When Maria Lindsay of St. Louis was pregnant with her second child, she had a nagging, anxious feeling something wasn’t right.
Lindsay had given birth to a healthy baby two years before, and her second pregnancy was progressing normally, too. But the feeling persisted.
Her fears were confirmed right after her daughter, Annie, was born. The baby couldn’t nurse, and turned purple within a few minutes. She was rushed to the neonatal intensive care unit.
Annie would stay in the NICU at St. Louis Children’s Hospital for five weeks for extensive testing, eventually being diagnosed with a rare multisystem disorder. The situation was difficult for both Lindsay and her husband, but Lindsay was especially anxious -- about what the baby’s life would be like and how their older daughter might be affected. Lindsay blamed herself and wasn’t sleeping or eating well.
During that time, a neonatologist approached Lindsay and said she would like to refer her to psychiatry.
“I looked at her and said, ‘What?’” said Lindsay, now 36. She didn’t understand what the doctor was talking about. She called her later, asking if she’d meant that baby Annie needed psychiatric care.
“No, I’m talking about you,” the doctor said. She had noticed that Lindsay had never stayed overnight with the baby and seemed extremely anxious. Lindsay was open to the idea, so the doctor called Washington University’s Perinatal Behavioral Health Service for them to set up an appointment.
Lindsay ended up talking to a therapist at PBHS weekly for 18 months, through dozens of Annie’s appointments.
“She was an excellent listener -- someone I could vent to. She really helped me to be resilient,” she said.
Dr. Cynthia Rogers, professor of psychiatry and pediatrics at Washington University, is co-director of PBHS. She points out that mental health disorders are among the top complications of pregnancy (either No. 1 or 2, depending on the study).
“Suicide is a greater maternal mortality risk than a hemorrhage,” she said.
Rates of postpartum depression rose nearly threefold during the pandemic, along with significant increases in major depression and thoughts of self-harm, according to a University of Michigan study published in BMC Research Notes.
Rogers said they noticed a rise in the number of patients at the center during the pandemic, as well as an increase in the number of women admitted to the hospital with perinatal and postpartum mental health disorders.
The demand for services hasn’t lessened even as pandemic restrictions have lifted.
“We’re still extremely busy,” she said.
Given that most new moms can feel overwhelmed, exhausted and anxious at times, how does one know if medical intervention is necessary?
“It really has to do with your functioning -- if you are really struggling to get out of bed to take care of yourself or take care of the baby,” Rogers said. When sadness, fears or intrusive thoughts occupy a large portion of your day and you can’t enjoy time with your infant, that’s when you should see someone for help, she said.
The center has funds to provide therapy and services for people who are uninsured. There are also organizations, like Nurses for Newborns, Lutheran Family Services and several doula groups, which can help new mothers. Postpartum Support International offers a helpline that people can call or text at 800-944-4773 to be connected to resources.
Tara Tinnin, program coordinator for PBHS, says some women fear being judged if they reach out for help, not realizing how common and treatable most conditions are. Others don’t know where to turn, or may lack insurance, transportation or childcare for appointments. The expansion of telehealth services has helped address some of those barriers.
In other cases, an obstetrician may have told a depressed or anxious mother that her struggles are normal, said Tinnin. In Lindsay’s case, the doctor who spotted her symptoms was likely aware that moms with children in the NICU are at greater risk for mental health disorders.
“If that neonatologist had not referred me, I would never have used a therapist,” she said.
She’s expecting her third child now, and she has noticed her anxiety spiking. She reconnected with her therapist and talks to her before each of her checkups.
“I’m rethinking about what happened with Annie. Every month is very scary for me,” she said. “She’s literally helping me get through this pregnancy.”