Why is this an important topic and how might this resource help?
Transcript
Hi, I’m Dr. Hannah Schwartz. I’m a psychiatrist at St. Mary’s Hospital. I treat women with a wide range of different mental health issues across the peripartum period. So, during pregnancy, postpartum.
As a McGill University affiliated hospital, I’m really lucky to also supervise family medicine residents. What I really enjoy is that there’s more and more of an interest in perinatal mental health. This gives some hope that there’ll be easier access to care in the future.
It’s like a wide range of problems, perinatal mental health. It could be anything from depression, anxiety, just too much stress during this period could be a problem for women. There’s a lot of changes. We really define perinatal mental health as kind of during pregnancy, which is the antenatal period, and the postpartum period. We consider it really up to a year postpartum to be the postpartum period that we’re interested in. The conditions can include anything that causes mental health difficulty for the woman, for the family system; depression, anxiety, sometimes post-traumatic stress disorder, any anxiety disorder like OCD. There’s also mood disorders that are included and some of the more severe kinds of psychotic disorders.
It’s pretty prevalent, when you include all of the perinatal mental health issues. The stats is usually about one in five women in Canada have some kind of experience with a mental health condition. It’s a problem because it affects the woman’s ability to function, it affects the woman’s ability to take care of themselves, of their baby, of the other children in the family.
A lot of women have difficulty seeking care, sometimes it’s underreported, it’s not recognized, or undertreated. So it becomes a problem more long term. It’s essential for the family system, for the mom, for the baby, that she be able to access care. What’s also less discussed is actually the issue, the perinatal mental health issues, also affect the non-birthing parents. They’re more at risk of having perinatal mental health issues when their partner is affected. This just highlights the need for a really inclusive approach to care.
The trajectory can really vary from person to person depending on so many different factors. It can depend on what the condition they have is, how severe it is, whether it’s mild, moderate, severe, or whether it’s a recurrent difficulty. It depends on their support system, on access to care. So, I wouldn’t say that there’s really one trajectory for all of these women. But, we do know that untreated postpartum depression can last. Some of them resolve spontaneously, for sure, the mild ones might resolve spontaneously, but there is a certain percentage that become chronic, or they’re still there at one year postpartum if they haven’t sought help or had access to treatment. So, it is important to treat these women as early as possible.
Any kind of mental health issues is actually, it’s becoming easier to talk about, but it’s still quite taboo. There are women who are reaching out on their own, but depending on culture, depending on family values, it still does remain taboo. So, many women feel ashamed, embarrassed. We have this idea of what pregnancy is going to be like; the glowing woman who’s pregnant or postpartum, the woman falling in love with their baby. When a woman doesn’t have those reactions, a lot of the time there’s guilt. So, sometimes there’s still those barriers to access care.
I believe – I’m hoping over time that women will be able to more freely talk about how they’re feeling and access care. Hopefully online resources like this one can show women that they’re not alone and that maybe they’ll become more comfortable
I think what’s becoming more mainstream during pregnancy right now is the need to have timely care. So, psychotherapy for mild to moderate symptoms. I see that being more prioritized in our system, which is great. More and more, we’re having more access to data that’s showing that medications, not all medications but most medications, can be given during pregnancy and the postpartum period. Right now a lot of our care is kind of divided. It’s like, you get your obstetrical follow-up here, your mental health follow-up there, and I’m hoping in the future that care will be more integrated. These mother-baby units when moms need to be hospitalized postpartum. So, I’m hoping in the future that this will be prioritized so that we can keep moms and babies together.
It’s complicated for women to navigate this system, right? You get access to care in one area of your life like physical, obstetrics, for the baby, and then access to care for mental health in another. It’s possible to have babies even with severe mental illness with the right kind of support. So, as we get better at treating mental health issues, it gets easier to be a parent and to want to have children.
It’s okay to ask for help. Some women feel kind of embarrassed or ashamed, but asking for help, it doesn’t mean that you’re weak. It means that it’s a sign of strength. Recognizing your limitations, that you need help. Recognizing that you don’t need to go through this alone. You can speak to your doctor, maybe friends, a support group, anyone you feel that can help you. It doesn’t make you a bad parent. It’s important to seek help so that you could be more there for yourself, more there for your family, more there for your baby. A lot of women think that taking time out to take care of themselves rather than the baby can be seen as selfish, but taking time for yourself, making sure that you eat properly, sleep as much as you can, taking a few minutes for yourself, that’s not selfish. That’s really taking care of yourself and making you more of an effective caregiver for your baby. Allow yourself time to heal, to change, to adjust, you know, sometimes it takes a while. So, to have some empathy towards yourself and give yourself that time to heal.
