Moving Perinatal Mental Health Forward
So that pregnant women get the care they need.
Posted Jan 25, 2021
This is a very different post entry.
A few weeks ago, I was named the Lois Hole Hospital for Women Cross-Provincial Chair in Perinatal Mental Health. This is a wonderful opportunity to move perinatal mental health forward in the Province of Alberta and in Canada. At the launch of the chair at the Lois Hole Hospital for Women in Edmonton, Alberta, on September 14, 2016, I shared this message.
It is a sobering message. It is a message of hope.
One of our faculty’s doctoral students suggested that I post it on the blog. Here it is.
The story that begins over 10 years ago
In 2003, Paula discovered she was pregnant with her first child. She and her husband were delighted with the pregnancy and this new beginning for their family. But what Paula most remembers about that time is the anger and anxiety that she felt most days through most of her pregnancy.
She delivered a healthy baby boy, but by the time her baby was 2 months old, she was suffering from a deep depression that lasted the entire first year of her baby boy’s life. When she talks about this time in her life, she is saddened because she remembers so little of the first year of his life.
In 2005, Paula and her husband were pleased they were going to have their second baby. But the story was the same—the anxiety during pregnancy, the depression after birth, and the blur of her second little boy’s first year.
Three years later, Paula became pregnant with her third child. She was terrified that she would experience the same anxiety and depression beginning in pregnancy—and that is exactly what happened. After her baby girl was born, she experienced yet another deep depression. She describes thinking about “ending it all” every day for the first year of her little girl’s life. She had a plan, and she knew that the only thing holding her back was that this little girl needed her.
Paula’s story is not unique. In fact, she’s only just now, 10 years later, started talking openly about her struggles. Looking back, she says it’s like having a dirty little secret that you keep in the closet.
We have an opportunity to move perinatal mental health care forward in the province of Alberta to break the kind of cycle that Paula experienced. We are well-positioned to be a leader in perinatal mental health care in Canada. But we need to listen to the science.
Science has brought us to understand that if we improve pregnant women’s mental health, we can improve mom and baby outcomes.
I’d like to challenge us to think about new science that is shifting perinatal mental health care globally.
We used to think that the main mental health problem in the perinatal period was postpartum depression.
But the science doesn’t support that anymore, and how we set up our mental health system and direct our resources should follow the science.
Here are four pieces of evidence that are shifting global perinatal mental health care toward earlier, prenatal mental health care:
1. We used to think that depression in pregnancy went away on its own.
Now we know that without treatment, 40 percent of women with depression in pregnancy still have symptoms when their child enters school.
2. Most of our resources go into screening and treating postpartum depression.
Now we know that 50 to 80 percent of women with postpartum depression or anxiety had symptoms that we could have detected and treated when they were pregnant. We need to move this earlier, into pregnancy, if we are to have the greatest impact and use our resources optimally (read more in "Screening for Depression During Pregnancy").
3. We used to think that postpartum depression was the mental health problem that posed the greatest threat to our children’s health.
Now we know that chronic depression and anxiety, beginning in pregnancy, are emerging as the major risk.
We also know that depression that begins in pregnancy and carries on in the face of no treatment doesn’t have to be severe. It can be barely detectable and still increase the risk of suboptimal developmental and mental and physical health problems in our children.
4. Perhaps most pressing—there is overwhelming, incontrovertible evidence of the effect of stress, depression, and anxiety on the unborn fetus, doubling the risk of child mental health, physical health, and developmental problems on this generation and the next.
I’d like to invite you into our vision. Imagine, if you will, what would happen if we had:
- A system that allows all pregnant women in Alberta to be screened for mental health problems and that could be implemented within a matter of months
- The opportunity to break the long-term cycle of maternal mental health, so that women who had depression or anxiety while they were pregnant don’t still have to struggle with symptoms when their child enters Kindergarten
- The capacity to interrupt the intergenerational transmission of child developmental, mental health, and physical health problems that will most certainly affect one-third of our children exposed to prenatal anxiety or depression
This is the gift that this Chair offers. It offers the opportunity to continue building the science upon which we can found a universal system of perinatal mental health care.
All women can receive the mental healthcare they need
We can improve the lives of Albertan families.
Pregnant? Your emotional health matters.
We are encouraging pregnant women from all of Alberta to participate in a research study to support emotional health during and after pregnancy.⠀