Lorna Rothery spoke to Wendy Davis, Executive Director of Postpartum Support International, about the prevalence of perinatal mental health problems and how inadequate medical education and policies surrounding mental health care can negatively affect new parents
Q. What are the key challenges facing the management and treatment of postpartum depression?
There is a tendency to use the term ‘postpartum depression’ to refer to various mental health disorders that can occur during pregnancy and the first year after delivery. These complications are collectively known as perinatal mental health conditions. It’s important to note that anxiety is just as prevalent as depression during this period.
Managing and treating postpartum depression
One of the biggest challenges in the management and treatment of postpartum depression itself is the lack of understanding among providers, the public, and policymakers about its symptoms, presentations, causes, and treatments. Experts and organizations like Postpartum Support International work hard to raise awareness so people can fully understand perinatal mental health conditions, which include depression, anxiety, obsessive-compulsive symptoms, bipolar disorders, and psychosis. If we only look for depression, we might miss some of the most critical symptoms and presentations that have the highest risk of adverse outcomes if left untreated or mistreated. Therefore, it’s essential to ensure that providers, families, and policymakers understand the common symptoms and presentations related to mental health during pregnancy and postpartum.
People should not be ashamed or embarrassed to discuss their mental health with their providers. Real, significant change will come from the understanding that perinatal mental health disorders are common, treatable, temporary, and a public health crisis.
Q. How does the lack of understanding around postpartum depression and other perinatal mental health disorders impact maternal health and wellbeing?
Medical education, including that for mental health providers, often lacks education on the topic of perinatal mental health. This means that perinatal mental health is rarely taught in academic or medical settings. Therefore, healthcare providers and medical institutions must take the responsibility to seek out and provide specific training and education on perinatal mental health disorders. It’s important to note that research shows that perinatal mental health disorders are among the most common complications of childbirth. Yet, it is still not widely taught in medical education, compared objectively with really common causes of maternal complications and maternal mortality, like hemorrhage and infection.
Maternal mortality
Maternal mental health complications are a leading cause of maternal mortality. Despite this, it is not considered a public health crisis and does not receive the same level of policy support and focus as other public health issues, such as smoking cessation and high blood pressure. This lack of attention is detrimental to our population’s health. We need to ask ourselves why this is the case and take action to address this problem.
According to experts in the field, perinatal mental health is often ignored despite its high prevalence and the fact that these disorders are treatable and temporary. The reason for this neglect is believed to be the shame and stigma surrounding mental health in general, and specifically around perinatal mental health.
There are a few key elements in public health science that indicate that preventive efforts can make a significant difference. In the case of perinatal mental health disorders, many of those elements are present: we know the population where prevention can focus (women of childbearing age, and more specifically during and after pregnancy); we have evidence-based screening tools that can identify those at risk; and reliable treatment to prevent escalation of symptoms. We have screening tools that have been developed and tested over decades, and anyone who has contact with pregnant or postpartum women can use them. These tools were specifically developed for health nurses to use and are available at no cost to anyone. It’s important to note that these tools do not make a diagnosis, but are used to help identify those who may be at risk or experiencing perinatal mood disorders. Universal screening should be a standard of care, just as it is for diabetes, hypertension, or cancer.
The treatments available are evidence-based and proven to be effective, with extensive research to back them up. Providers are able to undergo training and certification to ensure they can deliver quality care. Rather than asking if a mental illness itself is preventable, we should focus on what we can prevent, such as the escalation of symptoms, lack of knowledge for providers and families, and discontinuity of care.
If policies, medical education, and communities work together to implement preventive steps, we can save lives. There are statistics to support this. It’s an important point to consider, so we need to ask ourselves why we haven’t done this already. The answer is shame, stigma, and a burden on mothers. We tend to overlook their health and put them last on the list. Around the world, mental health and substance abuse are among the top three causes of death for women related to pregnancy and childbirth.
