America’s Maternal Mental Health Crisis – The Journal.

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Kate Linebaugh: Before we get started, I wanted to let you know that today’s episode includes talk of suicidal thoughts. So please take that into account before listening. There are days in life that we remember better than others, and if you’ve ever given birth, that’s one of those days, it just stands out. I spoke to two mothers, Jackie, and Patience about their birthing experience.

Jackie Omer: Oh my gosh, it was chaotic. It was very painful.

Patience Riley: I did have to be induced because he did not want to come out.

Jackie Omer: And then after that, the epidural only worked for one half of my body, so I was still getting hit a lot with contractions.

Patience Riley: I remember getting an epidural while I was there, and it did not take in one of my legs.

Jackie Omer: And I think I was just so tired at that point that I was kind of blacking in and out.

Patience Riley: Definitely took a long time for him to come out. Took quite some time.

Jackie Omer: I was pushing for about two hours, two and a half hours.

Patience Riley: I pushed for like three hours.

Jackie Omer: His heart rate was dropping.

Patience Riley: Exhausted, tired.

Jackie Omer: It was so scary.

Patience Riley: I didn’t think I had anything else left in me to give.

Jackie Omer: And then all of a sudden I hear the, and then as quick as you hear the cry, he’s on your chest and then everything else is a blur. It went from one type of energy to like, okay, baby’s here. Everything’s done. Everything’s good.

Patience Riley: There was that big change once he came and I saw him and I felt like once he came my heart, like the Grinch grew three sizes that day.

Kate Linebaugh: Jackie and Patience had relatively smooth deliveries, but they weren’t in the clear yet. Statistically, they were about to enter one of the most dangerous times for a new mother, a time when their mental health is at risk. In the US, one in five mothers suffers from mood and anxiety disorders either during pregnancy or up to a year after they give birth. And the leading cause of maternal deaths is suicide and drug overdose.

Jackie Omer: When the baby’s born, everyone is like, we want to come see the baby. No one ever stops to think, to make sure, like is the mom okay?

Patience Riley: And it’s almost become that norm of like, this is supposed to be this way and it’s not. Birth and postpartum is not supposed to be moments where we suffer.

Kate Linebaugh: Welcome to The Journal, our show about money, business and power. I’m Kate Linebaugh. It’s Friday, September 8th. Coming up on the show, the mental health crisis facing american mothers. For about a year now, reporter Anna Mutoh has been covering the mental health issues experienced by pregnant women and new mothers. And as you reported out this story and spoke to mothers and family members, what stood out to you the most in what you heard?

Anna Mutoh: I think what stood out to me the most was the pain and just the sheer frustration of not being able to get help despite trying. When you pause and think about it, that’s just tragic. And so I wanted to understand why is this happening? And also from my personal experience, you hear about the possibility of baby blues and postpartum depression, so you’re aware of it, but you’re just not told to what degree that is and what kind of things you need to be aware of.

Kate Linebaugh: What’s the maternal mortality rate in the US?

Anna Mutoh: It’s 33 deaths per 100,000 live births. Just to put that into perspective, 33 per 100,000 live births is 16 times higher than what Norway is, for example, which is two maternal deaths per 100,000 live births. So the US number is an outlier.

Kate Linebaugh: What does your reporting say about women’s healthcare in the US?

Anna Mutoh: Women have been giving birth since women existed, right, since the start of time, and this is not something new. And the fact that we’re in 2023, and this is still a huge issue, is just appalling, and frustrating, and shocking.

Kate Linebaugh: The high rate of mental health issues and maternal deaths in the US is due to a number of factors. There’s a fractured healthcare system where no one medical provider is focused on a mother’s mental health. There’s a lack of access to mental healthcare and a dearth of treatments. There’s limited parental leave. That means new mothers can be back at work within weeks of childbirth. And Anna says that a lot of new moms don’t seek help because they’re afraid they’ll be looked down on and seen as unfit. Some of this plays out in the story of one of the mothers you heard from, Jacqueline Omer, who goes by Jackie. She lives in Ohio with her husband Nick. And last June she gave birth to their son Owen. How did you feel seeing him?

Jackie Omer: It was like a moment of like, wow. It was so weird. You don’t know them, but you know them.

Kate Linebaugh: Right. And what were the first few weeks like with you and Owen?

