Glynis Ratcliffe was one of those women during her first pregnancy: Happy. Glowing. The perfect candidate for a glossy advertisement in the pages of Mother-To-Be magazine.
But two years later, with another baby unexpectedly on the way, Ratcliffe felt like a different person. “I would cry every time I would have to go out because I would have to pretend I was happy,” she says. “I couldn’t get out of the rut in the way I normally might have in the past.”
More than halfway through her pregnancy, Ratcliffe finally took the advice of her diligent midwife and decided to speak with a psychiatrist. The diagnosis was swift: Ratcliffe had prenatal depression, a condition that affects up to 23% of expectant mothers, according to the American Congress of Obstetricians and Gynecologists.
Why did it take so long for Ratcliffe’s prenatal depression to be identified? At least in part, the delayed diagnosis can be tied to a culture that celebrates the joyful aspects of pregnancy and minimizes anything else. Sure, people can sneak in a joke about morning sickness here and there, but by the second trimester, mothers are expected to get with the blissful program.
“There is such a dearth of education and information out there about mental health during pregnancy,” says Dr. Anna Glezer, a perinatal psychologist at the University of California-San Francisco and the founder of Mind, Body, Pregnancy. By the second trimester, mothers are expected to get with the blissful program. “It’s sort of thought to be this magical time and there’s a lot of societal pressure to think about pregnancy in that way.”
There is historical precedent for this myth. According to a study in the Journal of Psychiatry & Neuroscience: “It was once believed that for most women pregnancy could provide protection against psychiatric disorders.” Dr. Margaret Spinelli, a clinical professor of psychiatry at Columbia University Medical Center, notes that a century ago, doctors were likely to blame depression on hormones. In the cases where women were taken seriously, Spinelli says a standard treatment in the mid-20th century was electroshock therapy, a procedure—now generally reserved for “severe psychiatric disorders in the pregnancy period.” Although such theories have since been disproven, their vestiges live on in cultural taboos.
In January, the United States Preventative Services Task Force (USPSTF) issued a long-overdue recommendation that healthcare providers screen for depression during pregnancy. It’s a step in the right direction. Still, there remain significant barriers to meaningful, institutionalized change: According to a 2012 survey conducted by Slate, nearly one-third of medical providers were “outright dismissive of their patients’ moods.” One respondent said her doctor just advised that she “stop watching [too] many soap operas.” “It was once believed that for most women pregnancy could provide protection against psychiatric disorders.”
With so much pushback, it’s no wonder a 2015 study published in Nurse Practitioner found an estimated 80% of depressed pregnant women are never identified. Cheryl Anderson, one of the study’s lead researchers and an associate professor at the University of Texas-Arlington College of Nursing and Health Innovation, says the recommendations simply don’t go far enough when it comes to expectant mothers’ mental wellness. “There’s no routine assessment plan and there’s certainly no follow through,” she says.
Anderson says screening for prenatal depression is a simple and quick process: Expectant mothers can just fill out the simple, 10-question Edinburgh Postnatal Depression Scale periodically throughout gestational months. The form would help healthcare providers ascertain whether further questioning was necessary.
Yet, this simply isn’t happening—even for women with documented risk factors including a history of depression or lack of a comprehensive social support system. In situations where there is an undiagnosed issue, Anderson says, the depression “builds and builds” throughout pregnancy and into the postpartum period. The consequences of this cycle are potentially fatal: Suicide is the second most common cause of death among new mothers, according to research by Northwestern University.
For those women who don’t get needed treatment during pregnancy, suicidal ideation is not the only risk factor. For those women who don’t get needed treatment during pregnancy, suicidal ideation is not the only risk factor. According to a newly published study in Obstetrics & Gynecology, depressed mothers were “significantly more likely” to experience preterm births and have low-weight babies.
It’s clear healthcare providers need to be much more proactive when it comes to addressing prenatal depression. But the rest of us do, too. According to the Slate survey, 85% of women who experienced depression during pregnancy felt guilty. Fewer than one-third felt comfortable revealing their struggles to friends or family. As Spinelli puts it, “They are not sure of themselves and they’re not sure if other people will believe them because somebody is likely to say, ‘Don’t be ridiculous, this [pregnancy] is a wonderful thing.’”
For Glynis Ratcliffe, it was difficult to find a community willing and able to talk about her struggle. “It’s the same thing when people ask you how you’re doing and you’re like, ‘Well, actually, I’m depressed,’” she says. “Who wants to hear that, right?
The good news is that prenatal depression treatment is available and relatively successful: According to results from the Obstetrics & Gynecology study, the risks for preterm births and low birth-weight babies all but vanished among women with diagnosed prenatal depression who took antidepressants. Other studies confirm counseling and complementary therapies, such as massage and acupuncture, result in similarly positive health effects for depressed expectant mothers and their babies.
Help from a psychiatrist and social worker was ultimately an invaluable experience for Ratliffe. Just as meaningful was the realization she wasn’t alone in her struggles. “When I went to the clinic and saw other women who were pregnant [seeking depression treatment],” she says, “a light kind of switched on at that point.”