postpartum depression ‘must be a public health priority’ in wake of pandemic
6 minute read
in canada, it can be difficult for women experiencing postpartum depression to get the help they need, often because their symptoms aren’t taken seriously enough or the resources required aren’t available.
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maternal mental health received some much-needed attention in early august when the u.s. food and drug administration approved zuranalone, the first oral medication intended for the treatment of postpartum depression.
the drug, which will be sold under the brand name zurzuvae, is expected to be available in the u.s. before the end of the year. the manufacturer has not yet filed for approval from health canada but, by most accounts, it would be warmly received.
according to a statistics canada survey on maternal mental health, almost one in four women who gave birth during the first half of 2018 reported having feelings consistent with postpartum depression or an anxiety disorder not long after giving birth. only one in three of these women said they received treatment for their mental health since the birth of their child. things have only gotten worse since then.
“we know that rates of postpartum depression doubled through covid and rates of postpartum anxiety tripled,” says jaime charlebois, co-executive director of the canadian perinatal mental health collaborative, a non-profit health organization focused on improving the mental health of individuals before and after giving birth. “we can attribute that to isolation. we can attribute that to anxiety, worry, fear and obsessions about covid.”
postpartum depression is just one of a spectrum of disorders that can affect individuals during pregnancy and the period after giving birth but it’s the one we hear the most about. if left untreated, charlebois says people can experience a host of conditions that range in severity, including panic disorder, obsessive compulsive disorder, generalized anxiety disorder and even ptsd related to birth trauma.
“we see increased rates of bipolar disorder, eating disorders, insomnia and — in emergency cases — severe psychosis, which is a mental health emergency that requires immediate attention from healthcare providers.”
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surviving the stigma of motherhood
although there is no single cause of postpartum depression, a number of factors are believed to contribute, including family history of mental illness, the physical/hormonal changes associated with pregnancy and sociological effects, such as poverty or being part of a marginalized population. there’s also a stigma that can come with perceptions of how a new mother should behave.
“we have very high expectations of people as they transition into their parenting role,” charlebois says. “the whole phenomenon of ‘good enough’ parents is really difficult because to be a good mother, women can feel like they have to cook all the meals, clean the house, take the kids to all those hockey practices and they need to do this while looking good and being thin and making everybody think that they’ve got all their ducks in a row.”
failure to meet these lofty expectations can leave parents feeling inadequate and, in some cases, fearful of the potential repercussions of sharing these feelings with others. they may be concerned that “if they tell somebody they’re not feeling good, someone will call children’s aid and the baby may be taken away,” charlebois says. “that fear is a really big concern as people are parenting and struggling with their mental health.”
recognizing the warning signs of postpartum depression
in canada, it can be difficult for individuals experiencing these feelings to get the help they need, often because their symptoms aren’t taken seriously enough or the resources required aren’t available. it’s important for new or impending mothers to talk to their loved ones if something doesn’t feel quite right.
“speak to your family and friends, speak to your health care provider,” charlebois says. “a lot of the time, people who are experiencing these symptoms, they don’t necessarily recognize them. it’s your family and friends that might notice that you’re not acting like yourself, that you seem to be kind of on your own. speaking to your healthcare providers gives them the opportunity to intervene and provide support.”
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it’s also important that these providers receive the training they need to recognize the warning signs of poor maternal mental health when they see them. “this means providing trauma-informed or trauma-aware care so people feel safe to be able to talk about their mental health,” charlebois says. “it means providing environments that are open and allow for vulnerability.”
finding a framework for maternal mental health
part of the reason canada is behind the curve when it comes to maternal mental health is that the country lacks a national strategy or clinical practice guidelines to direct healthcare providers on when to screen patients or how to offer care. according to charlebois, the canadian perinatal mental health collaborative is trying to change this by lobbying the government to increase access to perinatal mental health services.
she says the organization was excited to see prime minister justin trudeau “ensure timely access to perinatal mental health services” in the mandate letter of priorities the federal government released in 2021. earlier this year, on world maternal mental health day on may 4, the government followed up by directing over $800,000 in funding to three organizations working on projects that support perinatal mental health. “sometimes you have to be loud,” charlebois says. “you have to really follow through with the cause and take it to the top because it’s challenging to enact change locally.”
ideally, the non-profit would like to see the country adopt a stepped care model for perinatal mental health so that people can receive access to the right services at the right time based on the severity of their symptoms. “not everybody requires psychiatric care — actually, very few do,” charlebois says. “but we need to have access to primary care providers who are knowledgeable about perinatal mental health disorders and we need to have a system in place where we can adequately create a pathway to care.”
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this model would help remove much of the anxiety that surrounds childbirth because the more healthcare workers express interest and concern about mental health, the more natural it becomes to talk about it. “stigma is reduced when i know that my family doctor, my obstetrician or my midwife are going to ask me about it and then, based on my response, they’re going to provide me with the support, the validation and the reassurance i need. it creates a kind of alliance to help me get to service and to help me stay in service until i’m feeling better.”
toward a healthier future
as for the drug zuranalone, charlebois hopes to see it come to canada as soon as possible. she says such medication has been few and far between, largely because of the lack of priority on women’s health issues coupled with concerns over the effect these drugs might have on an unborn child. while there will always be risk with new medications, the risk of not taking a drug can often be just as great depending on the mental health of the patient.
“we’re hoping to continue to advocate for zuranalone in canada because it’s probably quite expensive right now,” she says. “every healthcare provider needs training on the risks and benefits of taking a particular medication during pregnancy or while lactating and the risks and benefits of not taking that medication. to just say ‘no meds are safe’ still means that we’re going to have children that are exposed to untreated mental illness.”
going forward, charlebois says she hopes to see long-term studies on the effects of any new medication but she is encouraged to see that maternal mental health is being taken seriously and that researchers are working to improve the lives of new mothers everywhere.
“if we want to have a healthy population, we have to prioritize perinatal mental health,” she says. “it must be a public health priority because it will affect people as they go through their lives and it will help them be productive members of society.”
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dave yasvinski is a writer with healthing.ca
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