I went to the screening of the maternal mental health documentary, Dark Side of the Full Moon, last night, organized by Leslie McKeough, LICSW - a Lynnfield therapist - and the North Shore Postpartum Depression Task Force. The documentary highlights the experiences of several women who experienced perinatal mood and anxiety disorders, the dismal state of screening for emotional complications in pregnancy and postpartum, and the barriers to treatment for these women. Interspersed are the news stories of the lives lost to maternal mental illness while they were filming the documentary. 

Women feel guilty, self-conscious, isolated, and overwhelmed when they're experiencing emotional complications in the postpartum. Supporting women with perinatal emotional complications is about more than a 10-item questionnaire, though that's a good first step. It's about more than having a therapist's phone number, though that's needed too, and hopefully many people have that therapist's number or know where to look. It's knowing that if they reveal to you how they feel, they're doing so with fear and worry about not being a good mother, about their baby being "taken away," about never feeling like themselves again. 

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
  

We are on our way, in Massachusetts, to creating such systems of care, largely thanks to the advocacy of families with lived experiences of perinatal mood and anxiety disorders, clinicians, and state legislators, but we still have a ways to go. 

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. 

I'm so thankful for the chance to view Dark Side of the Full Moon, and that so many others did, too. We have much to do still to better support women through perinatal emotional complications - even in Massachusetts. Please, at least take a look at the trailer if you missed it. And maybe we can organize another viewing...

Depression and anxiety are incredibly common both during pregnancy and after childbirth, but sometimes it's hard to get past the jargon and austere clinical descriptions of symptoms. Postpartum Progress features clear, accessible writing from real women who've experienced perinatal emotional complications - Warrior Moms - as well as professionals from all over the country. They also have a private forum and are hosting their first conference in Boston this summer!

One of my favorite posts featured photos of women to demonstrate what it looks like when someone is suffering from a perinatal emotional complication (hint: not what you think!).

"Plain Mama English" posts describing symptoms of postpartum depression, anxiety and psychosis are probably my other most referenced posts. You can even download nice PDFs to print out. Their newest tool is a New Mom Checklist for Maternal Mental Health Help, a checklist that a postpartum woman can bring to her care provider to start a conversation about getting help. 

This year is their third putting on the Climb Out of the Darkness, an awareness and fundraising event for Postpartum Progress and perinatal emotional complications. On June 20, there will be a Climb at Walden Pond in Concord, MA and others around the country where women who've experienced perinatal emotional complications and the people who support them will get together outside, create community, and symbolize the journey out of postpartum depression and anxiety and into the light of hope and recovery on the longest day of the year. You can find a climb near you or donate to my "couch" climb effort here. 

Postpartum Progress started exploring the needs of women of color who suffer perinatal emotional complications and surveyed women of color about their experiences at the beginning of 2015. I hope Postpartum Progress continues engaging and amplifying the voices of women of color, as well as exploring and increasing awareness of unmet needs of mothers of color.

I've professed my love for Momma Zen: Walking the Crooked Path of Motherhood by Karen Maezen Miller before. I worry about parenting books that say "this -- my way -- is the way!" and their effect on vulnerable new moms looking for answers in the utterly chaotic early parenting days, but Momma Zen is different. Karen Maezen Miller says "I don't know either!" and compares the exhaustion of motherhood to a humidifier. Plus, the chapters are short: 3-4 pages and perfect for a quiet couple of minutes before bed, in the car while baby is sleeping, or while you're bouncing baby on a yoga ball. 

This is the book I recommend and give to my friends who become mothers. And, just because, I'm giving away 2 autographed copies. Subscribe to my email newsletter to enter!

I've been getting lots of great responses in my survey of groups and classes for pregnant women, parents-to-be, and new parents. Please, keep them coming! If you're expecting a child, have a young child, or work with expectant and new families, please share your thoughts in the survey below. Responses are anonymous, but if you have any feedback or groups you want to share with me directly, please feel free to contact me! And if you want to be sure to get the compiled results and hear about next steps to meet the needs in the community, sign up for my newsletter.