Giving birth is traumatic. Risks of emergency C-sections, vaginal tearing, and many other possibilities can leave those giving birth feeling frightened and alone. However, these are just the physical aspects of giving birth. The mental trauma that you can experience during and after is not as heavily discussed.
Postpartum psychosis is a medical condition that occurs most often within two weeks of giving birth. Mothers can experience hallucinations, manic behavior, delusions, and other extreme symptoms, even if they have never had a mental illness. Although rare, only 1 in 1,000 mothers experience the illness, it can be devastating and dangerous. Five percent of those experiencing this illness will attempt suicide, and four percent will attempt to hurt or kill their baby.
But this is not a new experience. Postpartum psychosis has been noted as far back as 400 BC, with Hippocrates detailing the experience of a patient experiencing delusions and confusion just days after giving birth. Literature dating back to the nineteenth century also explores this issue. “The Yellow Wallpaper”, written in 1892 by author Charlotte Perkins Gilman, follows a woman who has just given birth, experiencing what she refers to as “a temporary nervous depression.”
As we continue to read we realize that she is not being taken seriously by those around her. She eventually sees a woman in the wallpaper and then in a true fit of psychosis, believes she came from the wallpaper herself. At her breaking moment, she even thinks:
“To jump out of the window would be admirable exercise, but the bars are too strong even to try.”
This story was written after Gilman’s own experience with misogyny and misdiagnosis by her doctors, whose lack of help caused her nervous breakdown to last years.
Women are often misdiagnosed or dismissed when visiting their doctors, leading to health complications later in life. According to the CDC, twenty percent of women reported mistreatment while receiving maternity care. Women of color reported even higher rates, at thirty percent.
Maternal mortality rates are only rising in the U.S, with 32.9 deaths per 100,000 in 2021. This is ten times as high as other high income countries, such as Australia, Japan, and Spain. These countries have a rate of about 2 to 3 deaths per 100,000. Clearly, there is a maternal healthcare crisis occurring in America.
If there is one thing we can take away from this, it is that historically women who give birth in the United States are often mistreated, and not taken seriously. As the narrator of the story explains:
“If a physician of high standing, and one's own husband, assures friends and relatives that there is really nothing the matter with one but temporary nervous depression - a slight hysterical tendency - what is one to do?”
So what is one to do?
The first thing is to recognize that this is happening in the first place. By acknowledging the fact that maternal health care needs serious improvements, we can move forward from a place of knowledge and understanding. The physical and mental effects of giving birth can take a heavy toll, and by recognizing when something is wrong and building a support system of people who are also educated on the signs of a crisis can make a world of a difference.
Advocacy is another huge step towards improving maternal care. If a woman or an individual who can give birth does not feel confident about a doctor’s diagnosis or advice, especially while pregnant, they should feel empowered to seek a second opinion. This does not just fall on the patients however, advocacy should also occur within the doctor’s office itself.
The Association of Maternal and Child Health Services is an example of an advocacy group you can get involved in right away. This group focuses on growing mental health services for pregnant people, expanding health care services, and much more.
Support is vital to pre and postpartum care. Postpartum Support International is a peer to peer support group available for those postpartum. There are over twenty different support groups, ranging from birth trauma support for BIPOC birth givers, pregnancy mood support groups, and even a support group for families affected by postpartum psychosis. This resource is invaluable for those who are experiencing trauma during or after pregnancy, as well as improving the mental health side of maternal healthcare all together.
Overall, there needs to be an attitude change when we talk about pregnancy. The trauma of giving birth is often overlooked, and resources are not widely shared. Offer support to those around you who have been or are pregnant, and learn the signs of serious postpartum mental health issues. If you or someone you know is experiencing a postpartum mental health emergency, do not hesitate to call 911, or reach out to the SAMHSA helpline at 1-800-662-4357.
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