Photo Chris Ryan, Getty Images
Postpartum Depression is thought to affect at least 10-15% of mothers in Canada, according to a major national study from 2011.
Please take a moment to consider how many women that is. That is nearly one out of every 6 mothers.
But those are only the occurrences we know about. Because even a gold standard study of postpartum mood disorders supported by the Public Health Agency of Canada has some major flaws.
For example, lets look at how information was gathered for this study:
In the provinces, women were cold-called for computer-assisted telephone interveiws that lasted on average 45 minutes. In the territories, a paper survey was distributed in areas where a phone was not available in the household.
The Edinburgh Postnatal Depression Scale was used. This tool was developed in 1987 in Scotland. It is valued for its efficiency because it is only 10 questions long. Furthermore, it is concerned only with experiences of the mother in the previous seven days, so if you recovered from a perinatal mood disorder a month ago, no one is asking.
Stats Canada selected a group of 8, 542 women ages 15 and over who had had live singleton births.
- Mothers of twins and multiples
- Mothers of stillborn babies
- Mothers younger than 15
Who is more at risk for a postpartum mood disorder than a mother of multiples, a stillborn baby, or a mother under the age of 15? Why are these women excluded from the data? Why are they not being represented?
This study was a cross-section taking place over a matter of a few months, it was not longitudinal. This is problematic. Women in Canada have on average 2 living children. So obviously, a study that only collects data from one pregnancy at a time, is forgetting that the same woman will likely have more children, or has already. We want to know how many women will have been affected by postpartum mood disorder in their life, NOT just who had it the week of the phone-survey.
Very concerning is that out of the 8,542 women, only 6,421 mothers responded to the survey.
HERE ARE SOME REASONS WHY A MOTHER IS LESS LIKELY TO RESPOND TO A GOVERNMENT-ISSUED SURVEY:
- You have postpartum depression. And feeding and diapering your child is your only priority right now.
- You’re terribly ashamed and don’t want to tell anybody what you’re going through, let alone admit it to yourself. A symptom of postpartum mood disorder is thinking that you are the worst mother in the world. A woman can be an excellent mom and still think that, if she is suffering from this illness. A common fear is that if they disclose their illness, they will have their kids taken away.
- Postpartum mood disorder is enormously stigmatized. What if someone in your family reads your survey responses? Or hears your responses while you’re talking on the phone? Imagine if there was a similar phone survey to collect answers from victims of domestic violence or sexual assault? Would that not be hugely inappropriate? It’s absurd.
- “Is this person on the phone for real? I can’t see their face; they’re asking such personal questions, and they want me to talk about my mental health? While my in-laws are here??”
- You have poor literacy skills (which also can increase your PPMD risk).
- You come from a first nations/rural/remote community, where there is a history of strained relations with the government.
- The person on the phone is English-as-a-second-language and you struggle with non-English accents.
- You have a child hanging off one breast or you’re trying to heat a bottle, and the dog is barking at the door.
- You saw the unfamiliar number on the phone and yelled, “Kids, don’t answer it!” because you definitely don’t have 45 minutes to answer questions like how much money your husband makes.
- You have to pick up your older kids from hockey, there are bills to pay, the fridge is empty, it’s 8pm, and the stove is cold
I Think You Get the Picture.
“…Why, in the hospital, could I [receive] the services of a lactation consultant but not of a mental health professional to discuss PPD? Why did my OB/GYN stop by my room every day to check my Cesarean stitches but not my state of mind? During my pregnancy, my husband and I had to take six birthing and parenting classes in which we practiced putting on diapers and installing car seats but did not discuss maternal care options.”
– Angela Pandolfo Roy, My Voice Didn’t Soothe Him, My Touch Didn’t Comfort, 2007
The true statistic is obviously a lot higher than we can imagine. And that number can include women like your sister, your best friend, your wife, your daughter, or it could have been your own mom at one point.
And the bottom line is – mothers are not getting help.
