accounts for approximately 20 percent of postpartum deaths and is the second most common cause of mortality in postpartum women (Archives of Women’s Mental Health). Unfortunately, many people consciously and unconsciously believe PPD is a defect of character or is simply brought on by mental weakness. Some think it’s purely an emotional response to the stresses of motherhood, particularly in America where our culture fails to truly support mothers or families. I was told by a maternal educator that I should have “gotten a massage” to get over my PPD. Others deal with OB doctors who think PPD symptoms are normal for sleep deprived new mamas (PPD is not normal. It is common, but not normal). Of course, sleep deprivation plays a role in PPD and usually worsens the symptoms, but moderate to severe PPD often isn’t solved by just getting more sleep. One psychiatrist told me she doesn’t really believe in medication as treatment for PPD and that it’s caused by what we eat – the misconceptions around this condition only intensify and exacerbate the problem.
PPD is a real disease that can be complicated or bettered by our emotional state, our environment, our prior traumas, the way we experienced our child’s birth, our life stressors and our community of support. But at its core, it is a disease. A disease that is not a mother’s fault. PPD looks different on each Mom and symptoms range from mild to severe. Stigma around mental illness, particularly in relation to motherhood, prevents Moms from getting the help they need. Hopefully now, Moms with PPD will have more credibility as they advocate for themselves to their employer, to their family and to their medical providers.
When it comes to helping a Mom recover from a PMAD, it will take more than a drug to fully heal her (sometimes she may not need medication) and I believe most perinatal professional providers know this. A Mom is going to need as many options and tools as she can get to feel better and navigate the physical, mental and emotional toll of this disease.
Better prevention strategies and a cultural shift in attitudes and practices around parenthood are needed to combat PPD but we also need more tools to heal. To think that this medication is pathologizing a life threatening disease isn’t accurate because a Mom could have the ideal situation for bringing home a baby and still get PPD – it is not always preventable. My friend said to me once, “What a Mom needs is medication when she needs it.” I couldn’t agree more.
Moms with PPD need us to call PPD what it is, a disease, like diabetes, like cancer, like many other illnesses that are not equated with shame and stigma. A disease that has a promising chance of being treated quickly with this new medication. A disease that needs more research in prevention and treatment.
This drug isn’t right for everyone, not everyone will have easy access to it, not everyone will need it but for those of us who talk everyday with Moms fighting for their health and well-being, this new drug provides more hope and hope is what keeps our fellow mamas alive.
You are not alone. We hear this phrase in the maternal mental health community so often. But to a mom who who has experienced a miscarriage, it probably doesn’t feel that way. We are missing the mark by not talking about miscarriage and the anxiety, depression or even PTSD that can accompany one. While this post will focus on miscarriage, it’s important to acknowledge moms who have experienced stillbirth or infant loss as well. In my opinion, they each deserve a later post of their own.
According to the March of Dimes, “Miscarriage (also called early pregnancy loss) is when a baby dies in the womb (uterus) before 20 weeks of pregnancy. For women who know they’re pregnant, about 10 to 15 in 100 pregnancies (10 to 15 percent) end in miscarriage. Most miscarriages happen in the first trimester before the 12th week of pregnancy. Miscarriage in the second trimester (between 13 and 19 weeks) happens in 1 to 5 in 100 (1 to 5 percent) pregnancies.”*
These stats give a sterile view of an incredibly real and devastating experience. Because miscarriages often occur early in pregnancy, it’s possible that very few people were aware that a mom was expecting and this can, understandably, lead her to feel misunderstood, isolated and hopeless. Furthermore, watching life continue effortlessly for those around her can make those feelings even more intense.
Knowing that these moms are at a higher risk for developing anxiety and/or depression, both after a miscarriage and after subsequent births, we need to be doing more. We need better screening; both immediately after a miscarriage and at regular intervals thereafter. We need to give moms space to feel safe sharing what they need to feel supported. We need to recognize that grief is a process and that it might include a wide rage of shifting and unexpected emotions. We need to let moms know that there is no “right way” to deal with pregnancy loss and she is the only one who can determine what that process looks like for her. We also need to let moms know that while the emergence of grief, anxiety, depression or PTSD after such a harrowing experience is valid and completely understandable, it is also treatable. Depending on the severity of symptoms, support groups (in-person or through social media), therapy or even medication are valid options to help a mom who is struggling.
I almost feel like I don’t have a right to talk about this issue because I have never experienced a miscarriage myself. However, in this mom-tribe, we have to support one another. We need to be reminded to be sensitive and compassionate towards those around us because we might not know the internal battles they might be facing. Maybe I’m able to speak up when someone who is more closely affected cannot. Or, maybe my “you are not alone” is speaking to someone in a different way…a way that she’s been longing to hear. Your pregnancy matters. Your baby matters. Your experience matters. You are allowed to grieve, to be vulnerable, to be cared for by both yourself and others. You deserve to seek and receive help should you need it. You don’t ever have to go through this alone.
Let’s talk meds. You’re not alone if the idea of having this conversation makes you uncomfortable. Because for some reason, we are still vehemently fighting the stigma around the need to take psychiatric medications especially while pregnant and/or nursing. It’s a controversial topic and one that many moms feel passionately about no matter which side they fall on.
I have ZERO shame in sharing that medication is a crucial part of my overall treatment plan and an integral component of what keeps me in recovery. Medication, as well as therapy, exercise and good self-care are what keep me feeling like me. My dad is diabetic and no one would ever expect him to stop taking his insulin nor would they expect my mom to stop taking her high-blood pressure medication so why is my need for a prescription any different? I don’t know if I will always need medication but if it proves to be essential to helping me live my best life…then I’m more than okay with that.