During pregnancy, you have a lot of follow-ups with your obstetrician, right? You’re seen, like, every month, and every two weeks, and I think every week. So, that would be a really good place to discuss how you’re feeling, and they may have direct access to resources, so that would be a good spot. And you always have one postpartum visit with your obstetrician, so if it’s really not going well, then you can speak to them postpartum. It’s usually just one shot with the obstetrician postpartum, so if you’re having any issues, I think that would be a good place to start.
Otherwise, your family doctor, if you’re lucky enough to have a family doctor, or a nurse or a pediatrician, when they’re doing the baby’s wellness check, giving the vaccinations, you can speak up. I think it’s across Canada, there’s 8-1-1. It’s a free phone line that’s supposed to be a social worker or a nurse that’s able to let you know the available resources in your area and help you access care when needed. But it’s important to continue searching, because everyone needs different kinds of care, so continue searching until you get the care that you feel is most effective.
The online resource is a great way for women to hear other women’s stories. It can normalize their own experiences. When you’re depressed or anxious, you feel like you’re the only one going through this. Sometimes it’s difficult to speak to family and friends, you don’t want to let them know. But if you see a resource like this with women who have different experiences, you might say “Oh, I’m not alone” and it might just give you that courage to speak out to someone, speak out to a healthcare provider to get the help that you need. So, it can reduce stigma.
Sometimes women just talk about practical tips, what did they do in this situation? It might give other women ideas of where they can go. Hopefully through some stories – there will be some stories that are very difficult, but hopefully some of the stories provide some hope that you can recover. So, I think it gives a little bit of inspiration and hope that although they’re going through a difficult period, that they can get help.
For healthcare professionals, I think what it does is it brings the human aspect to what we learn about in classrooms and in theory. It gives more of a real world experience. I think it just can help us understand from the patient’s perspective how these issues affect their emotional wellbeing, their social wellbeing. I think it helps healthcare providers be a little bit more empathetic. I think it also sometimes shows that there are gaps in care. You know, women talk about long wait times and difficulty accessing care. Maybe it will help healthcare providers learn to advocate more for their own patients when they’re having difficulties and maybe advocate for more resources in the community. It might highlight where the gaps are in the current resources. Sharing experiences of being unable to access mental health care, long wait times, it just sensitizes policymakers as to where resources might need to go and where we can improve.
So, if I had a magic wand to improve care – this is a bit controversial, but I would advocate for a universal mental health screening during pregnancy and postpartum. It’s a bit controversial right now, there are some guidelines that advocate for universal screening and some guidelines that don’t. I believe it’s because there’s ethical concerns about screening and then having a positive screen but without enough resources to treat the woman. So, with universal screening, I would advocate for increased access to care, more of a collaborative integrated care. So, healthcare providers can work on a team. The obstetricians, the midwives can collaborate with mental health providers as well. This makes the women surrounded by all of their healthcare providers rather than them having to go around and look for each healthcare provider and provides more of a holistic care.
Maybe more mental health hotlines, more support groups online and in person, just ensuring that women have access to care. I think a lot of women already know about perinatal mental health issues, we’ve talked about depression and anxiety a lot, but some women don’t have access to that information or maybe they don’t think that it’s ever going to happen to them. So, to ensure that they have the information right from the start of their pregnancies, what is it that they need to look for? So they’re empowered to access care when they need.
It’s very isolating in – I don’t know about the rest of Canada, but in Montreal, it’s very isolating postpartum, especially in the winter it’s even more isolating. Women talk about being alone, difficulty getting out of the apartment. So, I’d probably want to improve community resources so that people don’t feel alone as much. Increase training for healthcare providers and provide more of a family-centred approach to include the non-birthing parent and, if needed, other children in that household to have an eye on what’s going on for the rest of the house.
For women who are experiencing mental health issues, it feels like you’re never going to get out of it, it feels like the symptoms are lasting forever, but I want to let women know that there is hope, that they do pass even though it feels like in the moment that it will never pass. So, I want to give people hope that with care, with treatment, with psychotherapy, that people do get better. It’s a complex period in people’s lives, a lot of changes, a lot of role changes, and to give yourself time to adjust is very important. It’s important to reach out when you need, reach out to family, friends, healthcare providers. I want to give a message of hope, but also understand that there are women who are suffering and unable to access care.
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