Silent mothers: More than just baby blues

According to the US National Coalition for Maternal Mental Health, more than 600,000 women experience depression and anxiety during pregnancy or within 12 months of childbirth. These illnesses, which frequently go unnoticed and untreated, can affect a mother’s well-being, her child’s cognitive and behavioral development, the health of her marriage, and her family’s stability.

In Israel the situation is no different. Women of every culture, race, age, and economic status are at risk, though Israel’s large immigrant component presents added complexity in the provision of culturally sensitive help. Varied quality and quantity of available psychological services, the high proportion of religious sufferers in need of help, and unfounded myths regarding medical interventions add to the barriers preventing effective treatment.

Ben-Gurion University of the Negev (BGU) researchers have recently issued new guidelines for treating perinatal (pre- and post-birth) mood and anxiety disorders (PMADs). These guidelines were formulated in the Center for Women’s Health Studies and Promotion, founded by Professor Julie Cwikel. The center is unique in that it both produces quality academic research in the field of women’s psychosocial health and runs community interventions, such as the mother-to-mother program and a busy psychotherapy center.

The production of concise treatment guidelines, which have been presented to the Ministry of Health, will both improve the treatment provided to those who seek help and also improve screening techniques to access the 30 percent of women who suffer in silence.

“The research is very clear,” Prof. Cwikel says. “Treating depression in pregnant and postpartum women benefits both the mothers and their children in the short  and long term.” Treating a depressed mother results in fewer premature and low-weight births, better outcomes in early development and greatly reduced likelihoods that the child will suffer from depression in their adolescence and early adulthood.

“Rachel” (name changed to respect her privacy) didn’t plan to have children but she was not averse to the idea. Early on in a new relationship she became pregnant. The highs of a new relationship coupled with the promise of stability and forming her own family led her to greet the pregnancy with joy and anticipation.

Rachel had a difficult birthing experience. Her daughter “Sarah” was born with intense medical support and Rachel feared she would lose her precious daughter. While the initial tears and panic caused by the situation were expected and she was comforted by those around her, when Rachel returned home she found herself alone, depressed and drowning in the guilt at her inability to embrace motherhood. She would spend days staring at her sleeping newborn, reading her stories, comforting her when she cried, and feeding her every two hours.

But Rachel was suffering. The more she suffered the less she was able to face her daughter, look into her pleading eyes or relate to her cries for help. The more Rachel plummeted into depression, the less she was able to understand Sarah and the greater her guilt grew. It was only when she was seen by a newly trained nurse in her local Tipat Chalav (Child Health Clinic) that she was able to give this pain, guilt and suffering a name: postpartum depression.

“Our new study contains excellent guidelines for treating mothers coping with perinatal mental health challenges,” says Prof. Cwikel. “These disorders affect millions of women around the world, yet only a third of them actually get treatment.”

BGU’s study contains detailed treatment guidelines and strongly recommends mandatory screening for perinatal and postnatal women. Prof. Cwikel explains that all mental health professionals should be able to identify and treat PMADs but so too should training be provided for doctors and nurses coming into contact with these women. Rachel’s case is representative of the thousands of women in Israel suffering from perinatal depression.

The women surveyed as part of this study overwhelmingly preferred to receive treatment in the community – without having to resort to mental health services – due to the stigma attached to receiving psychiatric care. Despite having a name for her condition, Rachel was reluctant to receive help and only began treatment when she had difficulty bonding with her five-month-old daughter.

“For every dollar invested in treating PMADs,” says Prof. Cwikel, “you can save approximately seven dollars in future treatment.”

Ben-Gurion University of the Negev’s study has far-reaching consequences for Israel’s maternal care. Providing basic guidelines will aid in the battle against inequality in maternal health care provision, which unfortunately is still prevalent in Israel. The guidelines will hopefully boost both uptake of care and create a service tailored to the needs of its users.

The Center for Women’s Health Studies and Promotion is now pioneering research into art-assisted therapies with PMADs, treatment for poorly served populations and understanding the long-term effects of traumatic births.