Jackie Omer: It was overwhelming. Not in a bad way. It was so much change. The first week was good because Nick was home. I had that help. I wasn’t alone. But when Nick went back to work, I remember I cried the day he went back to work because I was scared to do it by myself, and it was nice having that time with Owen. I don’t know how much I actually walked at that point, but I got up and we went for a little walk. So we had that time together by ourselves. And I remember being nervous putting him in the stroller just because he was so tiny, but he just would fall asleep in the car seat. I was nervous with him, but then it was more scary for me, I think, than it was for him. He went with the flow of everything where I was the one who was overwhelmed and figuring out the change. But I think nights were the hardest.

Kate Linebaugh: What was hard about the nights?

Jackie Omer: Just, I don’t know if it’s comparing. I don’t know if it’s like every mom feels it at the time or if it was just like a me issue at the time, but that’s when I felt like the loneliest. But I thought that was normal.

Kate Linebaugh: Yeah. When did you start to think it was something more serious?

Jackie Omer: I want to say end of July. We went up to my mom’s city. They did like their city fair kind of thing. And I don’t know what made her bring it up to me, but she just asked if I was doing okay and I was like, yeah, I’m fine. And she was like, you’re not having thoughts of hurting yourself or hurting Owen or anything, are you? And I was like, no, no, I’m okay. And I remember saying to myself after telling her no, I was like, why didn’t you say yes? But I was like, why didn’t you tell her that you just don’t want to be here anymore? And I don’t think I even realized it at the time.

Kate Linebaugh: Her mom later said she was concerned because Jackie was sleeping all day. And when she’d asked Jackie to go for a walk or grab a coffee or go antiquing, which Jackie loves doing, Jackie would turn her down. Jackie says around this time, one day Owen was shrieking and she had a terrifying thought of hurting him by covering his mouth. Unsure what to do, she says she turned to the internet.

Jackie Omer: I was online reading different articles about postpartum and some woman, I don’t even know where I found the article, but she was talking about her postpartum depression and when I read it I was like, oh my gosh, that’s how I’m feeling. And I remember reading it. I’m like, oh my gosh, I can’t feel like this forever. And I thought about it all night long. And then that next morning I tried to just chug through the day and I had a moment where I just crumbled and I called my husband at work and I was like, I can’t do this anymore. I’m like, I need help. I don’t know how I can be here anymore. I can’t (inaudible).

Kate Linebaugh: And what did he say?

Jackie Omer: He was almost speechless at first, but he packed up his stuff right away and was coming home from work, and he was calling my doctor and he knew my mom was home. So he said, either he’ll stay on the line with me or he said, or call my mom and talk to her. But he was coming home regardless.

Kate Linebaugh: After her husband got home, they went to the ER. There doctors did blood work and asked her to rate her depression and anxiety on a scale. They also asked her if she had made a plan to hurt herself or Owen. And what was the end result?

Jackie Omer: They sent me back home. They said, because I didn’t have a specific plan that I could go home since my mom was, because my mom was also home from work, she could still supervise me.

Kate Linebaugh: The ER did recommend a follow-up appointment with Jackie’s primary care doctor, but she had to wait over a week for a slot to open up.

Jackie Omer: We went in, I had to bring my mom with me because it was just very difficult talking about it. It was just uncomfortable to talk about. They prescribed me a antidepressant, and then I was supposed to meet with one of their social workers. I think it was like a team social worker kind of thing. And their social worker was supposed to pair me with, I guess psychologist or psychiatrist, and they called one place. The place had a nine to 12 month waiting list, so that wasn’t really going to be beneficial.

Kate Linebaugh: Jackie took the anxiety and depression meds that she was prescribed, but she was unable to find specialized care with a mental health professional. She says she felt defeated, like the doctors around her weren’t taking her seriously, and she wasn’t getting better. She remembered sending a suicidal text to her mom.

Jackie Omer: Saying how I’m not getting any help. I don’t feel like this is ever going to end. I don’t see myself ever getting better. I don’t think Owen deserves to have me as a mom, how I think he’s better off with my mom raising him, how I think Nick is better off without me, how I think in general all of them, they’re just better off with me not being here, and I don’t want to live feeling like this all the time.

Kate Linebaugh: Over the course of weeks, Jackie repeatedly tried to overdose on her anxiety medicine. Her family kept trying to get her help. She went back to her OB, back to the ER where she says a nurse suggested she was selfish to have attempted suicide. Then she went to a general mental health inpatient clinic. Nothing seemed to be working. The family finally drove nine hours to Chapel Hill, North Carolina, where Jackie was admitted to an inpatient facility that specializes in maternal mental health, one of only three such centers in the country. And there, Jackie says she finally got the help she needed.

Jackie Omer: That was like night and day compared to every other experience that I had here. My gosh, all the staff were nice there. They were very supportive. It made me feel so much better. I felt like it just made you feel like they cared about you. It just made you feel more human. It made such a big difference.

