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Last week, new mom Jessica Porten had her first obstetrician appointment since giving birth four months prior — they’d kept cancelling her appointments.
She'd waited for over an hour with her daughter, Kira, until a nurse practitioner finally called her in. When she let the nurse know that she was experiencing postpartum depression (PPD) that was “manifesting in fits of anger” but assured her that she’d never hurt herself of her baby — she only wanted to discuss her medication options — the nurse rushed through her pelvic exam, barely spoke of any medication, left the room to supposedly "talk to the doctor" about her PPD and, instead, called the police on her.
“The cops can clearly see I’m of sound mind... so they allow me to drive to the ER with Kira in my car while one cop drives in front of me and one follows behind,” Jessica explains in a now viral Facebook post that’s already garnered more than 39,000 engagements, more than 32,000 shares and more than 10,000 comments at the time of this writing.
After checking her in, drawing blood and taking a urine sample, the hospital staff removed and locked up all of her clothes and flip flops, gave her a pair of socks and fed her and her daughter two turkey sandwiches since they’d missed lunch. She wasn't seen by a social worker until 10:45 p.m., who ultimately decided that she didn't need to be put on a psychiatric hold and began to process her discharge.
“Not once during all of this has a doctor laid eyes on me,” she writes. “Not once. Not even before they decided to call the cops on me. The social worker hands me some papers and discusses the information in them, telling me she thinks these ‘will probably be good resources for you.’ I leave the ER at midnight, my spirit more broken than ever, no medication, no follow up appointment, never spoke to a doctor. This was a 10-hour ordeal that I had to go through all while caring for my infant that I had with me. And that’s it. That’s what I got for telling my OB that I have PPD and I need help. I was treated like a criminal and then discharged with nothing but a stack of xeroxed printouts with phone numbers on them… Ladies and gentleman, our healthcare system.”
Porten is not alone in experiencing PPD. Of course, childbirth affects a woman’s hormones immensely, which means it can rouse a range of emotions from elation to fear to anxiety. It’s not uncommon for mothers to experience mood swings, anxiety and insomnia after giving birth, especially within the first two weeks post-delivery. In fact, more than one-third of mothers have experienced mental health issues related to parenthood. But for upwards of 20 percent of women, according to the Centers for Disease Control and Prevention, these complications devolve into depression.
PPD can develop anywhere from a few weeks into motherhood to even a year after delivery. It’s “a severe, long-lasting form of depression” after childbirth, according to the Mayo Clinic, and it’s especially exacerbated for women who’ve endured problematic births with potentially traumatic procedures such as emergency Caesareans. Likewise, the recurrence risk is also evidently high for women who’ve had it before, according to the research published PLoS Medicine.
Porten’s Facebook post doesn’t mention whether or not she’d experienced PPD with her firstborn, but the research suggests that mothers who’ve ensured PPD with their first child are more likely to experience PPD again with subsequent births. A team of Danish researchers conducted a study to describe the risk of postpartum affective disorder (AD, an umbrella term that includes PPD and other postpartum conditions like postpartum psychosis) among women with no prior psychiatric episodes. By compiling data from national registries, they were able to look at a cohort of 457,317 first-time mothers and their subsequent births between 1996 and 2013.
The researchers found that 0.6 percent of birth resulted in PPD. After the first year postpartum, 27.9 percent of these women were still in treatment for it; after four years postpartum, that percentage dropped to just 5.4 percent. Moreover, the researchers found that the recurrence risk (or the chances of a woman experiencing PPD again) of PPD is quite high — 15 percent for women prescribed antidepressants after their first birth and 21 percent for women who were hospitalized for an affective disorder after their first birth. The risk of PPD after a second birth was 26.9 times higher in women who were prescribed antidepressants after their first birth, compared to women who’ve never had PPD, and 46.6 times higher in women who’ve been hospitalized for depression after their first birth.
These mothers who are at a greater risk of PPD need support both in understanding their condition and in medically treating those conditions, but many of them don’t seek help. And Porten’s story is a fine example of why a lot of them don’t seek help.
For example, a BabyCenter survey of more than 1,400 mothers and pregnant women called attention to the significant number of women who do not actually get prompt treatment for PPD. Twenty-one percent of the mothers polled said they had been given a diagnosis of PPD or felt like they might have it, but an overwhelming 40 percent of them did not seek any medical help. Thirty percent said they felt strong enough to “get over” their feelings without a doctor, and 26 percent of them said they felt that their symptoms were not serious enough to warrant a discussion. Meanwhile, 25 percent said they were too embarrassed to admit their feelings, 23 percent said they felt guilty about those feelings and 16 percent said they did not want to be labeled mentally ill.
As with Porten's case, most women probably don't want to be escorted by the police. But we live in a culture that consistently shames both women and mentally ill people of all gender identities, so it’s no surprise that mothers have these apprehensions.
Porten made an edit to her Facebook post to explain that, while she won’t be taking legal action, she does want her message to “spread far and wide so that awareness can be made.” She wants to fix what she calls the “broken system.”
“The fact of the matter is, even if I was mentally unstable, suicidal, and unfit to parent (which I am not), the way the situation was handled is not helpful to people,” she explains. She also asks the following questions to help crowd source ideas and induce change:
“Why is the way I was treated standard procedure?
“What can we do to improve standard procedures for all postpartum mothers, but also specifically those at a higher risk for developing PPD and presenting with signs of PPD?
“Who is most qualified to make suggestions for improvements?
“Who is actually capable of making the changes to standard procedures, and how can we can contact them?”
She later revised her post to add: “I may be marginalized as a woman, but I am white and heterosexual and hold privileges in these places. I am scared for our mothers of color and our LGBTQ mothers who seek out help in these situations.”
She, therefore, asked even more questions:
“Why was I let go, when so many others would have been put on a mandatory 72 hour psychiatric hold, and had their children taken away?
“Why do a disproportionate number of women of color who have PPD not receive the services they need, even when they initiate treatment?
“Why are a disproportionate number of women of color who have PPD misdiagnosed?
“Why are black women half as likely to receive mental health treatment and counseling as white women?
“What can we do as a community to lift up our marginalized members and make sure they receive the quality care that we ALL have a right to?!?”
Porten is working with 2020 Mom, the nonprofit host of Federal Maternal Mental Health Lobby Day and a leading advocate for maternal mental health (MMH) in California. Four bills are currently being introduced, and Porten will be posting the dates, times and locations of #4Bills4CAMoms rallies for anyone who’d like to get involved in the action.
PPD needs to be taken seriously among healthcare professionals. But to be taken "seriously" doesn't have to mean that it's to be taken criminally. Nor should it.
AnnaMarie Houlis is a multimedia journalist and an adventure aficionado with a keen cultural curiosity and an affinity for solo travel. She's an editor by day and a travel blogger at HerReport.org by night.
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