We've come a long way when it comes to talking about maternal mental health. These days celebrities speak openly about their experiences with perinatal mood disorders and many regular mothers share their experiences on social media. In 2019 it's okay to say "this is hard and I need help," but what actually happens when we ask for help varies and, in some instances, is downright unacceptable.
Recently an Alabama mom to a 2-year-old and a 2-month-old—we'll call her Beth to protect her privacy—showed up at her obstetrician's office seeking treatment for depression and unwelcome thoughts. But Beth didn't get the help she expected. Instead, her children were removed from the home she shares with her husband and were placed in the care of a relative.
What Beth experienced here is not uncommon and evidence that more work needs to be done to support mothers with their mental health.
Research indicates that maternal descriptions of violent, intrusive thoughts can result in children being taken out of a parent's care when that is not necessary. But research also indicates that such thoughts are common. A study published in the journal BCM Psychiatry this year found "unwanted, intrusive thoughts of harm-related to the infant are reported by the vast majority of new mothers, with half of all new mothers reporting unwanted, intrusive thoughts of harming their infant on purpose." But preliminary evidence suggests that these thoughts are not associated with an increased risk of harm to infants.
Beth's case is similar to one out of California last year and highlights how much work needs to be done to ensure that when vulnerable mothers seek treatment the systems and people receiving them are able to help them in a way that doesn't feel like punishment.
Beth is now bravely speaking out about what happened to her. In an exclusive interview with Motherly, she explains how she went to her OB's office (with her exclusively breastfed infant in tow) to seek help for a feeling she thought was postpartum depression. She says she described her feelings to a nurse at the OB's office, including a fleeting, intrusive thought she'd had about ending her life and her baby's. She tells Motherly it was not a thought she would act on—that the thought of harming her baby repulsed her—but the fact that such an image would pop into her mind concerned her a great deal.
When the doctor came into the exam room about an hour later Beth told her story a second time, telling her OB: "I feel hopeless and I'm crying a lot, and I had this fleeting thought of hurting myself and my child," she says. According to Beth, the doctor then left the room and returned with a plan for Beth to go to a nearby Emergency Room. Beth says she was told she could keep her baby with her, would be evaluated and sent home that evening with medication.
But things did not go as she expected once she arrived at the ER. While she was waiting to be seen by a doctor she called her mother, who suggested she leave the hospital, but Beth says nursing staff encouraged her to stay. Hours later Beth was admitted to the women and children's hospital where she'd given birth just weeks earlier. There, Beth was evaluated by a psychiatrist. Shortly afterward, her husband (who had been at work) arrived. It was now after 5 p.m. and the couple was growing concerned.
With her husband and her mother-in-law now by her side, Beth decided to sign out, advising staff she wanted to seek outpatient treatment. Hospital staff tried to convince her to stay, but she decided to leave with her husband. As they left the building a security guard followed them, telling them Beth was now on a "psych hold."
As Beth tells it, while the couple was getting into their cars (they had arrived separately) the hospital issued a Code Adam (a code for a missing child or baby) for her infant daughter, but Beth was able to simply pay $14 to leave the parking structure with no issues. The couple didn't go home, but rather to pick up their 2-year-old and head to Beth's mother-in-law's house. When a neighbor called and asked Beth why there were several police cars in front of her house she realized how serious the situation had become.
Beth's mother-in-law went to speak with the police and called Beth to bring her daughters to meet police and social workers from the Alabama Department of Human Resources. Beth was not allowed to spend the night with her children and was told to be in court the next morning.
In court, Beth was told she was a danger to her children, and they were placed in the care of a cousin. "My husband, since he was helping me leave the hospital, he's not allowed to have custody of the kids. They can't come to our house. I have to be supervised with the children at all times. I can't spend the night with them. It's just a big mess," Beth tells Motherly.
The Department of Human Resources responded to Motherly's request for comment on this case with the following statement: "All information regarding child welfare investigations is confidential under state law".
Joy Burkhard is the founder and executive director of 2020Mom.org, a national organization dedicated to closing "gaps in maternal mental health care through education, advocacy, and collaboration." She says Beth's case illustrates how much nuance and support is missing from maternal health care right now.
"Our health care system is completely failing so many mothers, like Beth, who speak up because they want to get treatment. By taking a mother's babies away, the system has failed not once but twice," she explains.
Burkhard is concerned that doctors still confuse symptoms of postpartum depression (including intrusive thoughts) with the more serious postpartum psychosis, which does increase a mother's risk of harming her children. She says that while awareness of maternal mental health disorders like postpartum depression has increased in recent years, "most doctors still aren't adequately trained in the nuances of these disorders and nuances matter."
Back in Alabama, Beth believes the nuance was lost in her case and insists she would not have acted on the thoughts that entered her mind and was not a danger to her child. "That's not me. I know I would never do that. I just wanted help to control the thoughts," she explains.
Her case highlights some serious issues with how mothers seeking mental health help are treated, but her experience should not discourage mothers from seeking help when they need it.
"If you are experiencing intrusive thoughts about harming yourself or your baby, the number one thing is safety. If anyone is in immediate danger, call 911," says Diana Spalding, Midwife and Motherly's Digital Education Editor.
Spalding continues: "If you know that you need help but danger is not imminent, try to find a professional that specializes in postpartum mood disorders. They'll understand the nuances of what you are experiencing. If this type of help does not exist, or you find yourself in the ER, ask for an interdisciplinary approach between an ER Doctor, an OB or midwife, and a psychiatrist. Together they may be able to provide a more holistic view of what you're going through."
Meanwhile, Beth is hoping no one has to go through what she is going through. She and her husband and doing everything they can to get their children back home. Beth is seeing a psychiatrist, a psychologist and a counselor and she and her husband are attending parenting classes five days a week. She says the deadline given to her by DHR was December 23, and that she will have met all the department's requirements long before then. She is hoping to be sleeping under the same roof as her children by Christmas.
2020mom is now circulating a petition addressed to the American College of Obstetrics and Gynecology, noting that it is "critical doctors, nurses, child protective services and judges receive training in the range of disorders and symptoms so they know when a mother is at risk of harming herself and/or her baby (with postpartum psychosis), and when she is not (with postpartum intrusive thoughts/anxiety)." More than 2,000 people have signed the petition.
If you are struggling with your mental health right now check out these resources to find the help you need, mama.