Home / Postpartum / Fourth Trimester At my 6-week postpartum checkup, I lied to my doctor about my postpartum depression As a physician myself, I knew that our healthcare system doesn’t adequately support mothers after childbirth. Here’s what helped me instead. By Jessica Gaulton MD, MPH May 4, 2022 Shutterstock/Semachkovsky In This Article Recognizing the fourth trimester Spotting the signs can be difficult Seeking help for maternal mental health We shouldn’t have to lie I was waiting in my obstetrician’s office six weeks after having my second baby, and was handed a piece of paper with 10 questions that would determine if I had postpartum depression (PPD). Being a doctor myself, I knew the score I needed to be considered “low risk”… so I lied about my symptoms. As someone who had struggled with PPD previously, I found it very difficult to find the help that I needed then—even though I’m a physician. Our healthcare system is broken and does not adequately support the health and wellness of new mothers. I didn’t speak up to my colleagues about my own struggles until years later because, as a neonatologist who cares for moms and babies every day, I was afraid that I would be judged and thought of as weak or incapable of doing my job. But as it turns out, lots of moms feel like they have to lie to their providers about their mental health in postpartum and put on a happy face. That helps no one. Recognizing the fourth trimester A pregnant person usually sees their doctor 14 or more times during pregnancy, but after childbirth, they are scheduled to see their doctor only once—6 weeks after delivery. Sadly, up to 40% of women in the U.S. aren’t seen at all because of gaps in care. The medical community thinks that pregnancy should include a ‘fourth trimester‘ because women need continued medical attention after childbirth. In fact, as many as 1 in 5 women are at risk of postpartum depression up to a year after delivery, but 75% are left untreated. The healthcare system is actually losing $32,000 per mother-infant pair with a total cost of $14.2 billion yearly. Related: Dear mama, you shouldn’t be an afterthought after giving birth Spotting the signs can be difficult I was one of those women who went undiagnosed and untreated for over a year. After the birth of my first child, I remember seeing my doctor at 6 weeks but don’t remember filling out a questionnaire or being asked about my mental health. By that time, I felt like so much had already happened—breastfeeding struggles, insomnia, panic attacks. I wish I could have had my doctor’s appointment sooner or had someone check in on me regularly because I didn’t realize those early symptoms were signs of anxiety and depression. You would think that as a doctor who works with moms and babies, I would have recognized my own symptoms. I think it’s even harder for female doctors sometimes because we’re used to being the one helping others and often overlook our own health. Related: 5 postpartum depression symptoms you may not have heard of My appointment with my OB was so rushed, and she clearly had a checklist that she needed to get through, so I didn’t feel comfortable speaking up about how I was feeling. I also felt embarrassed and ashamed. If she had asked me specifically if I was having panic attacks, difficulty sleeping or overwhelming sadness, I probably would have said yes. So for over a year, I struggled in silence. I was a trainee in a clinical Neonatology Fellowship program at one of the top ranked children’s hospitals in the country and only had 6 weeks of maternity leave before returning to work. I was struggling to keep up with being on-call every fourth night, pumping every 3 hours at work, while also finding time to spend with my new baby. I considered telling my colleagues, but I’d seen people judge other female doctors for leaving meetings to pump, and I didn’t want them to think I wasn’t committed or worthy of being there. Seeking help for maternal mental health When I finally reached a point where I knew I had to do something—a year later—the only place I knew to turn was employee health, but I wanted to remain anonymous and didn’t want anyone at work finding out. Having just moved to the area, I didn’t have girlfriends to lean on, and when I tried googling new mom groups, I didn’t find any that were easily accessible. I looked for a therapist who had experience in maternal mental health, but I quickly realized that the specialty really didn’t exist. These types of providers are few and far between and only a few of them were covered under my insurance. How can women afford to pay more than $100 for every therapy session out-of-pocket? I felt helpless, alone, with nowhere to turn. After I found the courage to tell a colleague at work, she referred me to a female physician who was a mom herself and had gone through what I was going through. She validated how hard it was to be a working mom and said my baby would be just fine if I wanted to stop pumping. She also told me that it was OK if I wanted to take a break from work to spend more time with my baby. She gave me permission to lighten my load. When I heard this, I felt a wave of relief come over me, like a weight was taken off my shoulders. She became my peer coach, and she saved me. So after the birth of my second child, I’d pretty much given up on getting help through my doctors or the healthcare system—which is why I lied on my postpartum depression questionnaire. What’s the point if I know that the healthcare system can’t help me? Many moms have told me that they are afraid their babies will be taken away by social services if they speak up. One mother shared with me that when she opened up to her doctor about feeling sad and anxious, that doctor made her feel like she was crazy and misdiagnosed her with bipolar disorder. Related: More than half of new moms aren’t getting the mental health support they need We shouldn’t have to lie I certainly do not recommend women lie to their doctors like I did, but I do understand why so many women do it. New moms deserve to feel nurtured and supported after childbirth, not judged and neglected. In the aftermath of the Covid pandemic, there is an even greater shortage of mental health providers. We need to fill the gaps in our system to support new mothers now, and we can’t wait for the healthcare system to catch up. That’s why, after recovering from my own battle with PPD, I started Mommi, to give birthing people access to all of the resources they need to stay healthy and happy in the postpartum period. Our mission at Mommi is to break down the stigma surrounding maternal mental health and provide equitable access to postpartum services that will improve the health and wellness of mothers and babies around the world. I truly believe that one way we can start filling that gap is by giving women access to peer coaches, other moms who have gone through similar experiences. My coach saved me, and I know that other women can benefit, too. Sources Byatt N, Levin LL, Ziedonis D, Simas TA, Allison J. Enhancing participation in depression care in outpatient perinatal care settings: a systematic review. Obstetrics & Gynecology. 2015 Nov;126(5):1048. doi:10.1097/aog.0000000000001067 Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstetrics & Gynecology. 2005 Nov 1;106(5 Part 1):1071-83. doi:10.1097/01.aog.0000183597.31630.db Luca DL, Margiotta C, Staatz C, Garlow E, Christensen A, Zivin K. Financial toll of untreated perinatal mood and anxiety disorders among 2017 births in the United States. American Journal of Public Health. 2020 Jun;110(6):888-96. doi:10.2105/AJPH.2020.305619 McKinney J, Keyser L, Clinton S, Pagliano C. ACOG Committee Opinion No. 736: optimizing postpartum care. Obstetrics & Gynecology. 2018 Sep 1;132(3):784-5. doi:10.1097/01.aog.0000183597.31630.db About the author Jessica Gaulton, MD, MPH, is a physician-entrepreneur whose expertise lies at the intersection of maternal & newborn health and healthcare innovation. She is a practicing neonatologist and also co-founder and chief medical officer at Mommi, INC (www.mommi.us). Mommi, INC aims to solve the maternal mental health crisis by closing the health equity and healthcare access gaps in the U.S. Dr. Gaulton received specialized training in Innovation and Design at the Penn Medicine Center for Health Care Innovation. She completed her Clinical Fellowship in Neonatology at the Children’s Hospital of Philadelphia/Penn Medicine, medical degree from the Johns Hopkins School of Medicine, a Master of Public Health from the Harvard School of Public Health, and pediatric residency at Boston Children’s Hospital/Harvard Medical School. This story is a part of The Motherly Collective contributor network where we showcase the stories, experiences and advice from brands, writers and experts who want to share their perspective with our community. We believe that there is no single story of motherhood, and that every mother's journey is unique. By amplifying each mother's experience and offering expert-driven content, we can support, inform and inspire each other on this incredible journey. If you're interested in contributing to The Motherly Collective please click here.