We know from experience that it’s hard, if not impossible, for mothers to do it all on their own, especially when their mental health needs are not met.
The two authors of this essay have both had motherhood journeys that were impacted by mental health struggles. From both personal experience and as health care professionals, we have witnessed a critical need for women’s mental well-being to be supported before, during, and after pregnancy, and throughout motherhood.
I am Cara McNulty, the president of behavioral health and mental well-being at CVS Health. When I first became a mother, it took me years to realize that I had experienced mental difficulties during my first pregnancy that I never took the time to address. After I had my second child, I experienced postpartum anxiety, a subset of postpartum depression that I had never even heard of at the time. It wasn’t until I was sitting on the kitchen floor, crying, and holding my sick baby, that I knew something was wrong. My husband came to me and said, “This isn’t how it’s supposed to be, we can get you help.” It was then that I realized I needed support beyond my family and friends. I knew I needed to speak to my doctor and get specific care for my mental health.
My daughter contracted Respiratory Syncytial Virus (RSV) at five months, a respiratory tract infection that can sometimes be deadly for babies. It was a scary period, and I was so worried that I constantly checked that she was breathing regularly. It began to impact my everyday life to the point where I wasn’t showering or eating because I needed to hold my sick baby.
I was taking care of every aspect of my daughter’s health, but my own had grown worse. I knew I needed to take care of my mental health if I wanted to be the best caregiver and mother to my daughter. I was extremely fortunate to be able to see an excellent physician who listened to my experiences and normalized mental health support. I felt seen and heard and was motivated to get the treatment I needed to get back to feeling my best.
I am Dr. Joanne Armstrong, the VP and chief medical officer of women’s health and genomics at CVS Health. My husband and I had just moved to Houston, far away from any family. We didn’t have a support system to lean on yet, and my husband’s job had a shorter paternity leave policy. I gave birth to my first child preterm at 35 weeks, and since she was so small, she had to be nursed very frequently, day and night. I grew so fearful of the night because I knew I wasn’t going to get any rest and was going to have to face a new day without proper sleep. Though I was a practicing OBGYN and experienced with functioning on little sleep, this was an entirely different level. I struggled mentally and physically to take care of myself and my daughter.
As population health experts, we look for solutions to help entire groups of people, but we always keep in mind that these groups consist of unique individuals, each facing their own physical and mental health challenges as we once did. Society needs to prioritize maternal mental health by dedicating the same level of resources and attention to mothers’ mental well-being as we do toward their physical health during pregnancy, birth, and its immediate aftermath.
Beyond the birth
After a woman gives birth, people often think first and foremost about providing physical care for the mother and their baby. However, data shows that this is also a crucial time when mothers need supportive mental health care. The post-delivery period, also known as the “fourth trimester,” is filled with emotional and physical shifts that can affect mothers’ holistic health. Physical changes to women’s hormones and brain activity, as well as recovery from bodily injuries or complications resulting from the birth process, itself, may affect one’s quality of life and their ability to carry out important or usual activities.
Some births may be emotionally traumatic for a range of other reasons, including physical injury related to the birth process, emotional or physical difficulties related to an unplanned or urgent Caesarean section, or infant conditions that cause worry such as premature birth or an unexpected NICU admission.
Adjusting to caring for a new, completely dependent infant can also disrupt your routine and prevent you from paying attention to your own health–whether it’s your first or fifth child. And it’s not only new moms who need support during this time. Women having their second or third delivery experience have to go through the pregnancy process all over again. Indeed, women who had postpartum depression previously have a 30% increased risk for each following pregnancy.
Many women suffer from postpartum mental health conditions, including postpartum blues, postpartum depression, and postpartum psychosis, a rare postpartum condition that often resembles a bipolar manic or mixed episode. These conditions arise due to a complex combination of changes to mothers’ bodies, minds and daily lives that often necessitate more support than we typically provide women during this time.
Though postpartum mental health conditions are common among women–up to 80% of women experience postpartum blues, and about one in seven suffer from postpartum depression–many mothers are not receiving the support they need to address these challenges or even understand the diagnoses around the emotions they are facing. Studies show that 1 in 8 women in the U.S. were never asked if they were feeling depressed during postpartum care, and it’s estimated that up to 50% of women with postpartum depression never get diagnosed. In addition, 75% of people who do screen as at-risk for postpartum depression go untreated.
Many women with postpartum health conditions fear their conflicting feelings about motherhood make them less fit to be a good mother–but needing mental health care does not mean that you are a worse parent or that you love your new child any less.
The most severe expression of perinatal mood disorder can result in maternal death. According to the CDC, the leading cause of pregnancy-related death among women (23%) is due to mental health conditions. These deaths can be prevented by educating women and their providers about the mental health challenges facing mothers and providing them with the mental health resources they need.
For expecting and new moms experiencing mental health challenges, the U.S. Health and Human Services Department’s Health Resources and Services Administration (HRSA) has a confidential, toll-free Maternal Mental Health Hotline at 1-833-9-HELP4MOMS (1-833-943-5746). The hotline has trained counselors who can provide interventions, support and referrals to additional community-based resources or telehealth providers if appropriate.
Our life experiences affect maternal health experiences
A woman's postpartum recovery needs–both physical and mental–may not look the same for any two individuals, and often vary based on a variety of social and biological circumstances.
While all pregnant women are at risk for pregnancy-related mental health challenges, Black women are particularly vulnerable. Although Black women have 1.6 times higher rates of postpartum depression, they have a lower chance of seeking out and receiving assistance due to factors including economic barriers, stigma around mental health challenges, and structural factors in the health care system that neglect their needs.
Even when controlling for socioeconomic status, maternal disparities still exist–showing that lack of culturally competent care and chronic stress from racism can contribute to this increased risk as well.
Managing motherhood and mental health needs
It’s hard to ask for help during this time, or even to recognize that these feelings warrant extra support. We all want to be “supermoms” for our babies and families.
The best way that expecting mothers can prepare themselves for the mental health challenges of pregnancy and motherhood is through education, tending to their mental well-being even during pre-pregnancy, so that they have built-in habits of care and support systems that carry on through pregnancy and after birth. Women can navigate this challenging time by reaching out to family and friends for advice and support, ensuring you are getting proper sleep and nutrition, joining new mom groups to share your experiences and learn from others, and remembering to take time for your own self-care. Of course, we can’t stress enough the importance of reaching out to your team of health care providers if you experience depression and anxiety that affects your quality of life.
Know that what you are feeling and going through is real, even if you are not receiving external validation of that.
Through sharing our own stories, we hope women see that experiencing postpartum mental health is often part of the maternity experience. Though identifying a need and asking for help can be difficult, mothers should never be ashamed to seek care and support.
Maternal mental health must also be prioritized at multiple levels, from families to the health care industry at large. It will take structural change and efforts across these areas to ensure that mothers are getting the mental health care they need, when they need it.
We can all help the mothers in our lives prioritize their own needs–whether it be a partner, family member, friend, or even ourselves.
Cara McNulty is the president of behavioral health and mental well-being at CVS Health. Dr. Joanne Armstrong is the VP and chief medical officer of women’s health and genomics at CVS Health.
The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.
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