"I got it into my head that Esther would die the next day at midday but God would then bring her back to life. I told my husband Andy, who thought it was odd and didn't know what to make of it," Hannah, a new mother to baby Esther, told the BBC. "When midday approached I ended up in a fetal position screaming and asking people to help me. I was screaming so loudly the neighbors came running."
Hannah was suffering from postpartum psychosis. She cycled through extreme highs and lows: Staying up until one in the morning with Esther, she wasn't exhausted like many new mothers, but full of energy. And she thought she could communicate with God.
Read more: The Broadly Guide to Pregnancy
Affecting one or two women per 1,000, postpartum psychosis is less common than other mental health issues, like postpartum depression or "the baby blues," that can arise during and after pregnancy, and it is also the most severe. In another case, a woman who had just given birth was convinced that her husband was poisoning her food and heard a voice in her head that told her to "go with her infant son to the subway and jump in front of the train."
A study published in the Journal of Women's Health explains that postpartum psychosis usually occurs shortly after childbirth and "is marked by symptoms of mood lability [mood swings], cognitive disorganization, delusional beliefs, and hallucinations." Treatments for postpartum psychosis include therapy and antipsychotics.
According to the Massachusetts General Hospital's Center for Women's Mental Health, the women most vulnerable to the condition commonly suffer from undiagnosed bipolar disorder. Eighty-five percent of all pregnant women, however, will experience "some type of mood disturbance," the hospital reports. While most won't hallucinate the face of Jesus, new mothers are commonly up against changes to the state of their mental health. "The miracle of childbirth" takes on a whole new meaning in this light.
Perinatal mental illnesses, or conditions that occur during pregnancy, affect ten percent of women, according to one UK report; the American Congress of Obstetricians and Gynecologists (ACOG) estimates that perinatal depression affects one in seven pregnant women. The New York State Department of Health states that up to 20 percent of women develop perinatal depression. ACOG also cites this grim statistic: "Maternal suicide exceeds hemorrhage and hypertensive disorders as a cause of maternal mortality."
If we see one more mother die because of an undiagnosed mental health crisis, we are failing as a society.
Certainly, women who are already predisposed to depression, anxiety, and OCD disorders are at the greatest risk. Fifty-two percent of women reported increased anxiety or depression while pregnant, according to a poll that the Anxiety and Depression Association of America conducted in 2009. And a recent study analyzing the development of panic disorders among pregnant women found that the condition was predicted by a pervious history of anxiety disorders. Not only are panic disorders that occur during pregnancy a strong indicator for postpartum depression, but they have been linked to adverse birth outcomes, including low-birth weight and preterm births.
While mental health issues that arise during pregnancy can vary in severity, overall they're not anomalies that only affect a certain few. However, they are still being overlooked, maternal health advocates say. "The emphasis on maternal mental health is really lacking," says Jamie Zahlaway Belsito, the director of advocacy for the National Coalition for Maternal Mental Health (NCMMH), who confronted mental health issues during her own pregnancy. "It's very obvious that in many respects we still think of pregnancy and family life like the Leave It to Beaver era. We're not supposed to talk about the messy parts. We're not supposed to talk about anything but the joy of being a mother."
Since last year, the NCMMH has helped petition for two bills, HR3235 and S2311, known as the "Bringing Postpartum Out of the Shadows Act of 2015," that would allocate federal funds for the screening and treatment of maternal depression. (One method of screening is the Edinburgh Postnatal Depression Scale.) Earlier this month, the organization started a social media campaign, #LoveAnotherMother, to bring attention to the bill and the need for better access to and awareness of early mental health screenings.
You're not a bad mom because you're dealing with mental health issues.
"Every year, more than 400,000 infants are born to mothers who have depression, which makes perinatal depression the most under-diagnosed obstetric complication in the United States," the bill reads, in part. "The consequences of maternal depression include poor bonding between mother and infant, which may have negative effects on cognitive development, social-emotional development, and behavior of the child."
By contrast, with early detection, "90 percent of women who have maternal depression can be treated successfully with a combination of medication and counseling."
"Mental health needs to be part of the overall conversation about maternal health," Belsito says. "Not only do OB/GYNs need to make sure that a mother is physically healthy—that she's exercising, etc.—but that she's feeling healthy, on a holistic level. And if she's not, OB/GYNs need to be there to reassure mothers that whatever they're feeling—whatever 'bad' thoughts they're having—are normal. You're not a bad mom because you're dealing with mental health issues."
"This needs to be destigmatized, and this bill could help do this," she continues, "Mental health should be openly discussed. It's part of the process of birth. If we see one more mother die because of an undiagnosed mental health crisis, we are failing as a society."