The Journal. - America's Maternal Mental Health Crisis

Episode Date: September 8, 2023

In the U.S., one in five mothers suffers from mood and anxiety disorders during pregnancy or after birth. But many of them struggle to find help. Last year, the CDC reported that the leading cause of maternal deaths in the country are suicide or drug overdose. We spoke with two mothers about their experience postpartum and to reporter Anna Mutoh about the FDA’s approval of a new drug to fight postpartum depression.  Further Reading: - The Tragedy of Being a New Mom in America  - First Pill for Postpartum Depression Is Approved by FDA  - U.S. Maternal Mortality Hits Highest Level Since 1965  Learn more about your ad choices. Visit megaphone.fm/adchoices

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. Oh my gosh, it was chaotic. It was very painful. I did have to be induced because he did not want to come out.

And then after that, it just, the epidural only worked for one half of my body. So I was still getting hit a lot with contractions. I remember getting an epidural while I was there and it did not take in one of my legs. And I think I was just so tired at that point that I was kind of like blacking in and out. Definitely took a long time for him to come out. Took quite some time. I was pushing for about two hours, two and a half hours. I like pushed for like three hours. His heart rate was dropping. Exhausted, tired. It was so scary. I didn't think I had anything else left in me to give. And then all of a sudden I hear the, and then he like, as quick as you hear

the cry, he's on your chest. And then like everything else is a blur. Like it went from like one type of energy to like, okay, baby's here. Everything's done. Everything's good. 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. 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 U.S., 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. When the baby's born, everyone is like, we want to come see the baby. No one ever stops to think, like, to make sure, like, is the mom okay? 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. 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. At AirMiles, we help you collect more moments. So instead of scrolling through photos of friends on social media, you can spend more time dinnering with them.

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Collect more moments with more ways to earn. Air Mile. For about a year now, reporter Anna Muto 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? 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. What's the maternal mortality rate in the U.S.?

It's 33 deaths per 100,000 live births. Just to put that into perspective, thousand 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 it is, the U.S. number is an outlier. What does your reporting say about women's health care in the U.S.? 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. is just appalling and frustrating and shocking.

The high rate of mental health issues and maternal deaths in the U.S. 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? It was like a moment of like, wow. Like, it was so weird. Like, you don't know them, but you know them. wow. Like it was so weird. Like you don't know them, but you know them.

Right. And what were the first few weeks like with you and Owen? It was overwhelming. Not in a bad way. Just, it was so much change. The first week was good because Nick was home. It was like, I had that help. I wasn't alone. But when Nick went back to work, I was like, I remember I cried the day he went back to work. Cause I was like scared to do it by myself. And it was nice having that time with Owen. Like, um, I don't know how much I actually walked at that point, but we like, 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. And, but like, he just would fall asleep in the car seat. Like I was nervous with him,

but then it was like, like, it was more scary for me, I think, than it was for him. Like he just went, 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. What was hard about the nights? Just, I don't know if it's like 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 like that's when it felt like the loneliest um but i thought that was i thought that was normal um, when did you start to think it was something more serious? I want to say end of July.

We went up to our, my mom's city. They did like a, like their city fair kind of thing and I don't know what made her bring it up to me but she was like she just asked if I was doing okay um I was like yeah I'm fine and um she's like you're not having, like, 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, like, you just don't want to be here anymore? And I don't think I even realized it at the time.

Her mom later said she was concerned because Jackie was sleeping all day. And when she'd ask 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. 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. like oh my gosh I can't feel like this forever and I just like I thought about it all night long and then that next morning I just I tried to just chug through the day and I had a moment where I

just crumbled um and I called my husband at work and I was like I can't like I can't do this anymore I'm like I need help like I don't know how I can be here anymore. I can't. And what did he say? He was almost like speechless at first. Um, but he, he, he like 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. After her husband got home, they went to the ER.

Regardless. 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? 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 like supervise me. 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. 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 an 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, a psychologist or psychiatrist. And they called one place. The place had a 9- to 12-month waiting list, so that wasn't really going to be beneficial.

