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By Cecelia Quinn, Ph.D., LCSW

*Sara was in her late 30’s when she became pregnant and she and her husband were ecstatic. However, her pregnancy included both physical and mental health concerns that increased with each trimester. Her physical discomfort included pain in her hips, difficulty walking and sleepless nights. She became increasingly paranoid and started to think of her baby as “an alien” growing inside of her. After giving birth her paranoia and delusions increased. Sara saw no less than five medical professionals, none of who were able or willing to properly diagnose or refer her for treatment. Sara had developed postpartum psychosis. Luckily, peripartum psychosis is rare, only impacting 0.1%-0.2% (Sit D., Rothschild AJ., & Wisner KL., 2006) of women. What is not rare is Sara’s experience finding appropriate mental health treatment. Many women suffering from perinatal mood disorders don’t seek professional help. Treatment for perinatal mood disorders can significantly decrease stress and reduce symptomology. So why aren’t women in treatment? 

In Sara’s case, she saw her medical doctor, her OB/GYN, her pediatrician, her physical therapist, and a lactation consultant! It was her physical therapist that offered to babysit, recognizing that she was distressed. Unfortunately, that wasn’t the kind of help she needed. Upon recognizing symptoms of a mood disorder, it is important to refer people to a mental health professional. Her physical therapist may have had good intentions but lacked the knowledge about perinatal mood disorders that would have benefited Sara.

Unfortunately, lack of referrals from medical professionals contributes to the low rate of women in treatment. They may have limited training in mental health or they may lack referral sources and, therefore, be fearful to broach the subject. If they are not asking probing questions such as; “How has motherhood been for you?”, “Are you sleeping okay?” or “Have you experienced increased anxiety?”, they may not realize how rough the situation has been at home. In our fast-paced, insurance-driven medical environment, they may also be rushed to see patients. 

In Sara’s case, her husband was supportive. He just didn’t know what she needed. He stayed home, spent time with the baby, and tried to help by cooking and cleaning. This is common with well-intentioned people. They may give advice that is great for people who do not actually have any mental health concerns, such as “just take a walk and get out of the house”, “go get a massage” or “have you tried exercising?” Although those things may be helpful for somebody who is well, they don’t address serious mental health concerns. 

Finally, Sara admitted all of the mental anguish she had been experiencing and called a therapist with specific experience in women’s mental health. Sara admitted to her therapist that she was embarrassed about the thoughts she was having. Women experiencing postpartum anxiety, often have intrusive thoughts or worries about things that could happen to their babies. Since intrusive thoughts are rarely discussed, they represent another reason that women may not seek treatment. New moms may feel ashamed, embarrassed or inadequate as a mom, preventing them from sharing their suffering with anyone. 

Since Sara’ssymptoms were already so severe she was referred to a psychiatrist, who put her on medication right away. However, not all women need medication and many find that with talk therapy or groups they feel better. New mothers and their partners or family members may mistakenly think that mental health treatment always includes medication and, therefore, avoid it. Unfortunately, other people’s opinions about mental health treatment impact the mother’s decision as well. 

In Sara’s case, she developed symptoms during pregnancy, which is the case for about 50% of women (American Psychiatric Association, 2013). Due to the belief that “everyone suffers in pregnancy”, many women think their symptoms will diminish after giving birth. The truth is you don’t have to suffer during pregnancy! Not every woman experiences a diagnosable mental health disorder during pregnancy but those that do should absolutely seek treatment. Many women may experience some physical discomfort or difficulty sleeping. However, if a pregnant woman has been frequently tearful, worried about the future, despondent, or has any other serious symptoms, mental health treatment during pregnancy should be considered. 

Other barriers to treatment may include a lack of services available, lack of culturally competent providers, and a lack of insurance or financial barriers. People living in rural areas with few mental health providers may want to consider teletherapy or an online support group. It is important that new mothers feel supported in a non-judgmental environment when they are in therapy. One needs to feel as if all of their intersecting identities are accepted, which may include culture, marital status, sexuality, sexual identity, religion, spoken language and other factors. Some mothers may prefer to be in couples’ therapy, as their relationship has been impacted. Other mothers may want a group of support and some mothers may prefer individual care. Regardless of what anyone’s preference may be, treatment exists! 

So, how can we help more women to enter treatment? End the stigma surrounding mental health. Seeking treatment represents strength, not weakness. Help women make the first step by assisting them in finding resources, encouraging them to contact professionals, and supporting them in their decisions to seek professional help. Share the facts. 10-20% of women report a perinatal mood disorder. Ask new mothers how they are feeling and listen to the words in between the lines. A new mother may not say, “I am depressed”, she may say, “I suck at this!” or something else that indicates she doubts herself or is suffering. 

Despite having a more serious illness, Sara’s story ends well. She decided to have another baby when her daughter was four. By that time she was off medication, out of therapy, and enjoying her preschooler. With the knowledge that she was at higher risk for developing a perinatal mood disorder, she entered treatment preemptively. With the guidance of her therapist and occasional check-ins with the psychiatrist, she experienced a much smoother pregnancy. She gave birth to a healthy baby and was able to nurse this time around! 

*Names have been changed to protect individual identities. 



About Cecelia Quinn, PhD, LCSW

Cecelia Quinn of Jamie Kreiter & Associates Therapy is a bilingual licensed clinical social worker with a focus on women’s mental health. She holds a PhD from Loyola University Chicago, where she is also an adjunct professor. Her research at Loyola focused on gender-based violence and the impact of immigration trauma. She also received a Masters of the Arts in Women’s Studies and a Masters in Social Work from LUC. She completed her second year internship in Mexico and served as a Peace Corps volunteer in Turkmenistan from 2002-2004. She received a B.A. in Spanish from the University of Illinois at Chicago. She has advanced training in trauma including the Global Mental Health Trauma and Recovery Certificate from the Harvard Program in Refugee Trauma (HPRT), the sixty-hour training in sexualviolence and forty hour training in domestic violence.Herinterests include gender-based violence, gender and LGBTQIA issues and mental health, international social work and immigration issues, and trauma. 

Thank you for sharing your expertise about how important it is to find support for perinatal mood disorders—the Birthways Team

References

Sit D, Rothschild AJ, Wisner KL. A review of postpartum psychosis. J Women’s Health (Larchmt). 2006; 15:352-368.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5thed.). Washington, DC: Author.