About 25% of people who gave birth in 2020 reported depression, anxiety or other mental health issues during their pregnancy or after their child was born, according to a report from the Vermont Department of Health.
The report, which is based on a yearly survey of people’s experiences after giving birth, showed an uptick from about 20% of birth parents in 2014, according to the department. That uptick could be the result of the pandemic’s effects on the mental health of everyone in Vermont, said Ilisa Stalberg, the health department’s director for family and child health.
A 2020 report from the health department quoted survey respondents on their experiences giving birth during the pandemic. Many reported that it affected their overall mental health, ability to access care, and connection to their support networks.
But the causes of pre- and postpartum mental health struggles go well beyond the specific changes brought on by the pandemic. Veerle Bergink, director of the women’s mental health program at New York City’s Mount Sinai Health System, said postpartum parents experienced a “huge” life-changing event on top of physiological triggers.
“In a transition from pregnancy to the postpartum period, like every system in your body changes: your endocrine system, your hormones, you completely go from pregnant to nonpregnant and all these changes switch,” Bergink said.
Those changes can lead to not only depression but, in rare cases, severe mental illnesses such as mania or psychosis, she said. The health department data showed that 12% of respondents reported symptoms after giving birth that suggested they were at risk for postpartum depression.
The mental health effects of childbirth can also begin during pregnancy or arise up to a year after giving birth, Stalberg said. Researchers use the term Perinatal Mood and Anxiety Disorders to describe the full spectrum of potential mental health challenges.
The top risk factor for those disorders, that “blows away other risk factors,” is a prior history of mental illness, Bergink said.
She said they’re also linked to socioeconomic status, likely because low socioeconomic status is tied to other risk factors: Financial stress, traumatic life events, less access to healthy food, more exposure to pollution, and a history of substance abuse.
The rate of postpartum depression varies significantly by country and region, she said, in part because of the different levels of financial and social support for new parents. “It does not help at all that (the United States) is not generous with parental leave,” she said.
Having stressors, like knowing ‘I’m going back to work or otherwise I cannot do this financially, that’s a huge pressure,” Bergink said.
According to the health department, two-thirds of parents who told the Vermont survey they were returning to work felt they had too little time off after delivery. A 2019 department report showed that low-income mothers in particular were less likely to get paid leave and took less time off before returning to work.
Bergink said acknowledging the realities of anxiety and depression that can come with new parenthood can help prevent or ease postpartum struggles. “I think it should be more like the new normal that pregnancy comes with a lot of physical discomfort, and the postpartum period is very intense,” she said.
“We see in movies, in society, the happy modern baby,” she said. “That’s just only part of reality: It’s also very hard work.”
Coping mechanisms that are helpful for mental illness in general can help with birth-related mental health, too, like exercise, eating well and seeing other people, she said. She added that a “good support network” can help with child care and make parents feel more supported.
Treatment for mental health symptoms is important, too. Stalberg said parents should reach out to anyone they’re comfortable with, from a primary care doctor to a therapist, but the state health department also has a birth-specific treatment hub called Help Me Grow. The system connects parents to mental health clinicians who are familiar with perinatal mental health conditions.
In 2018, the health department received a five-year grant from the federal government to expand screening for these disorders and provide resources to local organizations and health care providers who work closely with parents, such as obstetricians, Stalberg said.
The department is waiting to see whether it will qualify for another round of funding, she said. She’s “concerned” about being able to continue the current work without that money.
“The mental health workforce is extremely challenged in Vermont, and then (the number of) individuals who know how to work with pregnant and birthing people certainly also needs to be built up,” she said.
Stalberg said these mental health conditions have “not only an impact on the individual experiencing it, but pretty significant impacts for infants and children long into the future.”
“Being able to provide support early has long, long-term wins that we are quite confident in, and so investing in that feels really important,” she said.