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.

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.

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

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, what was its effect for you? So right away, I didn't notice a difference I felt because so I felt tired I know from those first couple days though my mom and Nick said I sounded different they said like my voice sounded lighter so right away they could tell a start um I did notice, though, that day that we were getting ready to leave, like, I was excited to go home. Like, I wanted to go home and see Owen. Like, that was such a change. Just in a matter of three days. Like, and I was still anxious at the hospital, but to go from, like, anxious to now, now, I'm going home and I can't wait to see him.

Yeah. That was such a big change. What was it like to see him? I was a little scared that he was not going to remember me. Oh, yeah. But he was obviously at my mom's house, and 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, 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. It made me cry because I was like, oh my gosh.

It just felt good. It felt worth it. We'll be right back. small talk. Suddenly, you spot something different. The Bold Seagram 13. A 13% cosmopolitan cocktail. You grab a can and take a sip. Suddenly, you're on a fresh adventure, becoming the hero of your own night. Unapologetically full-flavored cocktails with a 13% punch.

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Benefits vary by card. Terms apply. 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 Zoranilone. Unlike the infusion medicine that helped Jackie, it can be taken at home with a prescription from a doctor. Here's Anna again. It's called Zoranolone. Unlike the infusion medicine that helped Jackie, it can be taken at home with a prescription from a doctor.

Here's Anna again. 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. How does it work? The way it works is that hormones rise significantly during pregnancy and drop in a sharp way right after you give birth. Zoranolone 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.

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

Where do you live? I'm located right now in Georgia. I'm a military spouse as well, and so I bounce around quite a bit. Patients got into perinatal mental health after seeing spouses and mothers at military bases dealing with postpartum mood disorders. dealing with postpartum mood disorders. Now, the FDA recently approved a new pill to treat postpartum symptoms. Mm-hmm. Will that be a silver bullet for this?

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, you know, like 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.

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? So, of course, they're severe. Like you said, very acute. I would put that as acute. So that would be like severe postpartum depression. 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 aside from severity as well, that isn't just postpartum depression. Statistically, postpartum depression is hitting Black and brown women hard. Yeah, about one in three will experience postpartum depression and anxiety.

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 health care 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 U.S. are Black. 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 like four or five folks before I found my way to you. And finally someone gets it, someone who looks like me. 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? 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 just, I ended up picking up the phone and calling my mom and being like, I need some help. Did you have postpartum depression or were you overwhelmed? Because that's a lot. One could say that it could have been both. Yeah. You know, 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 and overwhelmed in that type of way, but not when they're upset. Patience says moving in with her parents eventually gave her the support she needed. I get emotional talking about it. It's a very tough, tough topic. And it's hard. It's an incredible thing that women's bodies do. It's, yeah, it's incredibly hard. And that's the thing. And, yeah, because I feel like it's not highlighted enough. And then, you know, people having to beg to get back into the hospital because we're dying too. Like, that's the thing.

Yeah. We are dying over here. And we shouldn't. We shouldn't be dying just because we're having babies. Thank you. Yeah, I appreciate you. Thank you too. 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. 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, Catherine Brewer, Maria Byrne, Victoria Dominguez, Pia Gadkari,

Rachel Humphries, Ryan Knudsen, Matt Kwong, Jessica Mendoza, Annie Minoff, Laura Morris, Enrique Perez de la Rosa, Sarah Platt, Alan Rodriguez-Espinosa, Heather Rogers, Jonathan Sanders, Pierce Singey, Jivika Verma, Lisa Wang, Catherine Whalen, and me, Kate Leinbach. Our engineers are Griffin Tanner, Nathan Singapak, and Peter Leonard. Our theme music is by So Wiley. Additional music this week from Peter Leonard, Nathan Singapak, Griffin Tanner, and Blue Dot Sessions. Fact-checking by Kate Gallagher and Nicole Pasolka.

Thanks for listening. See you Monday.