Paige Bellenbaum sat on a New York City park bench several years ago with her baby son, Max, when she saw another new mom staring adoringly at her own baby.
“And she looked at me and said, ‘Isn’t it wonderful?’” Bellenbaum said. “I looked back at her and I said, ‘No, not really, it’s actually the hardest thing I’ve ever done.’” The new mother’s smile faded as tears welled up in her eyes. “I’m so glad you said that,” she said.
Bellenbaum, who battled severe postpartum depression, said Tuesday’s announcement by a government-appointed task force, which recommends medical professionals screen women who are pregnant or who have recently given birth, was a step in the right direction in the fight to improve women’s mental health. According to the report, the 2009 task force had recommended depression screenings for all adults but had not specifically included pregnant and women who gave birth.
The United States Preventative Task Force’s new guidelines urge medical workers to screen pregnant women and new mothers regardless of whether they have services in place to provide treatment, given that mental health services are now more widely available and screenings are accepted as part of mental health care. The recommendation received a “B” rating from the Task Force, making it so that screening for maternal depression must now be covered under the Affordable Care Act.
“There’s been little to no conversation about this issue on a federal level until now,” Bellenbaum said. She worked with New York lawmakers to pass a maternal depression bill, which Governor Andrew Cuomo signed into law in August 2014. But like the Task Force’s recommendations, along with a handful of other states, it does not place a mandate on health care providers to talk with women about maternal health issues.
According to the non-profit Postpartum Support International (PSI), maternal depression or perinatal mood disorders, which occur during pregnancy or after childbirth, may lead to depression, anxiety, obsessive-compulsive behavior as well as psychosis. Symptoms may include anger, sadness, lack of interest in the baby, sleeplessness, thoughts of hopelessness, and in the most extreme cases, thoughts of suicide or harming the baby. Experts agree that there is no one single cause for these disorders, but rather a combination of factors including hormonal and psychological changes as well as social support, according to Dr. Wendy N. Davis, PSI’s executive director.
“It’s a huge deal,” Davis said about the panel’s recommendations, adding that, “I’m really excited, but the work goes on.” PSI provides free services to families during and after pregnancy and trains health care providers on how to screen and discuss maternal depression with women. “The recommendations from the Task Force are fully-formed and have been distributed to all medical providers who take them very seriously,” according to Davis.
About 10 to 15 percent of women in the United States will develop some form of maternal depression each year, according to the Centers for Disease Control and Prevention.
Bellenbaum’s downward spiral initially started with a traumatic labor. She experienced thoughts of suicide, insomnia, and obsessive-compulsive behavior—all signs of severe postpartum depression. “I would rock back and forth and cry and go into the bathroom and just stare at the medicine cabinet and think what I could do to end this,” Bellenbaum said.
Problems with nursing left her feeling paranoid and resentful of her baby. She didn’t know what was happening, which as a trained social worker, left Bellenbaum feeling embarrassed and ashamed. She withdrew socially, remaining with her baby in the family’s tiny apartment. When she did go outside, Bellenbaum said she would have “flashes of how to escape,” including buying a one-way ticket to the Bahamas to start her life over — alone.
Bellenbaum’s husband was supportive but wasn’t sure what to do. Her doctors never brought up the possibility that she could be suffering from depression. After months of suffering, she got in a cab and went to a free clinic at a hospital where specialists quickly diagnosed her with severe postpartum depression. She was put on medication immediately, which Bellenbaum said was the start to her recovery.
“After I came out of the dark from my own personal experience with postpartum depression, I began looking at what kinds of legislation other states and cities have passed to help women suffering from perinatal mood disorders,” Bellenbaum said.
Bellenbaum reached out to New York State Sen. Liz Krueger who, along with Assembly Health Chair Richard Gottfried, sponsored a maternal depression bill. It passed with both Democratic and Republican support.
Similar to New York’s law, the federal Task Force recommends screening for depression, which involves a short series of questions between the health care provider and the patient. If a woman shows signs of depression, she may be referred to a mental health professional for diagnosis and treatment, which may include counseling, support groups or medication.
“Although the level of awareness and even recognition is increasing, the fear and hesitancy for mothers to reach out is still pretty high,” Davis said. She said the Task Force’s recommendations that expectant and new mothers are screened for depression will help to lessen the stigma around postpartum depression.
In addition to government and advocacy groups working together, women also need to support each other, Bellenbaum said. After the new mother sitting on the park bench began to cry, Bellenbaum said, “I learned in that moment that women need to be given permission to talk about this issue that is impacting them directly or impacting someone they know.”