During her second pregnancy, Rebecca Fox Starr knew she wasn't connecting with her baby in the same way she did the first time around. Instead, she was consumed by stress, fear for her upcoming C-section and anxiety that manifested as trouble speaking.

After a debilitating migraine during her seventh month of pregnancy, she made an appointment with a neurologist—who was the first to pick up on the symptoms her other healthcare professionals overlooked: Starr was experiencing prenatal depression, a condition that affects an estimated 14-23% of pregnant women. More than 400,000 babies are born to depressed mothers every year, but the condition is considered the most underdiagnosed obstetric complication in America.

Starr's diagnosis came after her symptoms had been brushed off by other healthcare professionals, and it's not that she made any attempt to hide the way she was feeling. Recalling one discussion with her OB, Starr tells Motherly, "I said, 'I'm not doing well. I'm terrified for this C-section. How can we make it less scary for me because at this point I'm so terrified that I can't function.' And his answer to a lot of my woes was, 'You're pregnant. That's normal. That's what pregnancy is.'"

Failure on the part of healthcare professionals to detect mental health conditions during pregnancy has significant consequences: According to a 2017 study in the Canadian Medical Association Journal, suicide is on par with bleeding and high blood pressure as a leading cause of death during pregnancy and during the first year postpartum. Even for those without suicidal ideations, maternal depression has been shown to alter the experiences of mothers and their babies for years to come.

In her book, Beyond the Baby Blues: Anxiety and Depression During and After Pregnancy, Starr says there are some fundamental ways in which diagnosing mothers' mental health conditions needs to improve. "To me, a mental health issue is no less serious than a physical health issue," she says. "You just can't measure it with a blood test."

Licensed Master Social Worker Erin Barbossa agrees. "From my perspective, unfortunately, our medical system really lacks putting the mental health lens on unless symptoms are really severe," Barbossa previously told Motherly. "We tend to focus on the physical symptoms related to the health of the baby, and if all of those check out, all is good enough."

By going with an academic publisher for her book, Starr says she hopes healthcare professionals will learn about prenatal depression in the same way they learn about physical experiences associated with pregnancy. "The hope is if they hear a story, then they'll bring that information maybe into their practice and say, 'Just so you guys know, keep a heads up, look out for maybe this or that,'" Starr says. "And this will help to inform the entire process."

It's a process that certainly needs some improvement: A 2003 study found 86% of pregnant women who expressed "significant depressive symptoms" in obstetric appointments were not receiving any form of treatment.

In 2016, the U.S. Preventative Task Force finally recommended healthcare providers screen for depression during pregnancy, as a response to "adequate evidence that programs combining depression screening with adequate support systems in place improve clinical outcomes in adults, including pregnant and postpartum women."

But these prenatal screenings are still not universal and, based on Starr's research on the topic following her own experience, many maternal healthcare professionals don't know how to differentiate depression indicators from other pregnancy symptoms. "There are very, very clear warning signs and I think that the problem is, when you're pregnant, often times you don't feel great," she says, explaining these symptoms are easy for healthcare professionals to confuse if they don't also take the time to listen to the mother. "Bring the humanity back into the healthcare experience and just say, 'So, how are you doing?' And when you ask that question, not just look for the perfunctory answer to your perfunctory question."

And for the mothers—know there is no guilt in feeling distress. If you are struggling to feel joy during pregnancy or the postpartum period, speak up. You aren't alone in this, but you aren't a statistic, either: You are a strong mama who deserves to be heard.

[This post was originally published April 20, 2018.]

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