While being held at arm’s length by her mother, 7-day-old Sofia wouldn’t stop crying. My exam room in South Los Angeles was cold and the infant was hungry. Sofia’s mother, Rocio, wasn’t cuddling her child and didn’t want to breastfeed her.
Rocio—whose name, along with Sophia’s name, has been changed to protect their privacy—has six older children. Speaking through a Spanish interpreter, Rocio said that she already had to return to work as a self-employed merchant—her family needed the money. She told me she was sad but said it didn’t matter.
But it did. Sofia was losing weight.
As Sofia’s pediatrician, I couldn’t miss her mother’s overwhelming signs of postpartum depression. It’s a threat to the wellbeing of babies, their mothers and families.
Maternal depression, also called postpartum depression, is defined as intense feelings of sadness, anxiety or despair after childbirth that interfere with a mother’s ability to function. It’s a major public health problem—nationwide, nearly 15 million children live with a depressed mother.
Women living in poverty have higher rates of depression than the general public. This is amplified during the perinatal period, with nearly half of all low-income women, such as Rocio, reporting symptoms of depression.
Nationwide, depression affects 10 to 25 percent of all pregnant women during the perinatal period, defined as three months before pregnancy to one year after giving birth. Across California, the rate is about 20 percent, and in Los Angeles County, it’s 26 percent.
Approximately one-third of Latina, Native American and African-American mothers reported postpartum depressive symptoms in a 2012 survey by the LA County Department of Public Health. That was almost twice the rate reported by white and Asian mothers in the survey.
Symptoms of postpartum depression vary but may include frequent crying, feeling angry or fearful, withdrawing from loved ones, feeling detached from the infant and doubting one’s ability to care for the baby.
Poverty, stress, a personal or family history of depression, low social support, being a teen mom and having pregnancy complications, are among some of the risk factors. But, the illness can occur with any pregnancy.
Depressed mothers may have disrupted mother-baby bonding and decreased emotional and physical health.
Untreated, postpartum depression can become chronic. Women with chronic depression often have lower employment and income, and they are also more likely to be involved with publicly-funded assistance programs and child protective services, according to the Rand Corporation.
A mother’s postpartum depression also affects her infant, leading to impaired physical, emotional and cognitive development. Healthy brain development in a baby requires secure, nurturing interactions with a primary caregiver. Babies with a depressed caregiver are at risk for neglect and abuse. Maternal suicide and infanticide are the most feared consequences. Pregnancy-associated suicide is one of the leading causes of maternal deaths.
Grass-root and professional organizations are working to change negative perceptions about maternal mental health. The California Maternal Mental Health Collaborative was founded in 2011, which evolved into a nationwide program called 2020mom. The group’s mission is to close the gaps in understanding maternal mental health.
In 2015, the American College of Obstetrics and Gynecology recommended all women be screened for symptoms at least once each trimester using a standardized questionnaire. Northern California Kaiser researchers showed that screening women and referring them to treatment improve outcomes. However, in the 2012 LA County survey, fewer than two-thirds of women reported being screened. Even fewer follow through with getting treatment. One factor: Depressed women are less likely to comply with pre-natal and post-delivery care.
“I have no stigma and I want to help others realize [postpartum depression] is so normal,” said Ellie Berkowitz Handler, representative from Maternal Mental Health NOW. MMHN is a Los Angeles County public-private consortium of 50 organizations. In December 2017, the organization issued a briefing paper to improve maternal mental healthcare in LA with specific recommendations for raising awareness, policy and advocacy activities, and improving training for health care providers.
Handler joined MMHN in 2010 after she suffered perinatal anxiety following the birth of her first two children.
“For me, the symptoms were physiologic,” Handler said. “I had nausea, dry heaves and racing heart beat.”
She lived in constant fear that something bad was about to happen to her babies. Now, she tells her very personal story to help others.
Handler said she had a wealth of support and access to treatment but acknowledges that not all women do. Some don’t receive mental health services because their insurance doesn’t cover psychological care. Others don’t have access to therapy because of language and cultural barriers or inflexible jobs. And some fear they will be socially stigmatized if they seek help.
Rocio declined therapy because of household demands.
Fortunately, she did accept help from a grant-funded program for at-risk women and their infants. The program provides resources and home visits by a Spanish-speaking health worker, who models healthy parenting.
With this support, Rocio’s attachment with Sofia is improving. At her two-month check-up in December, Sofia was smiling, breastfeeding well and gaining weight. Although not out of the woods, Rocio and Sofia are on a healthier path.