Kate Linebaugh: At that clinic, Jackie was able to access the only drug that was specifically available at the time for postpartum depression. It’s called Brexanolone and it was approved by the FDA in 2019. It’s fast acting, but has some drawbacks. It can have some serious side effects and is expensive. It also needs to be delivered intravenously in a medical setting over a 60-hour period. And how did that infusion medication, like what was its effect for you?

Jackie Omer: So right away, I didn’t notice a difference. So I felt tired. I know from those first couple days though, my mom and Nick said I sounded different. They said my voice sounded lighter. So right away they could tell a start. I did notice though that day that we were getting ready to leave, like I was excited to go home. I wanted to go home and see Owen. That was such a change just in a matter of three days, and I was still anxious at the hospital, but to go from anxious to now I’m going home and I can’t wait to see him.

Kate Linebaugh: Yeah.

Jackie Omer: That was such a big change.

Kate Linebaugh: What was it like to see him?

Jackie Omer: I was a little scared that he was not going to remember me.

Kate Linebaugh: Oh, yeah.

Jackie Omer: But he was obviously at my mom’s, because my mom had him that weekend. We went straight to my mom’s house to go get him, and they were sitting in the living room, and I walked in and he’s on the floor playing, and I was like, hi. And he looked at me and he stared for a second. I was like, oh my gosh, he’s not going to remember me. And he just smiled. I was like, oh my gosh. And it made me cry because I was like, oh my gosh. It felt good. It felt worth it.

Kate Linebaugh: We’ll be right back. The infusion treatment that Jackie received was the only medical treatment on the market to specifically help postpartum symptoms. But last month, the FDA approved the first ever pill for postpartum depression. It’s called Zuranolone. Unlike the infusion medicine that helped Jackie, it can be taken at home with a prescription from a doctor. Here’s Anna again.

Anna Mutoh: It’s not yet available, but it is highly anticipated to come to the market because according to clinical studies, it had a very quick onset in terms of helping women feel much better than they were before. Studies show that as early as three days, new moms were feeling much better compared to how they were feeling before.

Kate Linebaugh: How does it work?

Anna Mutoh: The way it works is that hormones rise significantly during pregnancy and drop in a sharp way right after you give birth. Zuranolone can replace one of those hormones that drop in a very sharp way, and by replacing that, it helps the neural pathways regulate itself better.

Kate Linebaugh: We asked Patience, the other mom we spoke to earlier about this drug. Patience is also a therapist.

Patience Riley: My name is Patience Riley. I am a mom of two. I have two little boys, a four-year-old and a two-year-old. I’m also a licensed mental health therapist. I specialize in perinatal mental health. Amongst all of those things, I’m a creative, a foodie, I love yoga.

Kate Linebaugh: Where do you live?

Patience Riley: I’m located right now in Georgia. I’m a military spouse as well, and so I bounce around quite a bit.

Kate Linebaugh: Patience got into perinatal mental health after seeing spouses and mothers at military bases dealing with postpartum mood disorders. Now, the FDA recently approved a new pill to treat postpartum symptoms. Will that be a silver bullet for this?

Patience Riley: I think it’s an additional thing to help. So one of the things that I always talk to my clients about when we look at medications just in general, is medications can be a part of your coping tools. So we have therapy that’s here. We have medication that’s here. Sometimes they can give each other a hug, and that’s okay. It’s okay for both of them to coexist together. Now, we are really excited to hear that there is something in place that focuses specifically. It’s fast acting. It’s specifically for postpartum depression. So that is exciting. I don’t think that it’s going to replace just because it’s hard for a pill to replace community, and I really think community is important, but do I think that it could be a really, really helpful addition in coping skill that’s added on? Absolutely.

Kate Linebaugh: We spoke with a young new mom who really experienced acute postpartum depression with suicidal ideation and who received a medication to help. How do you think about the spectrum of postpartum symptoms?

Patience Riley: So of course, they’re severe, like you said, very acute. I would put that as acute, so that would be severe postpartum depression.

Kate Linebaugh: Yeah.

Patience Riley: However, there is postpartum depression, and then we could have moderate and mild forms of it, but then also just perinatal mood disorders in general. And so that in itself opens up more than just postpartum depression. It opens up postpartum anxiety. It opens up postpartum OCD, bipolar, psychosis, PTSD. So there’s a huge spectrum, aside from severity as well, that isn’t just postpartum depression.

Kate Linebaugh: Statistically, the postpartum depression is hitting black and brown women hard.

