This weekend, a story about a mother who had not seen a doctor for four months postpartum made the rounds on social media. The woman stated, in a lengthy Facebook post, that her doctor cancelled her appointments three times and by the time she finally had an appointment, she was suffering from postpartum depression. She reported that when she arrived, she was seen by a nurse practitioner who called the police to escort her to the emergency room.
What motivated me to write about this story is that there was a breakdown in a system somewhere. The author of the post stated her belief that the healthcare system is broken. There are certainly flaws in healthcare, like there are in every system and as mental health professionals, we strive to mend those gaps as much as we are able. Depression and anxiety related to pregnancy and childbirth are more widely talked about: by doctors, in mainstream books and articles about women’s health, and in pop culture. Many states have created initiatives to require doctors and medical facilities to screen and provide information about it, too.
No system is perfect so just as you educate yourself about pregnancy and create a birth plan, preparing for the possibility of a pregnancy-related mood disorder should be considered. If you have a pediatrician and a lactation consultant in place before your baby comes, why not consider having a referral for a therapist who specializes in perinatal mood disorders handy just in case?
There are things you can do to ensure that you are properly cared for during your pregnancy and thereafter.
- Discuss mental health with your partner. Hormonal changes during pregnancy and afterward can affect your mood. It’s important to be open with your partner when you are not feeling like yourself, if you are struggling, or if you feel like harming yourself. Come up with a game plan about how your partner can advocate for you in the event you are not feeling well. That can mean calling your doctor and/or other important members of your support system to get you proper help.
- Acknowledge that getting help does not mean you are weak, a bad mother, or a failure. Many women fear they will appear weak if they are struggling. Sometimes, women fear the judgment of other mothers, too. “Help” also doesn’t necessarily mean “medication”. Your medical provider can help you decide what is the best course of action for you.
- Tap into your support system. In addition to your partner, who do you go to when you have a problem or need help with something? This may include your parents, siblings, or close friends. Discuss with them how to proceed if they notice that you are acting differently (including depressed mood, statements about maybe the family being better off without you, increased crying, excessive worrying, desire to isolate) and decide with them how to go about getting a medical or mental health professional involved.
- Bring up the subject of mental health with your doctor if he/she has not done so already. Most doctors are increasingly more comfortable discussing mental health with patients and they may have additional resources for you.
- You don’t have to stay with your doctor. I had so many questions about the mother I mentioned earlier, in terms of who her doctor was. Did they have a good rapport? Was this doctor canceling appointments on her during the pregnancy? Changing doctors may feel like one more thing on your plate during pregnancy, but if you are not getting the care you need and deserve, why stay with that person?
- Take advantage of a nurse case manager if your insurance company has one to follow you through your pregnancy. Some insurance companies will have a nurse call you on a regular basis if you’ve had mental health needs in the past or various conditions during pregnancy. In these cases, the case manager will almost always screen you for depression and will help you locate a therapist or psychiatrist to help you. They can also help you make these appointments if you are unable to do so.
- Insurance companies are not always the enemy. Most providers and consumers will moan and groan about the restrictions placed upon them, but they can be used to gain access to better treatment. Surely, some are better than others, but all insurance companies have a telephone number for member services. I wonder if the outcome would have been different if someone in this mother’s support system (it would have likely had to be her husband because he’d have access to their pertinent insurance information) could have called the insurance company for advice on how to help her when she needed care and her medical provider repeatedly canceled her appointment.
- File a complaint with the patient relations department of the hospital or healthcare system where your doctor is. The mother in the Facebook post indicated she is not taking legal action in this case (though I’m not sure why she wouldn’t, given that she believed she was treated poorly). If a medical provider works for a group and the provider dropped the ball on something, the group can get involved with helping the provider to improve their services. Your voice can make a difference by helping another mother avoid further bad experiences.
One of the best resources for pregnancy-related mental health issues is Postpartum Support International. Their website is full of wonderful information as well as direct support in the form of a weekly chat for mothers and fathers and a non-urgent hotline for questions. Being prepared can help you get the care you need.
If you are interested in the possibility of working with me, please contact me at firstname.lastname@example.org. My practice is located in Livingston, New Jersey.