Rise in perinatal and postpartum depression needs to be tackled
Arryian Gorey had never felt so alone.
She got pregnant in March 2021, with the pandemic in full swing and coronavirus vaccines still hard to get. Gorey was also single, living by herself in an apartment in Buffalo, and making ends meet with a stressful day job and side gig as a yoga instructor.
“It was a lot to deal with,” she said. “I didn’t have an active partner, there was all this pushback at work — I mean, just being alone every day of your pregnancy is extremely depressing.”
Depression during and after pregnancy afflicts many people, and the pandemic has only worsened this mental health issue, health-care practitioners say. These kinds of depression can include deep sadness, heightened anxiety and incessant exhaustion that makes it hard for sufferers to care for themselves and their family.
“Even before covid happened, we knew there was an increase in the number of women who had postpartum depression, so the pandemic added on top of that,” said Clayton J. Shuman, an assistant professor at the University of Michigan School of Nursing.
Shuman is a lead author of a pair of studies from the University of Michigan School of Nursing and Michigan Medicine, which found that a third of people who had babies in early-to-mid-2020 experienced postpartum depression. That is triple pre-pandemic levels.
A fifth of the 670 survey respondents in one of the studies said they thought about harming themselves. The results, published in BMC Research Notes, showed that formula feeding, neonatal intensive care unit admission and worry about coronavirus infection drove up the risks of depression.
“We weren’t surprised there were more, but we were surprised there were so many more people suffering,” Shuman said.
For Shuman, the pandemic highlighted existing flaws in the nation’s response to maternal psychological health. “The major problem,” he said, “is that, systemically, I don’t think we screen very well” in perinatal and postpartum mental care. “And we also don’t really provide tailored resources for the needs we do identify,” he said. “It’s a one-size-fits-all approach.”
Addressing those flaws, he said, would require public health departments to work more closely with perinatal patients and create more robust and effective screening tools and treatments. It would also require more investment in education, such as free-to-affordable classes for new and expecting mothers and their families.
The pandemic — with its quarantines, visitation limits and political rifts — has made having a baby more isolating than usual for many people.
By eliminating many social supports for people with perinatal and postpartum depression and anxiety, experts say, the pandemic underscored just how vital they are for treating the mood disorders. They are even more needed for patients of color, who are several times more likely to suffer from perinatal mental illness but less likely to secure treatment than other people.
With mental health issues driving maternal mortality in some states — including California, where Stanford University researchers in 2019 identified it as the leading cause of deaths among new moms — experts say the stakes are too high to let it persist.
People suffering from perinatal and postpartum depression need support, and coping strategies that go beyond medications, experts say. Research — including a new study out of Northwestern University — shows that medications are not always effective in treating postpartum depression.
For Gorey, her pregnancy, marked by fatigue and fluctuating hormones, brought latent trauma back to the surface. “I was constantly fighting bouts of depression trying to seep in,” she says, “and realizing that every little mental problem you hold onto is going to be there throughout your pregnancy. I didn’t have all the joy that a lot of first-time moms normally have.”
From spring to fall, she endured anxiety, isolation and a fear of abandonment. Then came what felt like a blessing: Shyana Broughton, who founded Our Mommie Village a few years earlier to provide doula and lactation support for Black mothers such as Gorey.
“One of the biggest things I needed was for Shyana to help me process everything,” Gorey says, “not just saying, ‘Oh, you’re doing fine, you’re doing okay,’ but to really talk through things, to confront all those emotions, all those feelings that you know are going to become huge triggers postpartum.”
With Broughton’s support, Gorey, 33, says she learned to cry when she felt like crying, and to rest when she felt like resting.
With perinatal and postpartum depression, “a lot of it comes from not having a community,” Broughton says. “When she felt like flipping, she knew where to go. When she was crying, when she was sad, when she was saying, ‘I don’t know what else to do,’ I would say, ‘Come over for tea or coffee’ or ‘Come dance and have some mango because that’s what I happen to be cutting up at the moment.’ ”
Lack of community, supports
The problem is that the perinatal supports that most people could benefit from are unavailable to many people, pandemic or not, says Amber Parden, who oversees perinatal psychiatric services for Woman’s Hospital in Baton Rouge. “Or, if they do exist, they are very limited,” she added. “So, when you subtract from that in a pandemic, you wind up with sicker people. It strains the system.”