When it comes to maternal mental illness, not every mom shares my views on taking medication (and that is OKAY!!!). However, for those of you on the fence, I thought it might be helpful to talk through some of the common objections to adding medication to your treatment arsenal.
I can’t take medication while pregnant.
We all wish for healthy, full-term pregnancies without the need for prescription drugs. But the reality is that it often comes down to assessing the potential risks the psychiatric medication may pose for baby versus the potential risks if mom is left untreated. In some cases, the risk to the unborn child may actually be higher if a mother is taken of off, or declines to start, medication. Consider a mom who is suffering from severe depression. Without her medication, she may be unable to function in her daily life which means she’s unable to care for any existing children, eat sensibly, get an adequate amount of sleep and ensure she receives proper prenatal care. She may also be at a higher risk of engaging in dangerous behaviors including smoking and/or substance abuse.
Data is still limited but there are several psychiatric medications that are now considered to be safe during pregnancy. An informed and trustworthy provider will be able to discuss these options as well as help to perform your individual risk assessment.
I can’t take medication while nursing.
Similar to a mom’s concern of her prescription drug(s) being passed to her fetus, many moms also worry about potential side effects to baby should their medication be transmitted through breast milk. If together, mom and provider decide that it is best for mom to continue to include medication as a part of her treatment plan, there are several options that doctors now feel comfortable prescribing to breastfeeding moms. Having the discussion with your doctor will likely help ease some of these fears.
Another helpful tool is LactMed which can be accessed online (https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm ) or by using the Lactmed app. LactMed is the U.S. National Library of Medicine’s database containing information on drugs (or other chemicals) to which breastfeeding mothers may be exposed, levels of these substances in breast milk and infant blood as well as the possible adverse effects to the nursing infant. Having some background knowledge can help ensure that you are asking your provider all of the questions that are pertinent to your situation.
I want to try natural or alternative remedies.
GOOD! Therapy, exercise, fresh air, good nutrition, yoga, mediation, acupuncture, light therapy are just a few of the alternative treatments to take into consideration. There are many options that are available to try prior to seeking medication and there are just as many options available to enhance the benefits of medication should these alternative therapies prove to be ineffective on their own. Personally, I needed to complete Exposure and Response Prevention (ERP) therapy, maintain good exercise habits and work extensively on my self-compassion and mindfulness practice in addition to taking my medication daily. Unfortunately, mental illness does not come with an “easy” button but leading a happy and fulfilling life is absolutely possible!
I should be able to do this on my own.
Ever heard the saying, “it takes a village?” I think this phrase was coined specifically with motherhood in mind. Even more so when motherhood is overshadowed by a perinatal mood or anxiety disorder. WHY should you be able to do this on your own? What is the reward for never asking for or accepting help? WHAT should you be able to do on your own? Change your brain chemistry? When posed this way, the concept seems almost ridiculous! You aren’t alone in any of this. Help is available and you deserve to receive it, whatever that looks like for you.
I don’t want to suffer through the trial and error of finding the right medication and/or dose.
I get this one! Embarking on the journey to find the right medication(s) and the right dose(s) was extremely overwhelming for me. If I’m being honest, the first medication you try might not be the best one for you. Or, the medication that worked for you pre-baby may not be as effective post-baby (speaking from personal experience). To add to the misery, many psychiatric medications do not reach their full, therapeutic benefit until 6 to 8 weeks from the time the medication was started and that wait can be agonizing (again, personal experience). I got to a point in my own personal journey where this obstacle became irrelevant because I was merely trying to survive. I was so desperate to go back to the person I knew I was and to be able to enjoy one of the greatest times in my life, that I probably would have stood on my head and recited the alphabet backwards if I knew that was the fix. So when my provider (who I trust completely) said she thought a medication would be helpful, I was fully on board no matter what the adjustment period looked like. Maybe you’re not there yet, and that is okay.
I don’t want to feel like a zombie.
I had the same concern. I had no idea what Alexis on an antidepressant would look like. Would I be able to function? To laugh? To feel? In my experience, my medication has actually allowed me to feel and achieve to a greater degree. During the throes of postpartum-OCD, I was not functioning, nor was I laughing, loving or enjoying any aspect of my life or my family. I was completely engulfed by my disease. Medication helped to lift the darkness, clear my mind and allowed me to thrive. It helped enable me to be able to do the hard work in therapy and make the necessary efforts to care for myself. Something that I don’t think would have been possible otherwise.
Taking medication means acknowledging I have a shameful disorder.
It pains me that some of us are still afraid to admit that we may struggle with mental illness. Going back to the previous examples I gave about my parents, why are those diseases accepted and yet my mental illness may not be? I have never been ashamed of my illness and I’ll tell anyone about it who will listen. Because mine just might be the story that someone else needs to hear in order to have the courage to ask for help. We are working hard to make strides to end the stigma around mental illness, especially during the perinatal period. We still have far to go. You are not your illness nor did you choose to have your illness; but you can choose how you’re going to tackle it and what you might be able to do with it.
The goal of this post is not to preach that medication is the right choice for everyone, because it isn’t. However, it is the right choice for some. Sometimes, it’s as simple as having a conversation with your doctor and other times it means truly reflecting and taking ALL risks into account. If anything, I hope this post has made you reflect on your own perspective (whatever that may be) and has helped you be better able to a approach the topic from a place of non-judgement, self-directed or otherwise. Imagine how we could shift the paradigm if we started to empower ourselves, as well as those around us, to do whatever is needed to live our healthiest and happiest lives? That sounds pretty good to me!