The increase in perinatal and postpartum depression needs to be addressed

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Arryian Gorey had never felt so lonely.

She became pregnant in March 2021, while the pandemic is in full swing and coronavirus vaccines are 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.

“There was a lot to deal with,” she said. “I didn’t have an active partner, there was all this rejection at work – I mean, being alone every day of pregnancy is extremely depressing.”

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

“Even before the covid happened, we knew there was an increase in the number of women having postpartum depression, so a pandemic added to that,” said Clayton J. Shuman, an assistant professor at the University of Michigan School of Nursing.

Shuman is the lead author of a couple of studies from the University of Michigan School of Nursing and Michigan Medicine, which found that a third of people who gave birth to babies from early to mid-2020 experienced postpartum depression. That’s triple the level before the pandemic.

One-fifth of the 670 respondents to the survey in one of the studies said they were thinking about self-harm. The results, published in BMC Research Notes, showed that formula feeding, admission to the neonatal intensive care unit, and concerns about coronavirus infection increase the risk of depression.

“We were not surprised that there were more of them, but we were surprised that so many more people suffered,” Shuman said.

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For Shuman, the pandemic highlighted existing shortcomings in the nation’s response to maternal mental health. “The main problem,” he said, “is that, systematically, I don’t think we review very well” in perinatal and postpartum mental care. “And we also don’t provide really tailored resources for the needs we identify,” he said. “It’s an approach that suits everyone.”

Addressing these shortcomings, he said, would require the public health department 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 courses for new and future mothers and their families.

The pandemic – with its quarantines, visitation restrictions and political divisions – has made many people more isolated than usual.

By cutting off many social benefits for people with perinatal and postpartum depression and anxiety, experts say, the pandemic has highlighted how important they are in treating mood disorders. They are even more necessary for colored patients, who are several times more likely to suffer from perinatal mental illness, but less likely to provide treatment than other people.

With mental health problems driving maternal mortality in some states – including California, where researchers at Stanford University identified it in 2019 as the leading cause of death among new mothers – experts say the stakes are too high to last.

For black parents with postpartum depression, help can be hard to find

People suffering from 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 drugs are not always effective in treating postpartum depression.

For Gorey, her pregnancy, marked by fatigue and fluctuating hormones, brought latent trauma to the surface. “I was constantly battling bouts of depression trying to penetrate them,” she says, “and realizing that every little mental problem you hold on to will be present during pregnancy. I didn’t have all the joy that many mothers who come for the first time have. “

From spring to autumn she endured anxiety, isolation, and fear of abandonment. Then came what seemed like a blessing: Shyana Broughton, who founded Our Mommie Village a few years earlier to provide doula and breastfeeding support for black mothers like Gorey.

“One of the biggest things I needed was for Shyana to help me handle everything,” Gorey says, “not just to say,‘ Oh, you’re fine, you’re fine, ’but to really talk about things, to face everything. those emotions, all those feelings that you know will become great triggers after childbirth. ”

With Broughton’s support, Gorey, 33, says she learned to cry when she cried and to rest when she wants to rest.

With perinatal and postpartum depression, “a lot of it comes from not having a community,” Broughton says. “When she wanted to roll over, she knew where to go. When she cried, when she was sad, when she said, ‘I don’t know what else to do’, I would say, ‘Come for tea or coffee’ or ‘Come dance and drink some mango because that’s what I happen to be cutting at the moment . ‘ ”

Lack of community, support

The problem is that perinatal support that most people could benefit from is inaccessible to many people, regardless of the pandemic or not, says Amber Parden, who oversees perinatal psychiatric services for Baton Rouge Women’s Hospital. “Or, if they exist, they are very limited,” she added. “So when you subtract from that in a pandemic, you end up with sicker people. That puts a strain on the system. ”

This is the case in the state of Bayou, where a weak safety net and widespread poverty make access to health care a particular challenge for many people.

“We just don’t have enough service providers,” Parden said. “There are simply not enough therapists. When the pandemic hit, we tried to find enough help for these people, but the impact was so intense: everyone was overwhelmed. ”

That’s why it’s so hard to find mental health counseling right now

Parden found herself helping others solve many of the same problems she was facing. “I had a covid baby myself,” she said, “covid pregnancy – with complications.”

Parden had to turn to her family after returning to Louisiana after a long stay in New York State so that her children could be close to their relatives, grandparents, aunts and uncles.

“We are not destined to be independent, to deal with these things on our own,” she said. And being at a distance from so many loved ones has helped her cope with an otherwise alienating pandemic.

She knew the isolation many of her patients had experienced: anxiety about her husband not being by his side even during routine meetings, not being able to hold his hand, having to fulfill it after the fact.

“Pregnancy has largely turned into an experience of loneliness,” Parden said. “And that has taken a huge toll on moms, who will find a way to feel guilty no matter what’s going on in the world. My mother’s guilt is a very real thing. “

When the pandemic forced millions of people to become home-staying parents and home-based employees at the same time, Parden said she saw an influx of clients struggling to stay emotionally and mentally present for their families. Parden has partnered with other perinatal care providers to ensure that new moms have “more than just a psychiatrist prescribing medication”. She said she has started conducting a lot more training for parents with new moms due to increased demand from families trying to solve the behavioral problems of children who spend much more time at home.

It did not help, she added, that many support groups and breastfeeding services that would cut through that isolation were suspended or became virtual during the pandemic.

Coronavirus puts a lot of stress on new mothers and increases the risk of mental health problems

Stressful, lonely childbirth

Anslye Chatham, a 24-year-old public school teacher in rural Mississippi, had covid-19 just before the birth of her first child, as did her husband. When the couple arrived at the nearest hospital, 90 minutes from home, for a scheduled caesarean section, they were both quarantined and neither was symptomatic.

“But when I got to the maternity ward, I encountered a lot of hostility from the nurses,” she said. “I was told that my husband could not be there.”

She had an extremely stressful, lonely birth, she said. There was no direct skin-to-skin contact, no baby swaddling to bond with Dad, no time for a crib, she said. If it weren’t for the nurse who took care of herself to take a few pictures, Chatham says she wouldn’t have a way to visually mark the first moments of her daughter’s life. It was two hours before she caught her.

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

As someone who had been diagnosed with anxiety years earlier, Chatham says she expected mood disorders to be a challenge before and after pregnancy. But after a few weeks of bliss for the new mom, she says the hospital experience has begun to tilt her into a spiral of postpartum distress, a sharp guilt for depriving her and her daughter of something from the start.

“I mostly feel guilty for not spending that time with her – or for not fighting during that time with her,” she says.

Those worries were heightened by the stressors of her high school job in a small town in the Deep South and her life in a state that doesn’t offer paid maternity leave.

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

She was led through the process by Nell Blakely, a 66-year-old leader of the local lactation support network La Leche League. Although the pandemic forced La Leche League to include its support groups online, Blakely’s proximity became a source of consolation.

“She lives down the road from me,” Chatham said, “and she would give me such great advice on things like twist problems.”

Breastfeeding not only alleviated her worries, but also some of the long-term trauma of a stressful birth.

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

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