“If Moms Aren’t Well, Nobody’s Well”: What We’re Missing About Maternal Mental Health
In June 2019, I vividly remember sitting on my couch on a hot summer day, holding a newborn baby who felt impossibly tiny and overwhelmingly huge; there was so much joy, so much fatigue, so much confusion, so much pain, and wonder, grief, and love.
I remember wondering if I’d ever sleep again, ever work again, or ever feel like myself again. Becoming a mother introduced me to a topic my years of reporting on women’s health hadn’t prepared me for: the emotional complexities and challenges of motherhood.
It used to be that moms talked about their struggles quietly—behind closed doors at a therapist’s office, in whispers, or in looks that moms give other moms. Now, we have data to support what many mothers have been feeling for a long time: they’re struggling.
Last week, a study published in JAMA Internal Medicine asked mothers of kids under 18 a simple question: “In general, how is your mental or emotional health?” Only 26 percent described it as “excellent,” a figure that’s down from 40 percent in 2016. The percentage of moms reporting just “fair” or “poor” mental health rose, too.
“What’s really powerful about this data is how many mothers said, ‘Something is wrong here.’ There’s this deep, internal sense among so many that something just isn’t quite right. —Lucy Hutner, MD, a New York-based reproductive psychiatrist”
Generally, the term maternal mental health refers to the emotional, psychological, and social experience of fertility, pregnancy, postpartum, and beyond. Over the past six years, I’ve researched and reported deeply on it and have come to understand that it’s wildly complex, spanning from postpartum depression to daily stress, intrusive thoughts, rage, and sadly, suicide. Often, though, as this study touched on, maternal mental health is a feeling.
Lucy Hutner, MD, a New York-based reproductive psychiatrist, echoes this sentiment. “I think what’s really powerful about this data is how many mothers said, ‘Something is wrong here.’ There’s this deep, internal sense among so many that something just isn’t quite right.”
Catherine Birndorf, MD, a reproductive psychiatrist and co-founder of The Motherhood Center in New York City isn’t surprised by the new research. “We’re finally getting data to support what we’ve been figuring out over the last 20 years,” she says.
The research comes at a moment when parenthood feels particularly precarious. A recent analysis found that 60 percent of households can’t afford the basics to care for their families, and last August, former U.S. Surgeon General Vivek Murthy, MD, issued an advisory addressing the mental health of parents and the critical need for systemic support.
Yet, while there’s more conversation around maternal health and the everyday stress parents feel as well as more data, it wasn’t long ago that the field of maternal mental health didn’t even exist.
A Field That Wasn’t Allowed
When Birndorf, founding director of the Payne Whitney Women’s Program at Weill Cornell Medicine – New York-Presbyterian Hospital, began working in maternal mental health in the 1990s, she says her speciality was hardly recognized as a field at all.
“Back then, the idea that women needed specialized mental health care just wasn’t accepted,” she says. “Health was health, mental health was mental health, and the differences between men and women just weren’t a part of the conversation.”
It wasn’t until 1993 that women were even required by law to be included in clinical trials in this country—a reminder of how often women’s health struggles are swept under the rug. Hutner recalls being told early in her career that, should she choose to specialize in women’s health, she “wouldn’t have a career.” In 2021, she penned the first medical textbook on reproductive mental health, published by the American Psychiatric Association.
The field of maternal health, she says, was built from the ground up by a handful of experts committed to listening to what women were really struggling with.
High Stakes
Maternal mental health has come a long way since the 1990s—and major studies and advancements are wins. Yet, Birndorf also worries that for providers, the field is too often viewed as an optional part of training, rather than a core component. “It's like it’s not part of the meal. It's dessert.”
Fragile progress in maternal mental health could also be easily be lost. Maternal mortality review committees—groups of experts who review maternal deaths to understand why they happened and how to prevent similar tragedies in the future—for example, have unearthed much of the critical data on mothers’ health, and they are being dismantled under the current administration.
Eighty percent of maternal deaths are preventable. “In my opinion, from a public health standpoint, we should have zero tolerance for any mortality; nobody should be dying in the postpartum period,” Hutner says. Approximately 41 percent of births also occur on Medicaid, which is on the verge of major cuts.
