The increase in perinatal and postpartum depression must be combated

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Arryian Gorey had never felt so alone.

She became pregnant in March 2021, when the pandemic was in full swing and coronavirus vaccines were still hard to come by. Gorey was also single, living alone in an apartment in Buffalo, and making ends meet with a stressful day job and a 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 setback at work — I mean, just being alone every day of your pregnancy is extremely depressing.”

Depression during and after pregnancy affects many people, and the pandemic has only made this mental health problem worse, health professionals say. These types of depression can include deep sadness, increased anxiety, and relentless exhaustion that make it difficult for sufferers to take care of themselves and their families.

“Even before covid happened, we knew there was an increase in women with postpartum depression, so the pandemic added to that,” said Clayton J. Shuman, 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 suffered from postpartum depression. That’s triple pre-pandemic levels.

A fifth of 670 survey respondents in one of the studies said they had thought about harming themselves. The results, published in BMC Research Notes, showed formula feeding, neonatal intensive care unit admission and worry about coronavirus infection increased the risk of depression.

“We weren’t surprised there were more, but we were surprised there were so many more people suffering,” Shuman said.

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For Shuman, the pandemic has exposed existing flaws in the nation’s response to maternal psychological health. “The major problem,” he said, “is that, systemically, I don’t think we’re screening very well” in perinatal and postpartum psychiatric care. “And we also don’t really provide resources that are tailored to the needs that we identify,” he said. “It’s a one-size-fits-all approach.”

Addressing these flaws, he said, would require public health services 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 expectant mothers and their families.

The pandemic – with its quarantines, visitation limits and political divisions – 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 has underscored how essential they are for treating mood disorders. They are even more necessary for patients of color, who are several times more likely to suffer from perinatal mental illness but less likely to get treatment than other people.

With mental health problems leading to maternal mortality in some states — including California, where Stanford University researchers identified it in 2019 as the leading cause of death among new moms — experts say the stakes are too high to let it linger.

For Black parents with postpartum depression, help may be hard to come by

People with perinatal and postpartum depression need support and coping strategies that go beyond medication, experts say. Research – including a new study from Northwestern University – shows that medications are not always effective in treating postpartum depression.

For Gorey, her pregnancy, marked by fatigue and fluctuating hormones, brought to the surface a latent trauma. “I was constantly battling bouts of depression trying to infiltrate myself,” she says, “and realizing that every little mental issue you hold on to is going to be there throughout your pregnancy. I didn’t have all the joy that many first-time mothers normally have.

From spring to fall, she endured anxiety, isolation and 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 like Gorey.

“One of the most important things I needed was Shyana to help me process everything,” Gorey says, “not just saying, ‘Oh, you’re fine, you’re fine,’ but to really talk things, to deal with all those emotions, all those feelings that you know are going to be huge triggers after giving birth.

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 down to not having a community,” Broughton says. “When she felt like freaking out, she knew where to go. When she cried, when she was sad, when she said, “I don’t know what else to do”, I said, “Come and have a tea or a coffee” or “Come and dance and have a mango because it’s what I happen to be cutting right now. ”

Lack of community, support

The problem is that the perinatal supports that most people might benefit from aren’t available to many people, pandemic or not, says Amber Parden, who oversees perinatal psychiatric services for Woman’s Hospital in Baton Rouge. “Or, if they exist, they are very limited,” she added. “So when you subtract that in a pandemic, you end up with sicker people. This puts a strain on the system. »

This is the case in Bayou State, where a weak safety net and endemic poverty make it particularly difficult for many people to access health care.

“We just don’t have enough treatment providers,” Parden said. “There just aren’t enough therapists. When the pandemic hit, we were trying to find enough help for these people, but the impact was so intense: everyone was overwhelmed.

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Parden found herself helping others with many of the problems she faced. “I had a covid baby myself,” she said, “a covid pregnancy — with complications.”

Parden had family to turn to, having returned to Louisiana after years in upstate New York so her children could be surrounded by 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 of her loved ones, she said, has helped her through an otherwise alienating pandemic.

She knew the isolation experienced by many of her patients: the anguish of not having her husband by her side even during routine appointments, of not being able to hold his hand, of having to inform him afterwards.

“Pregnancy has become a lonely experience,” Parden said. “And it’s had a huge impact on mums, who are going to find a way to feel guilty no matter what’s going on in the world. Mom’s guilt is a very real thing.

When the pandemic forced millions more people to become stay-at-home parents and stay-at-home workers simultaneously, Parden said he saw an influx of clients struggling to stay emotionally and mentally present for their families. Parden initiated a collaboration with other perinatal care providers to ensure new moms had “more than just a psychiatrist prescribing medication.” She said she’s started doing a lot more parenting training with new moms due to increased demand from families trying to deal with behavioral issues in children who are spending a lot more time at home.

It hasn’t helped, she added, that many support groups and lactation services that would help break that isolation have been suspended or gone virtual during the pandemic.

Coronavirus puts high stress on new pregnant moms and increases risk of mental health issues

Stressful and 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 nearest hospital, 90 minutes from home, for a scheduled caesarean, both were quarantined and neither was symptomatic.

“But when I got to the birthing 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 and lonely delivery, she said. There was no immediate skin-to-skin contact, no swaddling of the baby to bond with dad, no daycare, she said. If a nurse hadn’t taken it upon herself to take a few photos, Chatham says she would have no way to visually commemorate the first moments of her daughter’s life. Two hours passed before she could hold it.

“At the time, I didn’t realize how much it affected me,” she says, “but it affected me a lot.”

As someone diagnosed with anxiety years earlier, Chatham says she expected the mood disorder to be a challenge before and after pregnancy. But after a few weeks of new-mum bliss, she says the hospital experience began to tip her into a spiral of postpartum distress, acute guilt that she and her daughter had been deprived of something from the start.

“Most of the time I feel guilty for not having spent that time with her — or for not fighting for that time with her,” she says.

Amplifying those worries were stressors with her job at a public high school in a small town in the Deep South and living in a state that offers no paid maternity leave.

While her psychiatrist gave her half her usual dose of Zoloft during pregnancy, Chatham said breastfeeding became one of the most effective ways to manage her clinical anxiety.

Nell Blakely, a 66-year-old leader of the local lactation support network La Leche League, guided her through the process. Although the pandemic has forced La Leche League to move its support groups online, Blakely’s closeness has become a source of comfort.

“She lives downstairs from me,” Chatham said, “and she would give me such great advice on things like lockdown issues.”

Breastfeeding not only alleviated her worry, but also some of the lingering trauma of a stressful childbirth.

“It also eased some of the guilt,” she said, “and it really helped me heal.”

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