Patience Riley: Yeah. About one in three will experience postpartum depression and anxiety.

Kate Linebaugh: Studies show that black women are twice as likely as white women to experience maternal mental health issues. There’s a number of reasons for this. Discrimination within the healthcare system is one. Black women widely report not being heard, understood, or believed by their doctors. That may be exacerbated by the fact that less than 6% of psychiatrists and psychologists in the US are black.

Patience Riley: A lot of the clients that I work with are either black or brown women who are pregnant and postpartum. And it’s interesting. I was talking to one of my clients in our last session, and she shared just like, hey, I’ve gone through four or five folks before I found my way to you, and finally someone gets it. Someone who looks like me.

Kate Linebaugh: Patience knows about postpartum mental health issues from her work as well as her personal experience. She says she struggled with mental health after the birth of her second child. Her husband had recently been deployed, and she struggled to care for a newborn, a two-year-old and herself alone. And what started happening for you?

Patience Riley: I was incredibly angry. Incredibly angry. I was angry at the Air Force. I was angry at my husband. I was tired, which that did not help either. One of the things that I did not notice until a friend pointed out to me who came to visit, and I remember one day she looked at me and she was like, you’re not eating as much. And it was because I didn’t have an appetite. I wasn’t hungry. And I remember just having moments where I just felt incredibly alone. But those were some of the things, those were probably the top three that I really remember experiencing, just feeling so incredibly alone, being incredibly angry, but also looking back now and knowing that that anger was me being incredibly sad and not having an appetite at all. And I just remember crying, crying, and I say that as somebody who does not usually cry. I was just bawling, and I remember just saying, I can’t do this anymore. I need help. That’s when I remember I ended up picking up the phone and calling my mom and being like, I need some help.

Kate Linebaugh: Did you have postpartum depression or were you overwhelmed? Because that’s a lot.

Patience Riley: One could say that it could have been both.

Kate Linebaugh: Yeah.

Patience Riley: So I never received a formal diagnosis just because I didn’t end up going to anyone to get formally diagnosed, but because of what I do, was I definitely having symptoms? Absolutely. Also, not saying that I’m diagnosing myself. That’s one thing that I cannot do, but was I experiencing symptoms of postpartum depression, postpartum anxiety? Absolutely. Absolutely. And one that I think that some folks don’t realize is like that anger. That’s a symptom too, and that’s why I like to highlight me being incredibly angry is also, that is the outward expression of me being incredibly sad because I think sometimes we’ll look at it and say, yeah, that’s absolutely depression when somebody is crying,

Kate Linebaugh: Right.

Patience Riley: And overwhelmed in that type of way, but not when they’re upset.

Kate Linebaugh: Patience says, moving in with her parents eventually gave her the support she needed. I get emotional talking about it.

Patience Riley: It’s a very tough, tough topic.

Kate Linebaugh: And it’s hard. It’s an incredible thing that women’s bodies do.

Patience Riley: Yeah, it’s incredibly hard. And that’s the thing. And yeah, because I feel like it’s not highlighted enough, and then people having to beg to get back into the hospital because we’re dying too. That’s the thing.

Kate Linebaugh: Yeah.

Patience Riley: We are dying over here and we shouldn’t, we shouldn’t be dying just because we’re having babies.

Kate Linebaugh: Thank you.

Patience Riley: Yeah, I appreciate you. Thank you too.

Kate Linebaugh: If you are experiencing suicidal thoughts or know someone who is call the 988 Suicide and Crisis Lifeline by dialing or texting 988. Help for new mothers is also available. Call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA, 1-833-852-6262.
That’s all for today, Friday, September 8th. The Journal is a co-production of Spotify and The Wall Street Journal. The show is made by Annie Baxter, Katherine Brewer, Maria Byrne, Victoria Dominguez, Pia Gadkari, Rachel Humphreys, Ryan Knutson, Matt Kwong, Jessica Mendoza, Annie Minoff, Laura Morris, Enrique Perez de la Rosa, Sarah Platt, Alan Rodriguez Espinoza, Heather Rogers, Jonathan Sanders, Pierce Singgih, Jeevika Verma, Lisa Wang, Catherine Whelan, and me, Kate Linebaugh. Our engineers are Griffin Tanner, Nathan Singhapok, and Peter Leonard. Our theme music is by So Wiley. Additional music this week from Peter Leonard, Nathan Singhapok, Griffin Tanner, and Blue Dot Sessions. Fact-checking by Kate Gallagher and Nicole Pasulka. Thanks for listening. See you Monday.