Beyond the Bump: Embracing Self-Advocacy in Maternal Care
Important Acknowledgement: I do want to address that some communities have more options than others and having a range of providers to choose from isn’t always an option. These “maternal healthcare deserts” as well as systemic racism and provider biases often make it more difficult to build trust in healthcare providers.
Many pregnant and postpartum clients I’ve worked with over the years have shared that they had little to no idea of what to expect in regards to their mental health experience and how this could possibly change. I’ve heard countless stories of overlooked mental health symptoms, those written off as a “normal” motherhood experience, or the baby blues that will “get better in time” even though it’s been months. They’d leave their appointments second-guessing themselves and their experiences, settling on internal narratives that they are failing as mothers because something must be wrong with them if they are struggling, right?
The good news is that although perinatal mood and anxiety disorders (PMADs) are more common than you may think (an estimated 1 in 5 birthing people and 1 in 10 non-birthing partners), they also have good treatment outcomes with early detection and intervention. Psychotherapy is typically a recommended first line treatment, followed by medication management, or a combination of the two.
While awareness of PMADs is growing, many healthcare providers continue to gloss over important conversations on signs/symptoms of PMADs. It was only in 2015 that the American College of Obstetrics and Gynecology (ACOG) recommended the use of screening measures, which are only effective if providers have some training on signs/symptoms of PMADs and access to mental health providers for referrals. While I could spend hours discussing the systemic barriers that contribute to this, the reality is that we have to start with what’s in our realm of control - self-advocacy.
Self-advocacy really starts with finding a perinatal care team that helps you feel seen, heard, and respected. This might mean getting personal recommendations from family and friends, taking a look at their website and social media to get an idea of their professional values and training. Sometimes it takes going to a few appointments and getting a feel for your interactions with providers and giving yourself permission to change providers if it is an option. Finding a provider that you feel comfortable with is essential since the perinatal period can be an incredibly vulnerable time.
Risk factors include:
Previous personal history (or family history) of mental health symptoms such as depression, anxiety, bipolar disorder, obsessive-compulsive disorders, or psychotic disorders.
History of significant emotional shifts due to hormonal imbalances (i.e. PMS, thyroid issues, diabetes).
History of trauma or abuse.
Limited or no family or social support.
Relationship issues or interpersonal violence.
Prior miscarriage(s) and/or stillbirth.
Pregnancy/birth of multiples and/or NICU stay.
It’s important to note that just because you have one or more of these risk factors doesn’t mean you’ll automatically develop a PMAD, it’s just something to have on your radar as share with your medical team. Additionally, it is possible to develop a PMAD during one pregnancy and not with another.
Oftentimes, it can be difficult to notice if you are experiencing a PMAD because it can start to feel like a part of you. Partners, close friends or family might pick up on changes earlier than you, so it’s also important for your primary support system to be aware of signs/symptoms of PMADs as well.
Signs & Symptoms of PMADs
Feeling depressed, empty, or hopeless
Difficulty sleeping, even when the baby sleeps
Significant changes in appetite, energy, or weight
Frequent worrying and difficulty controlling worries
Seeing images/hearing sounds that others do not see/hear
Frequent unwanted or scary thoughts
Irritability, rage
Feeling disconnected from yourself or “off”
Thoughts of harming yourself or the baby
Postpartum Support International provides a more extensive checklist that you can print and bring to your prenatal/postpartum appointments to serve as a discussion guide.
As women, learning to advocate for ourselves in the healthcare system might not come easily and feel overwhelming. Keep in mind that you are not alone and not to blame for any mental health symptoms you might be experiencing. Use your support system and if you don’t have one, reach out to schedule a free consultation. You don’t have to face this alone!
Postpartum Support International (PSI): Call the PSI Helpline at 1-800-944-4773 or text "Help" to 800-944-4773 for confidential support and information.
Website: www.postpartum.net
The National Suicide Prevention Lifeline: If you’re in crisis or need immediate support, call 1-800-273-TALK (1-800-273-8255) or dial 988.
Website: suicidepreventionlifeline.org
The Maternal Mental Health Hotline: A free, confidential, 24/7 support hotline for moms experiencing mental health challenges before, during, and after pregnancy.
Call or text: 1-833-9-HELP4MOMS (1-833-943-5746)
