We need to talk about preventing postpartum depression
Rather than waiting until people are suffering and handing them a questionnaire.
Screening for postpartum depression is really, really important. Having a way to efficiently flag people who are struggling, with a standardized list of questions asking how they’re feeling lately, is essential care.
The problem is, screening for symptoms is the standard of care that most birthing parents receive for their mental health. It is a low bar—using a sub-optimal list of questions to identify people who are already suffering, while they are in the middle of a dramatic upheaval in their lives and are directly responsible for keeping another human alive.
Why aren’t we doing more to prevent that suffering?
That question takes on more urgency when you consider the facts: Postpartum mood and anxiety disorders are thought to be the most common complication of pregnancy. And, mental health crises, including suicide and substance use, are the biggest underlying cause of maternal deaths during pregnancy and in the year postpartum. Maternal mortality is rising dramatically in the United States specifically, and Black women face the highest risk.
Why aren’t we doing more to protect parents’ mental health before they are ever in crisis? I asked this question in an essay published today on WBUR’s Cognoscenti, and I hope you’ll take a look. It’s a frustrating and important question to consider.
It’s one I’d been thinking about for a long while, but an essay that writer Miranda Rake published in Romper last year helped crystalize it for me.
Rake brought her second child, a daughter named Nellie, home from the hospital and felt “choked with fear, performing ‘normal’ with all my might,” she wrote. When she started taking an antidepressant and eventually connected with a good therapist, she was relieved. And she was frustrated.
Her history of anxiety had been well documented in her medical records, and she couldn’t understand why no one had flagged that history when she was pregnant or explained that it made her more likely to struggle postpartum.
Rake’s medical history was right there for her provider to see, because she had access to mental health care prior to her pregnancy. And she is White, financially secure and has good health insurance.
Yet, in a system where race and class so often dictate access to care, Rake also did not get the preventive care she needed, which could have included a referral to psychotherapy when she was still pregnant.
When I talked to her by phone, she told me she and her therapist have since discussed what they would have done to prepare her for birth. They could have made a plan for better support at home and for Rake to get adequate sleep in those first few postpartum days, when a mental health “crash” like the one she experienced is more likely.
“It was kind of wonderful to hear her say what we would've done,” Rake said, “but it was also heartbreaking, because it was so simple. It could have been so much better.”
It could be so much better, for so many people.
As I was finishing up edits on the essay for WBUR, I kept thinking about something journalist Marshall Allen wrote in a recent newsletter.
I’ve followed Allen’s work for years, as he investigated patterns of medical errors at Las Vegas hospitals and nationally, wrote about the roots of health care fraud, and helped readers understand disinformation during the pandemic. His book, Never Pay the First Bill, details how the health care industry takes, often ruthlessly, from patients.
Allen has a deep understanding of health care policy and practice. I didn’t know that he also spent five years in full-time ministry and has a master’s degree in theology, which makes him uniquely qualified to comment on the state of affairs.
“Politicians debate about our broken health care system as if it’s a mere policy issue,” he wrote. “But at its core, the American health care system has a moral problem. And it doesn’t require going to seminary to see it.”
Much of Allen’s work is focused on uncovering price gouging. He describes how the business side of the American health care system, far beyond incentivizing good care through reasonable profits, “is rooted in greedy and deceptive schemes that exploit people’s sickness. It’s using people’s suffering for profiteering.”
Such profiteering can take another form: neglect. When the health care system takes money from patients and taxpayers—a lot of it—while failing to meet their obvious and often dire needs that, too, is exploitation. And it is immoral. There’s lots of ways this plays out across society that require urgent attention. The neglect of birthing parents’ mental health is one of them.
Starting today, I’m relaunching this newsletter, which I began just before Mother Brain came out in September. I’ve learned so much in the past six months about the process of launching a book, about finding my voice and about what I want to explore next.
I have so much more to say about the parental brain and the stories that shape our experiences as caregivers. In the weeks to come, I’ll bring you essays about the return of the “refrigerator mother” theory, the vitriol certain mothers receive when they break form online, new research on fathers’ brains and much, much more.
Before Mother Brain, I was a full-time freelance writer, and I was good at it. I developed a system for collecting story ideas, organizing my reporting, and pitching relentlessly until something stuck. Each rejection, I learned, was progress toward publication. I built up the muscle for asking for more money.
There is a thrill in that process, and I loved working with and learning from different editors. But pitching takes time.
At my core, I am a beat reporter. I want to pour my energy into reporting things deeply and exploring the topics that catch my attention and readers’, from all angles. This newsletter will allow me to do that.
I’m still working out just what my beat here is, exactly. Something like “science and selfhood.” Who are we, individually and collectively, as parents and beyond, when the old stories don’t fit—and where do we find the fodder for a new one?
I’m excited about where this is headed. I hope you’ll subscribe and come along.