There's Now a Medical Textbook for Reproductive Mental Health—Here's What That Means
By Cassie Shortsleeve | May 20, 2022
"Ask any new birthing person about the realities of postpartum life or anyone post-menopausal about menopause and they'll usually say something along the lines of, "No one told me it was going to be like this."
There's a lot no one tells you about the way reproductive transitions impact mental health, say reproductive psychiatrists—doctors who specialize in the historically siloed field of mental health throughout the reproductive cycle, from adolescence through menopause.
People have long experienced reproductive transitions and the symptoms and conditions that come with those shifts—like postpartum depression (PPD), for example—but the medical community has not known much about them until recently. While the American Psychiatric Association (APA) has dozens of textbooks on all kinds of psychiatric topics, there has been no comprehensive textbook in reproductive psychiatry—until now.
In December, thanks to a volunteer effort by 80 authors from more than 30 different institutions around the country, the APA put forth a textbook: Textbook of Women's Reproductive Mental Health.
In the authors' words, it's "the first comprehensive text for understanding, diagnosing, and supporting the unique mental health needs of women and others who undergo female reproductive transitions during their entire reproductive life cycle."
Lucy Hutner, M.D., a reproductive psychiatrist in New York and one of the book's co-editors adds: "It's a flag-on-the-moon moment for women's mental health."
After all, when she was training to be a doctor, she was told that the field that she specializes in today didn't exist. As recently as the 1980s, doctors and research studies alike suggested falsehoods such as the idea that mood is protected in pregnancy or that "without exception" psychological changes after having a baby were positive.
It's ironic, Dr. Hutner says, considering that postpartum depression is the most common complication of childbirth. But when you have patients with symptoms of diseases that exist and a field that doesn't, it's more than just ironic; it's detrimental to the overall health and wellbeing of that population. A lack of legitimacy perpetuates shame, misinformation, silence, and stigma.
"This medical textbook is almost symbolically more important than anything else," says Dr. Hutner. "It sort of says, 'Hey, this is as important as any other aspect of medicine.' It validates people's voices. It says, 'We don't need to have this stigma anymore. We're done.'"
The Messy World of Reproductive Mental Health
There's nothing non-existent or niche about reproductive psychiatry. But today, if you find yourself with something like PPD or postpartum anxiety (PPA), one of your first touchpoints with the medical system is likely your six- or eight-week follow-up appointment with your OB-GYN or a few trips to the pediatrician.
If you're lucky, you might land in the office of someone like Dr. Hutner for specialized treatment. But too often new moms wind up in an OB-GYNs offices crying and reporting their symptoms with little to no guidance.
Just as this setup fails patients, it fails providers trying to care for those patients, too. The American College of Obstetrics and Gynecologists (ACOG), for example, recommends mental health screening at least once in the perinatal period. But as Dr. Hutner puts it, OBs may not always know what to do with positive screens, or may not know how to treat crying patients.
"The training, education, and dialogue around reproductive mental health have been ad hoc. There hasn't really been a standardized way of approaching it," says Dr. Hutner.
In short: Some physicians have training; some don't. Some are great at providing resources or spotting symptoms; some aren't. There are also big issues including systemic racism in medicine, as well as lack of awareness of queer health issues. This leads to a lot of patients who inadvertently wind up feeling invalidated and alone, without treatment.
Looking Ahead at Reproductive Mental Health
Most people recognize the importance of reproductive mental health, and doctors in training are eager to learn more about it. Lauren M. Osborne, M.D., one of the co-editors of the textbook and the director of the Johns Hopkins Center for Women's Reproductive Mental Health, has piloted a new curriculum designed to educate medical trainees in the field. She asked budding psychiatrists to rank six subspecialties of psychiatry—including reproductive psychiatry along with five officially recognized fields. Doctors ranked reproductive psychiatry in the top half, consistently outranking other specialties that are deemed essential knowledge for independent practice and board certification.
Yet because reproductive psychiatry isn't yet an official subspecialty of psychiatry, it currently lacks government funding for more post-graduate fellowship programs. And learning about widespread problems such as postpartum depression is elective, not a requirement. This contributes to a lack of faculty to teach reproductive mental health and a lack of providers to treat it."
By Melissa Willets | Updated August 22, 2021
"The term rainbow baby may not be familiar to people who haven't experienced a loss. But to those of us who have, it has a very deep and even life-changing significance.
So what is a rainbow baby? It's "a baby born after a miscarriage, stillborn, or neonatal death," says Jennifer Kulp-Makarov, M.D., FACOG. "It's called a rainbow baby because it's like a rainbow after a storm: something beautiful after something scary and dark."