“This is a life and death matter—and I worry it's not being taken seriously,” says Birndorf. “This is everybody's issue. It's economic, societal, and familial. If we’re not taking care of women, a foundational majority of the population, we’ve got a big problem. If moms aren't well, nobody's well.”
The Struggles of American Motherhood
In the U.S., maternal mental health conditions such as postpartum depression and postpartum anxiety impact one in five moms. They are a leading cause of distress and death postpartum, too “Suicide and overdose are two of the leading causes of maternal mortality,” says Hutner. “That’s a public health emergency.”
Black women, in particular, are more likely to have a maternal mental health condition, less likely to be treated for it, and face at least three times the maternal mortality rate of white women.
Maternal mental health is also deeply entangled with the conditions we parent in: a lack of paid leave, affordable childcare, and community—all of which make it downright difficult to parent in this country. “Affordable childcare is an oxymoron,” says Birndorf. Many of her patients—especially those who work irregular hours—struggle greatly to find and afford childcare. The United States is also the only developed nation without a federal paid leave policy; 25 percent of mothers return to work just two weeks after giving birth.
No One-Size-Fits All Wellness Solution
Maternal mental health conditions such as postpartum depression and postpartum anxiety are medical conditions, but the daily struggles—the impossibility of school and work hours that don’t match up, the haze of sleep deprivation, the struggle to make time for yourself, the feeling of being stretched too thin day in and day out—matter, too.
Little stressors build to be the big stressors that can increase risk of depression or anxiety, no matter how old your children are. And many mothers' struggles persist beyond the postpartum period we typically hear about. One study in Lancet Public Health found that while nearly one in four mothers experienced a mental health condition, rates rose as kids grew: For moms of high schoolers, that figure was more than 27 percent.
Maternal mental health conditions—and all mental health conditions outside of the postpartum period—have proven treatments, including a blend of medication, social support, and therapy. But experts worry that the “Instagramification of wellness”—the false idea that if you can just make time for a weekly yoga class, your stress will melt away—can make it seem like motherhood has a one-size-fits-all wellness solution. In reality, says Hutner, “we're sitting on top of a public health emergency that wellness can’t fix.”
Helping mothers feel better will require holistically addressing mothers’ mental health in different ways from increased societal support to community and more personalized solutions.
There are big benefits when moms band together to make change: In 2021, with a group of advocates in the space, we co-founded Chamber of Mothers, a nonprofit that advocates for paid leave, affordable childcare, and maternal health. Just last month, moms from our Arizona chapter shared their stories in support of a bill designed to close maternal mental health gaps—especially in rural areas where care can be hardest to access. The legislation, which focuses on educating both providers and patients, was signed into law soon after.
“If you have a broken arm, you go to a specialist. When you get into the business of fertility, being pregnant, or motherhood, you need a specialist who actually understands the landscape and the literature.—Catherine Birndorf, MD, a reproductive psychiatrist”
There’s power in looking inward, too. Hutner suggests asking yourself questions like, ‘What needs to change in order for me to feel even a little bit better?’ The answer will vary for everyone—maybe that you want time to play a game with your children or that you need Summer Fridays. “Most people know the answers already,” says Hutner. It’s not a perfect solution, but this exercise also gives you permission to prioritize yourself.
In terms of seeking the support you need, Postpartum Support International has a directory of providers trained in maternal mental health, and Hutner has worked to create a national curriculum on reproductive psychiatry—something currently being directed at OB/GYNs, who are not required to be trained in maternal mental health.
This type of specialized training is critical. “If you have a broken arm, you go to a specialist,” says Birndorf. “When you get into the business of fertility, being pregnant, or motherhood, you need a specialist who actually understands the landscape and the literature.”
Fortunately, what started as a small group of trained experts in the country has grown into a burgeoning field. “There are really strong, powerful networks being generated all over the country,” says Hutner, who reminds moms that they are not alone in their struggles.
Friends, family, and those who you can turn to when you’re struggling is another critical part of maternal mental health, Birndorf says. “We need to create villages and find a community where truth is spoken."