Part I: Perinatal Mental Health

2018 held a lot of surprises for me. I got pregnant, sort of unexpectedly, which caused me to relapse into a depressive episode that was similar to what I experienced after Mary Clare’s birth. The pregnancy is such a blessing but the mental health struggles were not welcome. However, looking back I’ve realized that this relapse brought me so much strength, understanding and a passion I didn’t have before. For the past 6 months, I’ve received treatment from the perinatal psychiatry program at the Zucker Hillside hospital. Not only has it helped me recover but it has also taught me about perinatal psychiatry and given me the ability to advocate for myself.

When I struggled initially with postpartum depression and anxiety, I was treated by my primary care doctor. My primary care doctor is an exceptional general practitioner. He treats mental health as well as any general practitioner should. I continue to see him and trust him with my care. Like the title states, he is a general practitioner. He does not specialize in perinatal psychiatry, nor should anyone expect him to. I believe that a primary care physician does not have the specific tools or training to provide perinatal mental health care. Perinatal mental health care focuses on the unique behavioral and mental challenges women experience during and after pregnancy.

Through my journey with postpartum and antepartum depression and anxiety, I have learned a lot.

First, perinatal mental health is very unique and as such, requires specialized care. Let's consider all the specialists you know of. We see gynecologists, podiatrists, allergists, dermatologists, urologists…all of these specialists for our physical health.

What about our mental health? When we have a mental health issue we usually go see a "therapist," or a "psychiatrist." It is not expected that we would seek out specialized mental health care. Many people view mental health as a specialty yet mental health is really a massive field. I believe these views go hand in hand with the fact that mental health continues to be stigmatized. Mental healthcare is not valued the way physical healthcare is valued. Yet the truth is, your mental health and your physical health are both equally important elements of your overall health. To be truly healthy, I believe both mental and physical health must be tended to.

I consider myself very hooked into my mental health and the mental health community. I am one of the lucky people to have always had easy access to healthcare. If I need to see a doctor, I find one and I go. I do not have to worry about cost or access. Yet even with these privileges, I found there was so much I did not know about my own mental health struggles. I have learned about the unique needs of a woman experiencing mental health issues during or after pregnancy. I learned that women who suffer from postpartum depression are typically advised to remain on their medication for at least one year postpartum, even if symptoms fully dissipate. The likelihood of relapse within the first year after childbirth is high. I learned about the specific medications that are totally safe to take during pregnancy. I learned that untreated, long term depression/anxiety can be dangerous to an unborn baby. These are things I didn't know and my general practitioner did not know either.

***I am not a medical professional nor do I have any medical training. None of what I share here or anywhere should be considered medical advice.***

This leads me to my next point. It became really clear to me over the holidays that perinatal mental health is vastly underserved in the U.S. On Christmas Eve, I was talking about my blog with a family member, it lead us to discuss my recent mental health challenges. I told him that the program I am involved in, only opened in March of 2016 and that there are only two inpatient perinatal programs available nationally. He was floored. The lack of perinatal care available is astounding.

According to PSI, there are twenty-two perinatal psychiatry programs nationally. Twenty of those programs only offer outpatient care while a mere two (Zucker Hillside being one of the two) offer both inpatient and outpatient care. To put this into perspective, it is estimated that 20% of women in the United States will experience perinatal mood and anxiety disorders. That prevalence raises to nearly 40% for women of low socio-economic status. If that’s not a seriously underserved population, I don’t know what is. When I really sat with the injustice of these statistics, I got really angry After the initial anger of this inequity dissipated, I started to focus and recognize that this is the stuff of change. It makes me want to make a change.

I would like to help women get access to the care they need, this care has helped me heal. I want to educate women so they can advocate for themselves, there was so much I didn’t know. Honestly, I have no idea how this passion is going to take shape. There is that voice inside of me that says, “you can’t make sweeping change, you're just another 30 something white girl from Long Island, you don’t have any training in mental health counseling or healthcare policy, what do you think you're going to do?” All the women not receiving the care they so need help me quiet that voice though.

For now, I am focused on educating women by writing about my experience and sharing it as far and wide as I can. I go to therapy group so I can support the women who are in the midst of an episode, like I was not long ago. Each day, I focus on being honest and real about motherhood in an attempt to slowly dismantle the unrealistic expectations of motherhood that society has created. I really don’t know where it will take me but I know I won’t stop trying.

xx

EJK