She adds, "It's an extremely emotional and devastating experience to lose a pregnancy [or baby]. To create a life or bring a baby into the world after such a loss is amazing like a miracle for these parents."
I'm currently seven months pregnant with a rainbow baby, and indeed, I feel like I'm walking around with a miracle in my belly. There was a time when I never thought I could feel hopeful again. Just last year, we lost our beloved baby Cara at 23 weeks of pregnancy. The days, weeks, and months after she became our angel baby were the darkest of my life. But soon a dim hope flickered inside my heart, and eventually ignited a flame, that became my desire to try again, in part to honor Cara, and to find meaning in her loss.
Rainbow Babies Can Honor an Angel Baby
Moline Prak Pandiyan, a previous ambassador for March for Babies, March of Dimes Eastern North Carolina, knows this feeling well. She lost her son Niko when he was five months old due to complications related to his premature birth. "Although Niko lost his fight, his spirit lives on, and he continues to inspire many," she explains. Not only is this mama involved in fighting prematurity, but she was also inspired to conceive a rainbow baby.
Not that she previously knew the meaning of the term "rainbow baby." "I remember the feeling that I had when I first heard [it]," says Pandiyan. "It was perfect. I so much wanted to make sure that Niko wasn't forgotten, and the term so eloquently acknowledges the babies who we've lost, while also celebrating the joy of our babies who do survive."
Prak Pandiyan is now a proud mom of a little girl, her rainbow, who truly informs her parenting philosophy. "My husband and I always wondered what life would have been like if our son could be discharged and come home with us," she says. "When we welcomed our rainbow baby into this world, our perspective as parents shifted. Whenever things get hard—feeding challenges, sleeping challenges, mild illnesses—we always make it a point to step back and remember that things could be so much worse."
Parenting a Rainbow Baby May Feel Different
Mama Stephanie Sherrill Huerta, who has one daughter, is also expecting a rainbow baby, via adoption, after several miscarriages and failed adoption attempts. She too acknowledges that parenting her rainbow baby will be different, telling Parents.com, "We will love him a little differently than our daughter because we went through so much grief and pain before meeting him. He will truly be the light at the end of the tunnel, the pot of gold under the rainbow, and the rainbow after our storm."
That same spirit has encouraged me to enjoy my current pregnancy more than before. Morning sickness and heartburn can't take away my gratitude for the chance to carry a healthy baby.
Elizabeth Lorde-Rollins, M.D., MSc, OB-GYN at CareMount Medical says this is normal. "For parents who have experienced the loss of a child, whether that loss occurs before or after birth, the life adjustments associated with pregnancy are accompanied with an acute sense of gratitude even when they are uncomfortable," she notes. "And although most of us have the great fortune of being wanted babies, parents tend to have a special, and in many cases incredibly sharp, sense of being blessed when they are expecting and then giving birth to a baby that follows loss."
By Loren Kleinman | May 12, 2021
"The day Lily was born, my husband, Joe, took pictures, murmured soft words, and held her every moment he could. "I want to stay home with her for her first year," he said. "I read it's important for their development."
Luckily, he was able to as he was honorably discharged from the Navy. But despite my three-month maternity leave, I wanted to go back to work.
But when we returned home from the hospital, I unraveled. No time to shower, eat, or pay a bill. Our lives revolved around Lily. Everything I imagined about motherhood exploded. Dreams of gardening with my daughter in a Snugli on my chest were replaced with her unrelenting cries and endless diaper changes.
Yet to Joe, she was just a baby. "What did you think having a baby would be like?" he asked.
"Not like this," I snapped, taking off my spit-up covered shirt and replacing it with a clean one.
It wasn't just the dirty shirt. I had thoughts of hurting myself and my baby, an alarming desire to drive us both off the road. I hated myself for these thoughts, but I hated her more. I hated that she never slept, and resented that I couldn't, either. I hated breastfeeding, which was not magical as I'd pictured, but painful and lonely.
I missed our date nights, coming and going as I pleased, and clean clothes.
Darkness settled over me, unlike any depression I'd experienced. I began experimenting with cutting myself just to feel something other than exhaustion, spending long minutes in the bathroom, my only escape. With each cut came relief from the burden of this new, agonizing life.
"You were in there a long time," Joe teased me.
Low spirited, I replied, "I wish I never had to come out."
