I started Stigmama to address stigma of mental illness as a mother. I wanted to create a space where women could express themselves without fear of retaliation or judgment. It was also important to me to encourage women to write. Writing our stories is transformative. Through telling our stories, our narratives of living with mental illness as mothers, we learn about that which we don’t understand and, in turn, change social constructs of stereotypes and discrimination.
What prompted you to get involved in maternal
mental health and create Stigmama.com?
I have been an advocate for maternal mental health for over a decade. In March,
shortly after I tried and failed to launch a White House petition for a
national conversation about universal mental health screening for pregnant and
postpartum women, there was an incident in which a pregnant mother, struggling
with mental illness, drove her minivan into the ocean with her children in the
car. The metaphor of this mother having no alternative but to literally drive
into the ocean spoke to me. How many of us – how many mothers who struggle with
depression or anxiety all alone – have sat behind the wheel of our minivans and
thought about making the very same choice? More than would or could admit it,
because of stigma.
Stigma of maternal mental illness has gone so thoroughly
unaddressed that when a tragedy occurs, media fans the flames of what feels
like archaic myth. Because it is hidden, society, communities, families, and
individuals are easily influenced by ignorance about mental illness.
Stereotypes are reinforced and eventually prejudice and discrimination occur.
The juxtaposition of mental illness and motherhood is a construct our society
just can’t handle.
In my research and work I have come to understand that how
we currently view, treat, measure, and diagnose mental illness is limited to a
reductionist interpretation by empirical, positivist science--namely medical
science. Not all physical or psychiatric experiences are pathological. We must
open that frame for childbearing women! How is it with all of the focus on
maternal health, infant health, and birth outcomes, women with life threatening
disease go untreated?
In your opinion, what
is the top-priority tool or resource that you would like to see more health
care professions develop for diagnosing and/or treating mental illness?
I am not an obstetric provider, so I wouldn’t try to speak
to their needs. What’s interesting clinically, however, is that we already have
the tools to accurately screen and diagnose perinatal mood and anxiety
disorders – we just don’t always use them. We have the wealth of evidence
showing the negative impact of maternal mood or anxiety disorders on the fetus,
birth outcomes, and development of infants, children, and even adolescents –
yet we don’t universally screen for PMADs in routine prenatal care. There is
overwhelming evidence for the correlation between major depression and
cardiovascular disease for women, yet we don’t screen. Why are we not fully integrating mental health screening into medical health screening? Time,
reimbursement, false positives – I have heard the arguments and many are true,
but poorly operating systems are not excuses for provider failure.
Here is a recent example. As part of the follow-up research
I did for my study on transformation through postpartum depression, I
anonymously surveyed 488 women who self-identified as having had
postpartum depression. Part of the
reason I did this was because in my original sample the report of care provider
failure was nearly universal. Midwives, OBGYNs, general practitioners,
emergency room physicians, family doctors, psychiatrists, doulas, and
pediatricians were all listed as providers who failed to treat, screen, or
diagnose women with PPD – even after disclosing!
I conducted a survey to further explore this failure. I
asked who was MOST responsible for your
getting help with your postpartum depression? With full respondents reporting:
|Medical care provider||11.89% (58)|
|Family member||17.01% (83)|
|Total respondents: 488|
In a follow up question, who
was LEAST helpful in getting you help for postpartum depression (PPD)?
respondents reported the following:
|Medical care providers (OBGYN, midwife, |
general or family physician, etc.)
|Family member||21.52% (105)|
|Total respondents: 488|
This is one anecdotal example. There are many peer-reviewed,
evidence-based studies demonstrating that a significant barrier to treatment is
often provider-related, and many times underlying that is a construct of
My point here is that we have the evidence, we have already
developed the methods to screen, assess, diagnose, and treat perinatal mental
illness—but we don’t.
Do you have any
advice for students and midwives who want to better address mental illness and
mental health issues in their immediate study or current practice?
Join the Marcé Society. Get good information from the subject
matter experts and take it back to your practice and studies. There is no single
approach that will fix it immediately when many women and providers are both at
a loss of knowledge. If you want to better address maternal mental illness, get
good information, good guidance, good mentors, good trusted colleagues, and
prepare for push back.
What are your hopes
for the future of Stigmama.com?
That more and more women of all ages will share the wide
range of motherhood with mental illness in ways that help them, their families,
and their communities. I hope that Stigmama helps encourage women to write, to
speak their truth. I hope that we will start to understand that mental illness
is not all negative. It is common. It is treatable, it is difficult, and it is
a constant, chronic condition that needs daily attention. But no one should
have to be ashamed of it. Our value and capacity to love our children is not
dictated by our mental illness. And in many ways, having a mental illness can
be a gift, if not an opportunity for strength in our parenting.
Is there anything
else you’d like to share with ACNM members?
The national suicide hotline: www.suicidepreventionlifeline.org.
Read ACNM’s position
statement on Depression in Women, which advocates for universal screening in
midwifery practice and public health policy, at http://bit.ly/Y8lUnW.