That is the case in the Bayou State, where a weak safety net and rampant poverty makes it especially challenging for many people to access health care.
“We simply do not have enough treatment providers,” Parden said. “There are simply not enough therapists. When the pandemic hit, we were trying to find enough help for these people, but the impact was so intense: Everyone was swamped.”
Parden found herself helping others navigate many of the same problems she was dealing with. “I myself had a covid baby,” she said, “a covid pregnancy — with complications.”
Parden had family to turn to, having moved back to Louisiana after a years-long sojourn in Upstate New York so her children could be around their cousins, grandparents, aunts and uncles.
“We’re not meant to be independent, to deal with these things alone,” she said. And being within driving distance of so many loved ones, she said, helped her pull through an otherwise alienating pandemic.
She knew the isolation many of her patients experienced: the anxiety of not having her husband by her side during even routine appointments, not being able to hold his hand, having to fill him in after the fact.
“Pregnancy very much shifted to a lonely experience,” Parden said. “And that took a huge toll on moms, who are going to find some way to feel guilt no matter what’s happening in the world. Mom guilt is a very real thing.”
When the pandemic forced millions more people to become simultaneously stay-at-home parents and stay-at-home employees, Parden said she saw an influx of clients struggling to remain emotionally and mentally present for their families. Parden kicked up collaboration with other perinatal care providers to make sure new moms had “more than just a psychiatrist prescribing meds.” She said she began doing a lot more parent training with new moms because of a heightened demand from families trying to manage behavioral issues in children spending much more time at home.
It didn’t help, she added, that many of the support groups and lactation services that would cut through that isolation were suspended or went virtual during the pandemic.
Stressful, lonely delivery
Anslye Chatham, a 24-year-old public school teacher in rural Mississippi, had covid-19 just before giving birth to her first child, as did her husband. When the couple arrived at the closest hospital, 90 minutes from home, for a scheduled Caesarean section, both were done with quarantine and neither was symptomatic.
“But when I arrived in the delivery unit, I was met with a lot of animosity from the nurses,” she said. “I was told my husband couldn’t be there.”
She had an extremely stressful, lonely delivery, she said. There was no immediate skin-to-skin contact, no swaddling the baby to bond with dad, no nursery time, she said. Had it not been for a nurse who took it upon herself to take a few pictures, Chatham says she would have no way to visually memorialize the first moments of her daughter’s life. Two hours passed before she got to hold her.
“In the moment, I didn’t realize how much that affected me,” she says, “but it has affected me a lot.”
As someone diagnosed with anxiety years earlier, Chatham says she anticipated the mood disorder to be a challenge before and after pregnancy. But after a few weeks of new-mom bliss, she says the hospital experience began to tilt her into a spiral of postpartum distress, of sharp guilt about her and her daughter having been deprived of something from the get-go.
“Mostly, I feel guilty that I didn’t get that time with her — or that I didn’t fight for that time with her,” she says.
Amplifying those worries were stressors with her job at a small-town public high school in the Deep South, and living in a state that offers no paid maternity leave.
While her psychiatrist had her on half her usual dose of Zoloft during the pregnancy, Chatham said it was breastfeeding that became one of the most effective ways to deal with her clinical anxiety.
Guiding her through the process was Nell Blakely, a 66-year-old leader of the grass-roots lactation support network La Leche League. Although the pandemic forced La Leche League to take its support groups online, Blakely’s proximity became a source of comfort.
“She lives down the road from me,” Chatham said, “and she would give me such great advice about things like latching issues.”
Breastfeeding has not only tempered her worry but also some of the lingering trauma from a stressful delivery.
“It’s also lessened some of the guilt,” she said, “and that’s really helped me heal.”