1 in 4.

That is the number of new moms that will experience symptoms of a postpartum mood disorder.  It was previously thought that postpartum mood disorders present themselves at some point during the first year of motherhood.  However, a new study by the National Institutes of Health suggests that 25% of women “experienced high levels of depressive symptoms at some point in the three years after giving birth.”

1 in 4 women.  Three years.

And, mamas, how many times did you receive postpartum care?  It is standard that new moms return for ONE postpartum visit, at six weeks.  Generally, beyond the six week mark it is up to your child’s pediatrician to conduct screenings for postpartum mood disorders up to six months postpartum.  

However, speaking as someone who fell between the cracks of the healthcare system – and given the new research that postpartum mood disorders can present themselves up to three years after giving birth – those few checks are simply not enough.

I always found it somewhat disturbing that as an expectant mother, you receive care monthly – and weekly as you approach full-term – but as a postpartum mother you only receive care at one predetermined appointment.  We spend so much time and energy caring for our babies, but when do we start caring for the mother?

The inherent issue with these infrequent postpartum checks, is that they assume that your symptoms have presented themselves by the time you are screened at the appointment.  But, what if you are like I was, and felt fine at the six week postpartum appointment?  

After the birth of my son, I experienced severe postpartum anxiety.  The sort of crippling anxiety that led me to near panic attacks if he was not within my reach.  It was heart racing, skin prickling, lightheadedness at the mere thought of leaving the safety of the bubble we had created at home.  

However, these symptoms did not peak until around eight weeks postpartum, so at my six week checkup when my doctor asked how I was doing, I quietly mustered up the words, “I’m doing fine”.  She took one look at me and said definitively that I was doing “much better than most other moms” she sees.  I vividly remember the shock and confusion I felt by her statement.  I couldn’t believe how easily I had been brushed off, all of my symptoms missed.  At that time, all I knew was that I didn’t feel like myself.  But when a medical professional assures you that you are okay, and that what you are feeling is all within the spectrum of normal, it causes you to second guess yourself.  Everyone was telling me that what I was feeling was to be expected.  That motherhood is an adjustment, or it’s just the baby blues, or you’re just exhausted – it will pass.  Except it didn’t pass.

It was a long six months before I began to receive the care that I needed.  I felt embarrassed that my adjustment to motherhood seemed to not be coming naturally to me, and that if I spoke up about my mental health and sought out help I was somehow less of a mother.  It wasn’t until a lactation consultant recognized in me what I already suspected – that what I was feeling were symptoms of a postpartum mood disorder, more specifically postpartum anxiety.  The moment that those words were spoken, I cried tears of relief.  I was finally being seen.  She assured me that, while what I was feeling was common, it is not “normal”.

So, then there is the issue of women experiencing depressive symptoms for up to three years after giving birth.  What if you are like me, and have more than one baby during that three year span?  When do prenatal mood disorders end, and postpartum mood disorders begin?  It’s hard to know if the depression that crept into my second pregnancy and postpartum period was new, or if the depression had always been lingering under the surface since my first postpartum experience with anxiety.  Given my history of postpartum anxiety, I was at a higher risk for prenatal and postpartum depression with my second baby.  Therefore, I received regular screenings at my prenatal appointments.  Every single time I took the screening, I was rated as being “moderately depressed”, yet was never offered any follow-up care for my symptoms.  I was told by my provider that if my symptoms remained steady that there was no reason for concern.  In other words, if I remained steadily depressed – but just a little bit – it was of no concern to them.  Once again, the system failed me, just as it has failed countless mothers.  

After the birth of my daughter, and amidst a raging pandemic, I returned for my postpartum checkup.  Due to concerns regarding the spread of COVID-19, I was required to verbalize my responses to the postpartum depression screening as opposed to writing them down privately.  As I tried to answer the questions as honestly as possible, I could feel the heat rising in my chest and hear the stutter in my voice.  I was filled with shame as I answered the questions that should have remained between myself and my doctor, yet I was oddly hopeful, so I pressed on.  

That hope that I felt, however, was fleeting.  I explained to my doctor that I wasn’t sure if how I was feeling was due to postpartum depression, or because of the fact that I had just given birth during a pandemic.  She quickly responded, “probably both”, and then continued on to give me some advice on how to combat postpartum depression.  However, the usual recommendations of support groups and to avoid isolation was in direct contradiction to the stay-at-home order we were under.  I left that appointment feeling defeated, as if I was drowning and there was no way out from under the water that was quickly rising.  

My experience is not a new one.  I am not the first mother to be disregarded, disrespected and brushed aside, and unfortunately I will not be the last.  Our system of caring for new mothers is flawed, and it is leaving us to fend for ourselves during a time that we should be supported the most.  We need to raise our voices and fight for a new standard of care – one that includes more postpartum visits taking place over the course of several years, and in an environment that is safe, nurturing and non-judgemental.  We as mothers also need to be aware of the symptoms of postpartum mood disorders, not only of depression or the “baby blues”.  Speak openly about your experiences, your feelings, to anyone who will listen.  You could be saving a life. We are not alone in this, and together we can break the stigma.  

I am 1 in 4, and this is my story.