When Claire Kerr-Zlobin's daughter was born six years ago, she didn't parade her around the neighbourhood in a shiny new stroller or schedule back-to-back play dates with other new moms.
Instead, Kerr-Zlobin was too afraid to leave the house. She imagined falling down the stairs, injuring her infant daughter. She avoided the park because she believed someone would kidnap her child. She was too anxious to drive.
Despite what many people believe – that having a child should be the happiest time of a new parent's life – a substantial number of mothers, and some fathers, will be gripped by anxiety, depression, guilt and hopelessness. Some of them will be so badly affected that they may kill themselves or harm their children. It's a grave situation that needs urgent attention. But a new editorial published Monday in the Canadian Medical Association Journal argues that Canada is failing new mothers by taking a lacklustre approach to postpartum mood disorders and suicide.
The recent deaths of Lisa Gibson and her two children in Winnipeg, believed to have occurred after the 32-year-old mother was treated for postpartum depression, are a jarring wake-up call that depression can be deadly and that more needs to be done to help those affected, wrote editorial author and CMAJ deputy editor Dr. Kirsten Patrick. (It's believed the deaths were a murder-suicide.)
Unlike other countries, notably Britain, Canada does not conduct detailed analyses of maternal deaths to identify suicide rates and look for ways to prevent them, said Patrick. Canada also lacks comprehensive screening programs designed to help health professionals identify postpartum mood disorders and has no reliable way to ensure women are connected to the proper supports, the editorial said. Doctors and other health professionals also need to recognize just how serious those disorders can be, Patrick said.
Postpartum depression is one of several postpartum mood disorders that women, and sometimes men, experience. The often debilitating condition is characterized by despondency, feelings of inadequacy, anxiety, guilt and fatigue, according to the Canadian Mental Health Association. And it can have long-lasting negative impacts on other family members, including a higher rate of depression among men, and anxiety, social problems and cognitive-development problems among children. The association estimates that between 3 and 20 per cent of women will experience postpartum depression after giving birth. Postpartum psychosis is rarer, occurring in one out of every 1,000 births, and can cause extreme confusion, hopelessness, mania and hallucinations. Risk factors for postpartum mood disorders include a history of depression, being socially isolated and not having a strong support network.
Postpartum mood disorders remain highly stigmatized, which can make it difficult to seek help. It also means the severity and prevalence of the condition can easily be underestimated.
"It's something that gets quite hidden," Patrick said in an interview. "It has this huge wrecking influence on families and it has to get more attention than it does."
Without a comprehensive system for analyzing each maternal suicide in order to devise strategies to prevent them in the future, Canada is doing a disservice to women and their families, she said.
Dr. Cindy-Lee Dennis, Canada Research Chair in perinatal community health and a professor at the University of Toronto, says one solution is to arm health professionals with better knowledge in order to connect women with the right resources. Dennis is preparing to launch a large trial that will have family doctors focus on identifying women dealing with postpartum mood disorders during follow-up visits and then referring them to the right resources.
"Right now we have no systematic approach to postpartum depression," she said. "We need clear referral pathways."
The Public Health Agency of Canada has a report on its website highlighting the number of mothers who died during pregnancy, childbirth or within 42 days of delivery or termination of pregnancy, as well as the cause of death. Suicide is not included as a separate cause of death, but is instead grouped in a category called "other indirect causes," which can include digestive system diseases, mental disorders and diseases of the nervous system.
A spokesman for the agency said in a statement that it supports several programs that can help refer women to provincial support resources. The statement also mentioned money the government has spent on national mental health programs and initiatives such as the National Aboriginal Youth Suicide Prevention Strategy.
Kerr-Zlobin considers herself lucky. When she sought help for breastfeeding issues, a public-health nurse noticed something was wrong and referred her for help. Now, she wants other mothers to realize that postpartum depression doesn't necessarily mean you are a threat to yourself or your child. But it does mean you need help – and that you shouldn't be afraid to speak up.
"A lot of people think you have a baby, you should be happy. They don't try to see if you need help because what could be wrong?" Kerr-Zlobin said. "The lucky ones are the ones who end up getting the support."