He reached out to console me and saw the cuts on my arm. I didn't hide them. I didn't care. But Joe called his therapist, who told him about a clinic for women with postpartum depression.
"He doesn't even know me," I argued.
"You're going," a frazzled Joe said. "Today."
My First Dose of Postpartum Depression Treatment
We arrived to find a room filled with infants, dads, and moms, many of the latter red-faced and crying, while their husbands stood by, holding babies. I was amazed to see so many men like my husband, cradling their little ones, in solidarity with their wives, as the women went one by one to meet with a psychiatrist.
When it was my turn, I looked back at Joe and Lily. A concerned smile dusted his face. "We'll be right here when you're done."
During my intake, I asked flatly, "Will I ever love her?"
"This is a classic postpartum depression question. You will love her," the psychiatrist assured me. "But I have to ask, do you have any plans to kill yourself?"
Without hesitation, I said, "I want to drive off the road." Then I wept.
I wasn't allowed to drive until further notice, and if I didn't abide, the psychiatrist warned, "We'd have to consider hospitalization."
Joe ferried me to and from the clinic every day, no matter how many times he'd been up with Lily the night before. On weekends, Joe tended to me and to Lily, making sure we both ate and slept, as his parents flew out from Washington State to lend a hand, a relief to both of us.
For the first time, I felt some hope.
Every week, I attended weekly dialectical behavior therapy sessions (DBT), learning skills for coping with my anxiety and insomnia like radical acceptance and positive self-talk.
Things Only Got Worse
Then, one night, after Joe put Lily to bed, we sat on our back porch, me with my usual glass of wine, him with his Coke and ice.
"Are you OK?" he asked, as I stared, glassy-eyed, into the trees.
Before coming outside, I'd already washed down a handful of Tylenols, along with sedatives and a few glasses of wine.
"I can't live like this anymore." I paused. "Lily deserves a mom, not me."
Joe sighed and said, "I'm calling the clinic's emergency line."
The therapist on duty advised Joe to bring me to the hospital immediately, even though I protested. But I had no choice. I confessed my desire to kill myself, so I could go voluntarily or in an ambulance.
Joe stayed with me for nine hours in the emergency room, until there was a bed ready in the psychiatric unit. His parents watched Lily at home.
"Please don't let them take me away," I called out to Joe, as a nurse led me to the unit.
"I'll see you in the morning," Joe answered back. "You will be OK."
When he arrived the next day, I pleaded with him to get me out.
"Someone tried to kill themselves last night," I cried. "I don't belong here."
"Can you give it a chance?" he begged.
I sat back in my chair and folded my arms. I resented Joe for bringing me here. At the beginning of our relationship, I'd been the strong one, helping him through his own hardships. But Lily changed everything.
"I have to get back," he said. "Focus on getting better, not getting out."
When Joe leaned in to give me a kiss goodbye, I stopped him. "I want a divorce when this is over," I whispered.
He teared up and said, "You've said some of the meanest things anyone has ever said to me."
I felt no remorse. Before the baby, we never went to bed angry. Now, I loathed him for keeping me here. I was determined to punish him, and I did, lashing out constantly, but he kept visiting and taking my phone calls. He never stopped trying.
I was discharged after five days. Joe and I argued for the entire ride home. When we arrived at the house, I imploded: "I can't take this anymore!"
I threw chairs and baby toys, wailing, and punching the wall. Joe couldn't calm me, so he took Lily and his parents to the farthest part of the house.
The next morning, Joe gave me a choice: "You either go to your parents' house and take a break, or you go back to the hospital."
I chose the first option.
A few days later, Joe called me. "I told my therapist what happened. He called Child Protective Services," he said matter-of-factly.
"They're going to take Lily away?" I asked.
Shocked, I suddenly realized how much I wanted her."
By Paige Glidden | May 07, 2021
"During TheBlueDotProject's Maternal Mental Health Awareness Week, it's time to focus on the mental health of mothers—especially during a life-changing pandemic. The most recognized maternal mental health disorder is postpartum depression, but there are other common mental health concerns to look out for.
Juggling societal and familial expectations is a heavy burden for anyone. But when you add a new baby into the mix (during a pandemic!), it can become overwhelming. Sleepless nights, hormones, and new emotions all feed into overwhelm after the birth of a baby, not to mention that maternal anxiety and depression are the most common complications of childbirth, impacting up to 1 in 5 women.