When public health authorities talk about maternal mortality, it’s natural to assume that we’re only talking about physical causes such as hemorrhage, infection, or hypertension. However, what we’re missing is that even the Centers for Disease Control and Prevention (CDC) in the United States says that 80% of maternal deaths are preventable through scientific research. On average, 23% of those preventable deaths are caused by mental health and substance abuse issues. When we look at the big picture, we realize that we are separating physical health from mental health when, in reality, it’s a single subject. Unfortunately, almost every government in the world focuses only on ‘hard sciences’ while ignoring mental health. This separation is one of the biggest problems, and in the case of maternal mortality, it’s alarming how high the rates are due to the lack of mental health support. Postpartum Support International (PSI) is working to make a difference as we teach and certify mental health providers and provide peer support to families.
Q. Coming back to the stigma and shame surrounding mental health, can you tell me about the common mental health issues affecting new fathers?
It is important to note that when discussing mental health in the context of pregnancy or postpartum, we must include men as well. Studies have revealed that up to one in 10 fathers suffer from depression postpartum, so it is imperative to recognize that perinatal mental health complications and disorders are complex and multifaceted. They can be caused by physical and biological factors, genetics, social aspects, and psychological factors. Therefore, all of these factors impact every individual who experiences perinatal complications. When you think about it that way, you see that men are very susceptible, and men are also at risk.
Mental health in fathers
It is important to acknowledge that men can also be impacted by the social and psychological pressures associated with pregnancy and childbirth. These pressures may include previous mental health disorders, previous trauma, and social determinants of health such as access to food and shelter. Men are often culturally and biologically conditioned to feel responsible for providing and protecting their families, which can add to the stress of job and food insecurity, as well as the social stigma of experiencing mental health issues. Additionally, new fathers may experience sleep deprivation, lack of time to rest, and increased stress and conflict with their partner during this challenging time. All of the pressures that mothers are facing, men are also facing.
Research has shown that men also experience hormonal changes during and after childbirth, although they don’t have the same physical experience as women. These hormonal shifts can affect testosterone levels and other hormones related to sleep and mood.
In the modern world, there is a social stigma around discussing mental health, and men are generally conditioned not to share their mental health vulnerabilities as much as women. Keeping our emotions bottled up and not seeking help can worsen our mental health symptoms. Men are often taught to withhold their feelings and not show vulnerability, which can lead to their symptoms getting worse. This may manifest externally as a dad withdrawing more, being irritable or angry, although women also experience these symptoms. However, men tend to be conditioned more to become quiet, stay busy, and sometimes isolate themselves socially.
If the workplace and our governmental and medical policies included questions on awareness and support for mental health, as much as physical health or financial health, we would be a healthier planet.
Q. Can you talk me through the support and training PSI offers to both expecting and new families and healthcare professionals?
PSI offers free social support to expecting and new families through virtual platforms, including telephone and online groups, all across the globe. Peer-to-peer support and mentoring are the foundation of PSI’s services.
Perinatal mental health training
The organization also provides training and certification to care providers of all professions, with the aim of creating a safety net for families. In the 21st century, perinatal mental health disorders are detectable, curable, and temporary, and standardized training is offered to all care providers. We train all care providers, from peer mentors to psychiatrists, and teach elements that bring all providers up to speed in screening, detection, assessment, treatment, and social support.
Our training programs are accessible to all care providers. We have developed standardized training based on evidence-based research, practice, and treatment methods. In 2018, we also created a perinatal mental health certification program that is available worldwide. Providers can become perinatal mental health certified professionals by meeting a standardized requisite of education, training, and years of practice. The certification recognizes that they have the necessary education, knowledge, and skills to treat perinatal mental health complications and prevent crises. Having an approved professional certification also provides visibility for the need and the existence of this specialist in both medical and public settings.
PSI training programs aim to increase providers’ knowledge base so they can be more confident in asking questions, screening, referring, and supporting individuals at risk of or experiencing treatable mental health conditions. Our training programs are available virtually and in person, in English and Spanish. They are offered at every level for medical providers like psychiatrists, obstetricians, nurse midwives, therapists, counselors, peer supporters, faith-based clergy, and home visitors.
Educated providers and supported families would create the safety net we all need. Our vision is that every care provider has the information they need within the scope of their practice so families have access to support to be healthy and make it through this vulnerable transitional time. We want all families to know that they are not alone, and there is knowledgeable and compassionate help available. They can find support and knowledge through PSI at www.postpartum.net, @postpartumsupportinternational on social media, or download the app Connect by PSI.
