• Brittany Evans

Maternal Mortality: When It's More Than the Baby Blues


American culture tells us that pregnancy and childbirth are two of a woman's happiest occasions throughout her life. Unfortunately, this is not the case for some women. Postpartum depression can occur within twelve months following delivery, though most cases of postpartum depression occur within the first six weeks after delivery. Symptoms of postpartum depression can manifest in many ways, but the most common symptoms are depressed mood, loss of interest, sleep disturbance, appetite disturbance, loss of energy, feelings of worthlessness or guilt, diminished concentration, irritability, anxiety, and thoughts of suicide.


The prevalence of self-reported postpartum depressive symptoms was 13.2% as reported by the CDC in 2020. Those numbers translate to approximately one in eight women. The CDC also states that postpartum depression accounts for approximately 9% of maternal deaths. New mothers were offered a Pregnancy Risk Assessment Monitoring System (PRAMS) to examine the prevalence of self-reported postpartum depressive symptoms. The PRAMS also considers whether a health care provider inquired about depression during prenatal and postpartum health care visits until about six months postpartum to gather information for the CDC study. The CDC notes that the purpose of PRAMS is to find out why some babies are born healthy while others are not.


When focusing on the mother's mental health, the Edinburgh Postnatal Depression Scale (EPDS) is a screening questionnaire offered to new mothers to help identify depressive symptoms during the postnatal period. Centre of Perinatal Excellence, COPE, recommends all new mothers take the EPDS twice, ideally six to 12 weeks after birth. Clinical judgment is integral to interpreting EPDS scores, as in some cases the score may not accurately represent a woman’s mental health. For example, a woman may have a low score, even though there is good reason to believe that she is experiencing depressive symptoms. A very high EPDS score could suggest a crisis, other mental health issues, or unresolved trauma. There is no definitive cause of postpartum depression.

Postpartum psychosis occurs in approximately one in 1000 women within the first four weeks after delivery. The onset of postpartum psychosis is rapid and can occur without warning. As early as two to three days after childbirth, the patient develops paranoid, grandiose, or bizarre hallucinations, mood swings, confused thinking, and disorganized behavior that represent a dramatic change from her previous functioning. The onset of postpartum psychosis can occur with any child, at any age of a woman's life. In year one after childbirth, suicide risk increases 70-fold, and suicide is the leading cause of maternal death up to one year after delivery. Of 1000 women with postpartum psychosis, two committed suicide. These women often used more irreversible and aggressive means (self-incineration, jumping from heights) compared with most reports that indicate women generally complete suicide nonviolently (overdose). Therefore, physicians and health professionals must gauge the safety of their patients by inquiring about suicidal ideation—thoughts of dying, feelings of life not being worth living, active plans to take her life, access to weapons, and past suicide attempts. Postpartum psychosis is often found in patients who have a prior history of mental illness, or who have relatives with mental illness; the nature of the birth (birth without complication or birth with complications) has not been shown to always affect the onset of postpartum psychosis.


Emily Dyches is an example of a woman who suffered from severe postpartum depression that was not treated properly. Emily had just given birth to her fifth child when her husband, Eric, noticed a change in her behavior. Emily and Eric exhausted all medical resources available to them before Emily voluntarily admitted herself to a mental hospital. The mental hospital did not accommodate new mothers battling postpartum disorders, so after eleven days Emily returned home. Emily felt the symptoms of her diagnosis return with force. She sought a safe place and opted to visit her parents. As her father was driving her home, Emily began to experience an extreme panic attack. While on the phone with Eric, her father pulled the car over to try and comfort her, but simultaneously Emily fled to escape the collapsing feeling she was experiencing and ran, disoriented, into oncoming traffic on a busy interstate where she was fatally struck by a semi. This is just one incidence of the consequences of postpartum disorders. Emily's family has set up the Emily Effect Foundation to help mothers and families in similar situations. The effects of postpartum psychosis can be devastating to mothers and other family members and postnatal testing does not always detect the severity of the psychosis and depression. As new mothers and supporters of new mothers, communication is key to maintaining a healthy life; reach out at the first sign of any unusual behavior or feelings, there is always help available.

 

Speaking Plainly:

  • Postpartum depression is a common disorder that can affect new mothers anytime throughout the first year after birth.

  • Postpartum depression symptoms can vary from loss of interest, sleep, and appetite, to irritability, anxiety, and depression.

  • Postpartum psychosis is much less prevalent but is much more severe than postpartum depression.

  • Postpartum psychosis can be a rapid onset of suicidal ideations, and thoughts, hallucinations, and delusional behaviors.

  • If you or someone you know is suffering from a postpartum disorder contact a local healthcare provider or the national suicide hotline at 800-273-8255.