The first week of May serves as Maternal Mental Health Awareness Week, bringing to light the challenges that moms face and the reality of postpartum depression and anxiety. Maternal Mental Health Disorders (MMHDs) include a range of disorders and symptoms, including depression, anxiety, and psychosis. Although often referred to more commonly as "postpartum depression," there are several different types of postpartum mental health disorders that affect new moms.
Symptoms can occur during pregnancy and/or the postpartum period (together often referred to as the perinatal period). These illnesses can affect anyone—and they are far more common than you'd think. Although an estimated one in five women have a maternal mental health disorder, most cases go undiagnosed, leading experts to believe that the number should be much higher. New parents also experience the baby blues, which is not formally considered an MMHD—up to 80 percent of women suffer from this in the initial two to three days postpartum, according to Bridget Frese Hutchens, Ph.D., CNM, RN, CNL, PHN.
What's worse is that only 30 percent of women who screen positive for depression or anxiety seek or receive treatment. When left untreated these disorders can cause devastating consequences for moms, babies, families and communities. The good news is that risk for both depression and anxiety can be reduced (and sometimes even prevented), and with treatment, women can recover.
It can be hard to identify some of the symptoms of postpartum mental health challenges, but it's worth paying attention to. Here are five types of maternal mental health conditions to look out for:
Common Maternal Mental Health Disorders
1. Postpartum Depression
Pregnancy and Postpartum Depression (PPD) is a mood disorder that can begin during pregnancy or in the first three weeks after having a baby, according to ACOG, the American College of Obstetricians and Gynecologists. Symptoms can range from mild sadness, trouble concentrating, or difficulty finding joy in once-loved activities to severe depression, and mothers with pre-existing depression prior to or during pregnancy are more likely to experience postpartum depression, according to The Blue Dot Project. While there is no single cause for PPD, experts attribute it to the drop in hormones estrogen and progesterone following childbirth and general stressors which increase during pregnancy and the postpartum period. With proper mental health care, PPD is treatable and the risk of severe depression can also be prevented.
2. Dysthymia, Persistent Depressive Disorder
Dysthymia is defined as a low mood occurring for at least two years, along with at least two other symptoms of depression. According to the Mayo Clinic, people with dysthymia may lose interest in normal daily activities, feel hopeless, or have overall feelings of inadequacy. Women with pre-existing dysthymia may be at a higher risk for severe symptoms/depression during the perinatal period, according to The Blue Dot Project.
3. Pregnancy and Postpartum General Anxiety
It might seem normal to worry before or after having a baby, but if your anxiety is more than just the baby blues and you can't get these worries out of your brain, you might be suffering from pregnancy or postpartum related generalized anxiety . Around 10 percent of women will develop anxiety during pregnancy or after childbirth, according to the American Pregnancy Association. Anxiety is treatable during pregnancy and postpartum.
Symptoms often include restlessness, racing heartbeat, inability to sleep, extreme worry about the "what if's"—questions like "what if my baby experiences SIDS" or "what if my baby has autism," and extreme worry about not being a good parent or being able to provide for her family, according to The Blue Dot Project."
BY ANNE LORA SCAGLIUSI | May 25, 2021
"Jen Schwartz, mental health advocate and CEO of Motherhood Understood, first experienced perinatal depression a day after giving birth. “The biggest red flag was that I was having scary thoughts about wanting to get hurt or sick so I could go back to the hospital and not have to take care of my baby,” she says. “I had no interest in my son. I thought I had made a huge mistake becoming a mother and I couldn’t understand why I was failing at something that I believed was supposed to come naturally and that all other women were so good at.”
According to the World Health Organization, about 10 percent of pregnant women and 13 percent of new mothers will experience a mental disorder, the main one being depression. Without appropriate intervention, poor maternal mental health can have long term and adverse implications for not just these women, but their children and families, too. In most cases, however, women may not be aware of the help available or even that they might need it.
“Most of the time, they mistakenly think they are failing at parenting,” says Wendy Davis, executive director of Postpartum Support International (PSI). “They don't realize they are going through a temporary, treatable experience that many others have gone through.”
To find out more during World Mental Health Awareness Month, Vogue speaks to a range of global mental health experts and women who have experienced perinatal depression.
What is perinatal depression?
"Perinatal depression is the experience of depression that begins during pregnancy [prenatal depression] or after the baby is born [postpartum depression]. Most people have heard of perinatal depression, but what’s equally common for mums to experience is perinatal anxiety either separately, or with depression,” explains Canadian therapist Kate Borsato. Perinatal depression does not discriminate. “Some people are surprised when I tell them that I experienced postpartum anxiety, because of my job as a therapist for mums. But mental illness doesn’t really care who you are or what you know.”