- Impaired infant bonding
- Difficulty establishing breastfeeding, which is also associated with depression
- decreased performance in school-age children
- Delay of developmental milestones
- Decreased weight gain and thriving in infants
- Increased risk of SIDS
- Behaviour problems
- Difficulty in making secure relationships throughout life
- A greatly increased chance of children having a mental health disorder like depression, anxiety, ADHD, or autism
- Increased chance that children participate in crime or drugs
- Stressful marriages and family environment
In 2012, as reported by the Globe and Mail,
“…more than 49,000 Canadian mothers experienced depression within the first 12 months after giving birth, putting at least 80,000 children at risk for poor development.”
Furthermore the downstream effect of UNTREATED perinatal mood disorders on our healthcare system is just enormous:
- A national Canadian figure is not available, but lack of maternal mental health care costs the UK £8 billion a year, the US $1 billion and Australia $433 million.
- When moms don’t get help right away, their first point of entry with the health care system is usually with acute inpatient services
- Increased pressure on an outpatient care stream that cannot adapt to the individual needs of moms vs. other members of the public
- Unnecessary trips to the ER, for mothers and children in crisis, or unknowingly suffering symptoms of anxiety or depression (ever heard, “oh, she’s just a nervous/new mom”?)
- Increased doctor visits and repeated contact with the health care system, while a resolution is not found
- Mental illness of any kind is associated with chronic diseases such as heart disease, stroke, dementia, obesity, diabetes, and hypertension
- Increased risk of self-medication with drugs and alcohol, and during successive pregnancies
- Increased sick days and sick leave time from work
- Less likely to follow up with adequate prenatal care, which leads to problems such as early termination of pregnancy or complications at delivery time
- Increased usage of social work or police in a crisis situation
- In the case of very severe mental illness, such as postpartum psychosis, there is a risk of infanticide, although rare
Referring to Canada’s embarrassing lack of information on maternal suicide, also from the Globe and Mail:
“In contrast to Canada, Britain has rigorously analyzed maternal deaths for more than 50 years to sift out contributing factors. The findings are astonishing. When maternal deaths between 2000 and 2002 were examined, for example, psychiatric illness accounted for the majority of those deaths. Put bluntly, more mothers died by committing suicide than by succumbing to any other medical complication, such as hemorrhage or heart disease.”
Mothers are the bedrock that shape our families and our communities, both local and beyond. So it’s no wonder that when moms are sick, it affects everybody.
Postpartum mood disorders are not somebody else’s problem. They are not something that expecting women or moms alone should watch out for. We are greatly underestimating both incidence and impact of these illnesses.
We’ve heard of things like postpartum depression before. So why should we do anything differently? In the words of our new Prime Minister in response to why he appointed a 50% female cabinet,
“Because it’s 2015.”
And we are failing moms. We have been, and we still are.
Why is this? Despite the fact that so many women are ill, we have a really hard time talking about postpartum mood disorder.
Mothers are supposed to be happy and glowing after the birth of their child, right? They just have to be. Any challenging of that view creates enormous cognitive dissonance, and we quickly sweep it under the rug.
And by sweep it under the rug, I mean we give out a pamphlet with ten questions, spend more time going over proper fit of the car seat, wave them off, and hope for the best.
We need to do more in our communities for moms, and the time to start is now.
We need to improve access to information on perinatal mood disorders for both healthcare providers and the public.
We need to improve screening, such as at regular paediatric doctor visits throughout the first year and beyond.
We need to improve our screening tools, so that we don’t miss any of the warning signs and symptoms (there are more than ten).
We need to improve follow up.
We need to improve the doorways to the healthcare system so that moms can be connected with people who can help.
We need improved access and response time so that moms don’t have to wait months for a therapist who specializes in perinatal mood disorders.
We need more support groups of other moms going through the same thing.
We need more teams of health care warriors, ready to stand up for moms and fight perinatal illness.
If you are in health care, your presence here, reading this, is a great start. I hope you share this call for action with other health care providers – nurses, doctors, paramedics, social workers, counsellors, anyone who will listen.
If you’re not in health care, then you are still one of two: someone who knows a mom, or someone who is a mom. And you have two choices: to pretend this problem is not as big as it is, or to raise your voice.
Because when moms get better, everybody gets better.
– Jessica C., RN, BN