Why Moms Are Not Okay

Few providers are trained to recognize and treat postpartum mood disorders

Photo by Filipp Romanovski on Unsplash

A few months after her second daughter was born, Kristina Dulaney started having strange thoughts. One morning she quit her job as a registered nurse. Another day she hallucinated that Jesus was returning to earth. She begged God to save her children. Then she passed out.

Dulaney ended up in a perinatal psychiatric ward at UNC-Chapel Hill, suffering from postpartum psychosis. The condition is rare—affecting 1 out of every 500 women after delivery—and heavily stigmatized. We often associate it with tragedy, such as the trial of Lindsay Clancy, who is accused of killing her three children before attempting suicide.

But I thought of Dulaney last week, when a new study in JAMA Internal Medicine made headlines. It documented a steep decline in the mental health of mothers from 2016 to 2023. In a survey of nearly 200,000 mothers, the number reporting their mental health was poor or fair rose from 5.5 percent of respondents to 8.5 percent. That’s a 64 percent increase over eight years. It occurred across all socioeconomic backgrounds, and less than half of it was attributable to the pandemic, the authors wrote.

Dulaney was hospitalized in 2016. Back then, the crisis in maternal mortality was not commonly acknowledged, and neither was the its connection to mental health. We now know that suicide, overdose, and other mental health conditions are the leading cause of pregnancy-related deaths, according to the CDC.

After she was released from the hospital and began her recovery, Dulaney was shocked to learn how few doctors and psychologists were trained to help her. Her therapist asked, “Are you sure you’re not bipolar?” And Dulaney thought, “Why am I educating you on this?”

According to a 2023 report by the nonprofit Policy Center for Maternal Mental Health, roughly 70 percent of counties in this country don’t have enough mental health providers to meet the needs of new mothers. I live in one of them. When I was suffering from postpartum anxiety in early 2021, Postpartum Support International connected me to one of the few providers in my region who specialized in perinatal mental health. She was an hour away, but offered online appointments. I don’t know where I would be without her.

Much of this newsletter is dedicated to covering the isolation, confusion, and desperation mothers feel when left alone to care for a young child. The JAMA study makes it clear this isolation is harming us and our families. “Maternal mortality may be a canary in the coal mine for women’s health,” the authors wrote.

It doesn’t have to be this way. PSI and the Policy Center for Maternal Mental Health offer online training and certificates for professionals who want to become certified in maternal mental health. Students can learn how to assess and treat the mood disorders that affect women during and after pregnancy. This education is available to anyone willing to put in the work—including nurses, doctors, and doulas.

Dulaney organized trainings near her home in Tennessee. In the span of eight years, her area went from having no perinatal mental health providers to 10 therapists and 13 midwives, doulas, doctors and nurses trained to provide support. She founded a nonprofit, Cherished Mom, to continue advocating and supporting new moms.

Her efforts can’t fix everything that’s burdening new mothers. She can’t provide universal child care or paid maternity leave. But making mental health care more accessible is a great start.