While anyone can experience it, there are some known risk factors that increase women’s chances of developing mental health difficulties in the perinatal period. According to Australia-based social worker and founder of Mama Matters, Fiona Weaver, these include a “previous history of depression or anxiety, those who have limited support networks, have experienced birth or pregnancy trauma, infertility or who may be genetically predisposed to it.”
What are the signs and symptoms to look out for?
Symptoms differ for everyone, and may include feelings of anger, anxiety, fatigue, neglecting personal hygiene and health or surroundings, fear and/or guilt, lack of interest in the baby, change in appetite and sleep disturbance, difficulty concentrating/making decisions, loss of enjoyment or enthusiasm for anything, and possible thoughts of harming the baby or oneself.
Women can also develop postpartum obsessive-compulsive disorder, and postpartum psychosis. Copenhagen-based content creator Clara Aatoft was diagnosed with severe postpartum depression and psychosis months after becoming a new mum. “For the first three months, I didn't sleep at all. I was constantly aware of my daughter’s needs. She was later diagnosed with colic. When I gave up breastfeeding and switched to the bottle, my depression and psychosis went full-blown.” She continues, “I started thinking that my daughter was a robot that someone placed a chip inside at the hospital. I attempted suicide and ended up in the psychiatric ward. I’m very well now, still medicated on antidepressants. But my daughter and I have the best relationship.”
By Wendy Wisner | Medically reviewed by Carly Snyder, MD |Updated on June 14, 2021
"What Is Prenatal Depression?
Prenatal depression, also called perinatal depression, is depression experienced by women during pregnancy. Like postpartum depression, prenatal (or perinatal) depression isn’t just a feeling of sadness—mothers who experience this mental health disorder may also feel anxious and angry.
You've likely heard of postpartum depression—and that's a good thing. The more that postpartum depression is talked about and understood, the more mothers will seek the help they need so that they can feel better and live full and healthy lives as new moms.
But prenatal depression is a maternal mood disorder that hasn’t gotten nearly as much attention as it should. While prenatal depression can be treated, many expecting mothers don’t even know that it’s a “thing” and therefore don’t seek treatment for it.
Many feel ashamed to even share how they are feeling. After all, you are supposed to be overjoyed and excited when you are expecting a baby, right? It’s easy to feel guilt and shame when you are feeling the exact opposite.
Here’s what you should know about prenatal depression, including how common it is, what to look for in terms of symptoms, and most importantly, how to get help.
How Common Is Prenatal Depression?
Like postpartum depression, which impacts as many as 1 in 7 new moms, prenatal depression is actually quite common.
According to a journal article by Maria Muzik, MD, and Stefana Borovska, published in Mental Health in Family Medicine, 13% of pregnant moms experience depression.
As the authors note, perinatal depression (both prenatal and postpartum) is even more common among mothers facing adverse experiences, such as a history of depression or economic hardship.
“The prevalence of perinatal depression is even higher in vulnerable groups with certain risk factors,” the authors explain. “Young, single mothers, experiencing complications, with a history of stress, loss or trauma are far more likely to succumb to depression. Furthermore, one study found that up to 51% of women who experience socioeconomic disadvantage also report depressive symptoms during pregnancy.”
It's important to note prenatal depression doesn’t discriminate: You can experience it whether or not you have pre-existing risk factors. Always remember there is no shame in experiencing a serious bout of depression during pregnancy, and you are not alone.
Similar to postpartum depression, experts can’t pinpoint one particular cause of prenatal depression, but have hypothesized that it’s likely caused by a confluence of factors—a “perfect storm” of triggers that come to a head for some mothers during their pregnancies.
Either way, it’s important to note that whatever caused your prenatal depression, it most certainly wasn’t your fault. There was nothing you did wrong, and you are not a bad mom (or going to be a bad mom).
“Depression and anxiety during pregnancy or after birth don't happen because of something you do or don't do—they are medical conditions,” notes the Academy of American Pediatrics (AAP).
“Although we don't fully understand the causes of these conditions, researchers think depression and anxiety during this time may result from a mix of physical, emotional, and environmental factors,” they add.
Prenatal depression manifests differently for every mom—you may even experience it differently from one pregnancy to another. It’s important to understand that anytime you feel overwhelmed by your emotions, unable to function in your day-to-day life, or just “off,” you should reach out to discuss your feelings with a trusted loved one or medical provider.
Here are some of the most common symptoms of prenatal depression:
For more mental health resources, see our National Helpline Database."