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Caring For Our Mothers: A Plea for Action

Posted By Cassidy Freitas, Thursday, February 07, 2013

"I just want to sleep…I just want to go rent a hotel room, and go to sleep.”

"I’m not strong enough for this....”

"I look at my twins and I don’t know them, shouldn’t I feel differently?”

"I’ve never felt so dark and low. Sometimes I wonder if they’d all be better off without me.”

"I can’t stop worrying, I can’t even bathe him. What if I drowned him…”

"I wouldn’t have said anything if my doctor hadn’t asked…”

Fluctuating hormones. Little or no sleep. A fledgling maternal identity filled with self-doubt. These are the experiences of almost all new mothers, not just the ones who experience a Postpartum Mood and Anxiety Disorder (PMAD). Typical statistics regarding the prevalence of PMADs vary anywhere from 10 to 20%, but I don’t believe they capture the full picture. What would happen if we accounted for those mothers that may not meet DSM criteria? What about those mothers that never come forward due to shame or fear? What about those mothers who experience Psychosis? Where do we account for them?

According to the American Pregnancy Association, approximately 6 million pregnancies occur in the U.S. each year (I report the number of pregnancies rather than the number of live births because every postpartum mother is at risk for PMADs despite the outcome of her pregnancy.) While postpartum mental health issues are far more common than gestational diabetes, every woman will get screened for diabetes during her pregnancy and not nearly as many new mothers will get screened for postpartum mental health issues.
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The University of California San Diego’s (UCSD) Department of Family Medicine has come a long way in addressing these issues. With trailblazers like Dr. Katie Hirst (who teamed up with LMFT Amber Rukaj to found the Maternal Mental Health Clinic at UCSD in 2007), we have implemented screening, educational resources, and interventions that are helping postpartum mothers and their providers. As a Medical Family Therapist Intern at this site, I’ve had the special privilege of working with primary care physicians and psychiatrists who believe in what my presence can offer which affords me the opportunity to work with women and their families during pregnancy, postpartum, and beyond.

While changes in the treatment of maternal/pregnancy/postpartum, etc. are called for, it is also important to consider the financial ramifications of these pressing issues. The U.S. has not really tried to quantify the cost of postpartum mental health disorders, but Australia has. Their nationwide organization Post and Antenatal Depression Association found that perinatal depression alone will cost them an estimated $433 million dollars in 2012. This number includes health care costs, lost productivity and foregone tax. Let’s also note that Australia has a population of 22.6 million people, and we have 311.6 million. Do the math. Not caring for our mothers is costing us, big time.

Whether it’s due to stigma, limited skills and training, a fast paced schedule, or lack of resources, not enough providers are talking to mothers about postpartum mental health risks and disorders. In order to address these important issues, I suggest a collaborative approach between physicians and mental health clinicians to increase detection and treatment.

If you are looking to help this population, a way to begin coordination in this area is to get in contact with your local postpartum health organization. In San Diego we have the Postpartum Health Alliance, an organization whose entire mission is to connect mothers and providers to each other and to the vast array of resources that exist out there. I’ve been lucky enough to serve as one of their warmline volunteers, and through the process have run into some amazing resources that you can find at the bottom of this post.

We know that untreated postpartum mental health issues have long term costs for mothers, their children, and their families. Whether it’s the personal or financial costs that make you cringe, that doesn’t matter to me. What matters to me is that we do something. Let’s amplify the voices of our hurting mothers. Let’s tell them that they’re not alone, that we care, and that we are taking action.


Cassidy Freitas is a Marriage and Family Therapy doctoral student at Loma Linda University as well as an AAMFT Minority Fellow. Along with her PhD she is pursuing a certificate in Medical Family therapy offered by the doctoral program at Loma Linda. She is currently working at the UCSD Department of Family and Preventive Medicine as an MFT Intern.

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Aimee Galick says...
Posted Thursday, February 07, 2013
I really appreciate your post Cassidy. I think there is so much pressure on mothers in this culture to be perfect and with our increasingly hectic lives and schedules, having the time for bonding is difficult. I think that the normal level of concern mothers have is compounded by feelings of guilt and shame of not living up to the impossible standards we as a culture set. We all need to be more aware of young mothers around us and how we can be supportive and validating. I know I have been more aware this issue since starting my doctoral education and take the time to ask family members and friends with new babies how they are coping.
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Matthew P. Martin says...
Posted Monday, February 11, 2013
Very helpful post Cassidy. I appreciate the resources and the inspiration for better care you have provided here. Aimee, I agree with you completely. Our health care centers can go a long way in normalizing and validating the experiences of mothers postpartum. The family medicine centers in which I have worked usually include some individuals (physicians, nurses, developmental specialists) who screen for mental health issues postpartum. However these have been more reflective of the individual health professionals and not of the entire system. A better alternative is to have an entire culture or program in place to support the mental health of mothers postpartum. Patient- and family-centered care can only go far when it's being practiced by just a handful of providers. The change, although it can begin on the micro level, should eventually become a system-wide event to reach as many new parents and babies as possible.
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Sharon Bursky says...
Posted Thursday, June 27, 2013
I really appreciate this post and this is the first time I have read anything regarding post partum and the need for collaboration with mfts and health care providers. I have been in the position (as an mft) where I have had a client experiencing these symptoms and I felt like I did not have enough resources. I also feel that, even though I reached out to her health care providers, I failed in collaborating to the extent that was needed. The resources you provide in the post as well as the inspiration to contact our local health care centers is a challenge I will pose to myself as an mft. I think that post partum is one of those illnesses we do not speak about enough and we do not treat collaboratively, which is essential. The amount of mothers experiencing these symptoms is far too high for us to ignore.
Thank you again for planting the seed and I hope we all can work together to help these mothers and families.

Sharon Apel Bursky, M.A., LMFT
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