Postpartum mental illness: the health crisis no expectant mother expects

Eva Schwartz didn’t have a history of mental illness. There were never any indicators that the birth of her first child would spark a yearslong struggle that would threaten her marriage and her life.

Schwartz was 29 in 2015, with a stable home life in Sacramento, as she awaited the arrival of her firstborn son, Isaac. She felt prepared. She had taken all the classes, followed all the mommy pages on Facebook. She was going to have a natural birth, she said, and exclusively breastfeed once Isaac was born.

Those plans started to go awry during labor, when doctors decided she needed an unscheduled cesarean section. Then her breast milk didn’t come in. Schwartz panicked, fearing Isaac would somehow be “damaged” if he wasn’t exclusively breastfed, or that she wouldn’t be able to bond with him.

As days turned to weeks, her psychological health went into a tailspin. Her ability to mother her child became a fixation. At night,

her husband said, he would awaken to her crying in bed, detailing scenarios in which she would kill herself and he would remarry before Isaac was old enough to “know that (she) existed.” Eventually, 10 days after giving birth, she began raving to a neighbor who told her husband to take her to the emergency room, where her mania spiked.

Forcibly sedated, Schwartz was taken to Heritage Oaks Hospital on a 51-50 hold, where she was diagnosed with postpartum psychosis, a condition which can begin in the first few days after childbirth, even in women with no history of mental illness.

“There’s all sorts of prenatal classes that they do to help you prepare for a new baby,” Schwartz said. “But no one warned me that mental illness can hit.”

The health of expectant mothers has been an urgent concern, nationally and in California, as studies have shown maternal mortality rates falling worldwide, yet steadily increasing in the United States. Health initiatives here have focused on reducing complications of pregnancy and childbirth, and California’s progress, with a few exceptions, has been held up as a national model.

But the mental health side of the picture, which can be just as lethal, has received less attention, say lawmakers and public health experts.

A recent report by researchers at UC Merced and Michigan State University linked nearly one in five postpartum deaths among California women to drug abuse or suicide — psychological crises. The death toll was highest, the study found, among socioeconomically disadvantaged women and white women, but it added that data is generally scant on mental health-related deaths of new mothers.

Sidra Goldman-Mellor, a psychiatric epidemiologist at UC Merced who is one of the study’s authors, said official maternal mortality rates in the U.S. only focus on causes of death immediately linked to the pregnancy or childbirth — medical complications such as hemorrhages or preeclampsia, for example.

“They’re not even counting deaths that are due to other problems,” GoldmanMellor said.

Assemblywoman Sabrina Cervantes agrees that postpartum mental health has been neglected as an issue. “We celebrate the birth of children, but the well-being of the mother who gives birth often gets forgotten,” she said.

The Riverside Democrat is working to establish a pilot program to provide greater mental health services to new mothers, one among several new efforts to address that aspect of postpartum care. Her AB 798 would create a privately funded pilot program that would provide mental health screenings, psychiatry, teleconsultations and mentoring services aimed at detecting and treating postpartum mothers for up to one year after delivery.

Already in effect as of this month is Assemblyman Brian Maienschein’s AB 2193, which requires health insurers to develop a maternal mental health program and requires prenatal or postpartum providers to ensure that new mothers are offered screening for maternal mental health conditions.

Maienschein has also put forth AB 845, which will be taken up on the Senate floor when the Legislature reconvenes next week. That bill would require the California medical board to consider including a course in maternal mental health among its continuing education requirements for providers.

Meanwhile, last month, Gov. Gavin Newsom signed a budget bill temporarily expanding access to MediCal maternal mental health services from two months to one full year after giving birth, an $8.6 million initiative funded by revenue from the tobacco tax passed by voters in 2016. The experimental expansion, slated to start next year, will sunset at the end of 2021 unless state lawmakers vote to keep it.

As many as “one in five new or expectant mothers will experience a mental health disorder during pregnancy or the first year following childbirth, including depression, anxiety and postpartum psychosis,” Cervantes notes in her bill, which has passed the Assembly and is now parked in the Senate Appropriations Committee while she and other backers try to figure out funding. Because socioeconomic factors and stigma can also prevent women from seeking treatment, the bill includes an opt-in pilot program for counties, including Riverside, to offer remote mental health teleconsultations to new mothers.

Over the following year, Schwartz said, she was in and out of the hospital as doctors experimented with different types of medications and treatments. At her low point, during a manic episode that started when she tried to stop taking her medication, her husband Brent filed for divorce. “I thought I couldn’t take it anymore,” he said.

Eventually, she resumed her medication, found a sustainable treatment plan and reconciled with her husband, she said, but her recovery has been a long process. She counts herself lucky that she had the health insurance and access to care that allowed her to reclaim her life.

“I didn’t get a divorce. Most women do. I didn’t end up on the street. And I didn’t, as people I met in the mental hospital did, end up on methamphetamines or heroin,” Schwartz said. “I had healthcare. The fact that these women don’t is absolutely terrifying. They need it. It’s the basics of everything else. I didn’t lose my mind, because of that.”