Adrienne Griffen had just given birth to her second child in 2001. The “baby blues” that had quickly subsided after her first pregnancy did not seem to be going away after her second – and they were much more intense.
When she talked to her doctor, they abruptly informed her of their duty to call Child Protective Services if she hurt her children.
“I am here to get help, so I don’t hurt my children,” she replied.
“Well, we don’t want another Andrea Yates,” she recalls the doctor saying, referring to the Texas mom who drowned her five children in the bathtub that same year.
It took another six months after that conversation for Griffen to get the help she needed for her postpartum depression.
“It was like banging my head against a brick wall,” Griffen, now CEO of the Maternal Mental Health Leadership Alliance, told CNN.
Twenty-five years later, a lot has changed, she said – but not enough.
Conversations about maternal mental health that once existed only in hushed tones have broken into mainstream consciousness amid the ongoing trial of 36-year-old labor and delivery nurse Lindsay Clancy, who says she strangled her three young children while experiencing postpartum psychosis, and the death of beloved actress Hayden Panettiere, who was outspoken about her struggles with postpartum depression. Women are telling their stories on the internet, at work, at home and in public – and experts say it’s a long overdue moment of reckoning with a system that has neglected mothers in need.
For many, Clancy’s trial is the first they’ve heard of postpartum psychosis, a severe and rare mental health condition, which can affect up to 2 of every 1,000 women after childbirth.
But mental health issues – whether depression, anxiety or psychosis – affect as many as 1 in 5 women in the US during pregnancy and in the year after birth, and some experts say a culture of shame has led to serious issues going undiscussed, undetected and untreated.
Out of the shadows
The sudden death of Panettiere, who spent her childhood and teen years starring in big-budget films, has infused nuance into the conversation about maternal mental health.
Many of the young women who grew up watching Panettiere’s movies saw themselves in the bold, passionate and complex characters she brought to life on screen. Years later, they saw themselves in the actress’ own fraught experience with motherhood, which she had long spoken about publicly.
“There’s a lot of stigma around postpartum, and there’s a lot of misunderstanding,” Panettiere said in a podcast interview in May. “It’s on a spectrum. It’s on a scale, and fortunately, I never felt any hostility or negativity towards my child, thankfully, but I wasn’t connecting with her the way that I knew I should be.”
Panettiere said she was fired from a decade-plus brand deal with Neutrogena after speaking out about postpartum depression in a 2015 interview on national TV.
After Panettiere’s passing, Neutrogena released a statement saying the company is deeply saddened by her death.
“We are proud to have partnered with her and understand that we made her feel unsupported during a very difficult time. This is not what Neutrogena stands for or who we want to be,” the company said in a statement posted Thursday.
That same day, hundreds of women gathered outside the courthouse where Clancy is standing trial, wearing bright pink, in an attempt to raise awareness around maternal mental health. The groundswell of support has been echoed by women across the nation who have seen some of their own experiences reflected in Clancy’s descriptions of her postpartum mental health struggles and difficulty navigating the system to get help.
Navigating the system
Most new mothers are lying in a hospital bed, recovering from birth with their hormones out of whack, and immediately handed an infant to care for, Griffen said.
“In no other situation do we have one hospital patient, the mother, caring for another hospital patient, the baby.”
Care coordinators – health professionals who help patients navigate the medical system – are often assigned to people diagnosed with cancer or other serious health issues, but they’re rarely made available to postpartum mothers, Griffen said.
With all the attention focused on the newborn, struggling mothers can often fall through the cracks, and a lack of support and resources can make matters worse, she noted.
The American College of Obstetricians and Gynecologists has guidelines for how healthcare providers can screen pregnant and postpartum mothers for mental health issues, but Griffen said these have yet to be practically implemented across the US health system. A lack of reporting requirements also makes it difficult to know how often the guidelines are being followed, she added.
Maternal mental health issues like anxiety and depression are more common than better-known conditions such as gestational diabetes, said Dr. Andrea Diaz Stransky, assistant professor of psychiatry and behavioral sciences at Duke University.
“Even though we have guidelines for how to screen for both conditions – gestational diabetes as well as perinatal mood and anxiety disorders – we don’t have the same level of implementation,” Diaz Stransky said.
Even doctors who are screening their patients for these conditions sometimes have a limited array of treatment and referral options, she noted.
“If I screen and it’s positive, the waitlist for therapy is so long that this patient might not be able to access that soon enough,” she said.
The system can be difficult for even physicians to navigate, she noted, let alone someone experiencing a mental health crisis.
It takes a village
It takes a village to raise a child, and it’s important to prepare the whole village – not just the mother – for the perinatal experience, Diaz Stransky said.
It starts with a care team, educated and equipped to meet a patient’s needs. North Carolina, where Diaz Stransky practices, has a specialized phone line doctors can call to consult a reproductive psychiatry expert and ask for resources.
Letting mental health conditions go untreated is a risk to both the pregnant parent and the baby, Diaz Stransky said. For instance, untreated anxiety and depression are linked to increased risk of preeclampsia and preterm birth.
For those who need help, treatment can include specialized therapies or medication, she said.
Partners and family members should also be prepared for what to expect during the massive life transition that comes with having a child, including their own mental health challenges, she said. It’s possible for partners to experience postpartum depression themselves, she added.
“We need to know who else would be part of that village and have a system to provide psychoeducation to all of them, not just the mom.”
In the rare case a mother is unable to care for her child for any period of time, it’s important to know who in her village could step in, Diaz Stransky said.
“Just like if a parent all of a sudden had appendicitis and had to have emergency surgery, they would need to designate someone to care for baby,” she said.
Breaking down barriers to care
Mothers with mental health issues can face complex and layered barriers to care.
Many people living in the US struggle to access any kind of regular healthcare due to a lack of insurance, logistical challenges, fears over immigration enforcement and more. But even those with insurance can be affected by a fractured system, said Joy Burkhard, CEO of the Policy Center for Maternal Mental Health.
The majority of obstetric providers “are paid one flat rate for all the care they provide, from when pregnancy is confirmed to six weeks postpartum, and this structure was created 30 years ago,” Burkhard said.
“There’s been disincentives to address mental health, because mental health was never considered part of these bundled payments at the outset, 30 years ago,” she added.
Burkhard’s organization advocates for changes to this and other policies, like a bill currently being considered at the federal level, aiming to lower the out-of-pocket cost of perinatal care for mothers.
She hopes the increased awareness around mothers who are experiencing mental health issues will encourage those in power to pursue policy change to help them.
But even when care is available, stigma can still present a huge barrier.
Women who are typically high-functioning are often able to hide the fact they are struggling, licensed clinical psychologist Dr. Noelle Santorelli told CNN’s Sara Sidner this week.
“You can use compensatory mechanisms to sort of cover up what you’re experiencing,” she said.
And it isn’t just the fear of judgment.
“Women get really afraid to be separated from their children, right? There’s a fear that if they report what they’re really experiencing, their children might be taken away,” Santorelli said.
She advises people who are struggling to talk to someone trusted – and to be specific about the thoughts and feelings they’re having – so loved ones can advocate for them. Just being honest can help, she said.
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