A few weeks ago, ProPublica published a sobering article entitled The Last Person You’d Expect to Die in Childbirth. The article addressed the extremely high maternal mortality rates in the United States, which are contrasted significantly with low infant mortality rates.
In trying to understand this enormous discrepancy, the authors note numerous examples in which our medical system: from medical education, to Medicaid spending, to hospital credentialing, to routine obstetric and postpartum care protocols; privileges the health of babies while ignoring the health of moms.
And this does not just apply to medical health. I see this problematic dynamic reflected in our thinking and practices around perinatal mental health all the time. Below are some examples from women I have worked with in my practice.
- An anxious pregnant woman is told “if you don’t get your anxiety under control you will hurt your growing baby” and at the same time is told “taking medication for your anxiety could endanger your baby.” She feels enormous guilt about her anxiety, she feels she has no options to help herself and that to get help is selfish at best, and dangerous at worst. Her anxiety gets worse.
- A pregnant woman with a history of an eating disorder who is given “rules to follow” about her diet without consideration or sensitivity around her history. She is told she “must be weighed” at every appointment, without being told that she has the right to refuse to be weighed or she can be weighed backwards. She is not told that her diet is good enough to make sure her baby is healthy. She is not told that gaining too little weight is more worrisome than gaining too much for someone of her size, so she begins to restrict her food.
- A new mother who experienced a traumatic labor and delivery where she was medically compromised and emotionally devastated. Her medical team, her family, her friends keep telling her, “its ok, stop worrying, at the least the baby is ok.” And yes thankfully her baby was fine, but she is not fine, and feels she’s not allowed to not be ok.
- A new mother who is three weeks postpartum with anxiety and depression and is struggling to breastfeed. She is told that she cannot take her psychiatric medication if she wants continue breastfeeding. She seeks advice on weaning from her doctors and a lactation consultant who keep reinforcing to her that breast is best. She feels helpless and confused, and that any decision she makes will harm her baby.
What is clear from these examples is that from the get go, we treat pregnant women and new moms as vessels. We tell them their needs no longer matter, and that to take care of their needs is selfish. The system positions mom’s needs and baby’s needs as diametrically opposed.
This has enormous emotional consequences that reverberate from pregnancy all the way through to motherhood. It sends the message that moms shouldn’t take care of their needs or have needs at all. It plants (and waters) the seeds of guilt that are so endemic amongst moms. It is an additive factor in the high incidence of perinatal mood and anxiety disorders, and most certainly gets in the way of women seeking help when they need it. And remember, perinatal mood and anxiety disorders are the #1 complication of childbirth. We are are putting women’s lives at stake.
We can and must do better.
We need a system that recognizes and cares for moms in a comprehensive and holistic manner. We need a system frames the relationship between a mother’s health and her baby’s health as symbiotic and recognizes that both are of equal importance. We need to tell moms to put their oxygen masks on first, and assure them that taking care of themselves is taking care of their babies.
It is a long and complicated road to fix a system that is broken. But here is one small step we can all take which can be tremendously impactful.
Whether you are a friend or a medical or mental health provider, make sure you ask mom about how she is feeling. Ask her this before asking about her baby. Listen to her closely and carefully. Do not dismiss or belittle her feelings. Take her seriously, validate her feelings. Just ask!