The film does a good job talking about the prevalence of perinatal emotional complications - up to 20% of women experience mood and/or anxiety complications during pregnancy or postpartum with 1 in 1000 suffering from postpartum psychosis and the sad state of affairs when it comes to accessing treatment - particularly for families in rural areas. They really hammer home the point that emotional complications are the most common complication of childbirth: a statement with which I'm very familiar, but judging from audience reactions, is still not widely-known.
In the first half of the movie, the filmmakers focus on the fact that screening for postpartum (let alone pregnancy) mood and anxiety disorders is not mandatory and is incredibly inconsistent. Then they interview a woman who states she wouldn't have answered the questions truthfully anyway. This realization that even if a woman is handed a questionnaire ONCE at her OB's office, she may not be identified is a key piece of the puzzle. Another woman in the movie states that she reached out to her OB and her lactation consultant and was told to "just put the baby down." Liz Friedman of MotherWoman states in the movie that "unless our providers talk about it women aren't necessarily going to open up."
Since the movie was released, ACOG actually revised their position to recommend "that clinicians screen patients at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool. Although screening is important for detecting perinatal depression, screening by itself is insufficient to improve clinical outcomes and must be coupled with appropriate follow-up and treatment when indicated"
Supporting women with perinatal emotional complications is about having effective systems of care in the community that would include
- doctors and midwives who are screening at regular intervals during pregnancy and postpartum, and who are aware of both the risk factors for perinatal emotional complications and their patients' histories regarding those risk factors,
- behavioral health clinicians & psychiatrists who are trained in maternal mental health, who are accessible geographically and financially (a troubling trend is in psychiatrists' reluctance to accept insurance)
- a network of treatment options and support including groups, peer support, home visits, acupuncture and other complementary treatments,
- insurance companies that reimburse treatment, and
- psychiatric emergency providers who understand and can assess the difference between intrusive, scary thoughts and true psychotic symptoms
These issues, this stigma, these barriers to care are why I and three colleagues founded the Every Mother Project with the belief that every mother deserves comprehensive perinatal support. We developed a Perinatal Toolkit for women's health professionals to better understand, recognize, know how to talk about, and support women through perinatal emotional complications. We've had lactation counselors, doulas, pelvic floor physical therapists, midwives, acupuncturists and many other birth and postpartum professionals download the toolkit. Our hope is that with more training and awareness for all the myriad of people who come into contact - and often develop quite close and important relationships - with pregnant and postpartum women and new parents, more women will feel heard and understood and will be able to be connected to the right supports.
The movie didn't get into the racial and socioeconomic disparities that exist in maternal mental health, but I'd be remiss in not mentioning them here. There's been yet another study that examined stress in pregnancy and risk of postpartum depression, finding that more stress events (financial, partner, trauma, or emotional) in a woman's life was directly correlated with a higher risk for emotion complications. Other studies have identified that experiences of racial discrimination during pregnancy (which can be prevalent within medical systems) not only affect the pregnant woman's own emotional and physical health, but also impact the infant's stress physiology response. So yes, institutional racism and systemic oppression have real effects on pregnant and postpartum women of color and women in poverty, increasing their risk for perinatal emotional complications, all while making it harder for them to be identified and access treatment.