The Healthy Lawyer: Perinatal Depression

My Trip to Sacramento

I recently spent a memorable day at the California State Capitol attending a press conference, expert panel discussion, and visit to legislators’ offices on the topic of maternal mental health.  May is National Maternal Mental Health Awareness Month, or as it’s known in my home state of California, Perinatal Mental Health Awareness Month. 

Approximately 15 to 20 percent of all women experience some form of pregnancy-related depression or anxiety. I was surprised to learn that untreated depression is the number one complication of pregnancy, more so than gestational diabetes or pre-eclampsia. In the United States, pregnant women are commonly tested for gestational diabetes, which affects approximately one to two percent of pregnant women.  Unfortunately, there is no uniform screening done for perinatal depression.

What is Perinatal Depression?

Like many people, I had heard of postpartum depression, but I had never heard of perinatal depression. Postpartum depression occurs after delivery whereas perinatal depression can occur during pregnancy and up to 12 months after a mother gives birth.

Perinatal mood disorders can include anxiety, depression, panic disorder, obsessive-compulsive disorder, and in rare instances, postpartum psychosis. Postpartum psychosis occurs in approximately 1 to 2 out of every 1000 deliveries, or about .1 percent and can include delusions and irrational thoughts. 

More common, affecting around 80 percent of mothers, is what’s commonly known as the “baby blues,” which includes temporary feelings of sadness and weepiness during the first few weeks after giving birth.

Symptoms of Perinatal Depression

So how do you know if what you’re experiencing is the baby blues or something more serious?  It is usually duration and intensity of symptoms that distinguish one form of depression from another.

The Los Angeles County Perinatal Mental Health Task Force lists the following symptoms of perinatal depression:

  • Feelings of sadness
  • Mood swings: highs and lows, feeling overwhelmed
  • Difficulty concentrating
  • Lack of interest in things you used to enjoy
  • Changes in sleeping and eating habits
  • Panic attacks, nervousness, and anxiety
  • Excessive worry about your baby
  • Thoughts of harming yourself or your baby
  • Fearing that you can’t take care of your baby
  • Feelings of guilt and inadequacy
  • Difficulty accepting motherhood
  • Irrational thinking; seeing or hearing things that are not there

Perinatal depression experts emphasize several points that are worth reiterating. 

     You are not alone.

Motherhood is supposed to be the happiest time in a woman’s life. It can also be the most overwhelming. Remember that other women have experienced the same range of emotions you have, including feeling sad, anxious, and alone, and that there are people out there who want to help you.

     It’s not your fault.

There are several factors that may contribute to perinatal depression. A woman experiences large hormonal changes during and after pregnancy. Hormones increase three-fold during pregnancy; after birth, they rapidly drop down to pre-pregnancy levels. These changes, along with a lack of social and family support, an inability to bond with your baby, sleeplessness, problems with lactation, and a prior history of anxiety or depression are all risk factors for perinatal depression.  Unfortunately, many women blame themselves for the difficulties they experience.

     Perinatal depression is treatable.

There are several treatment options available to help women overcome perinatal depression. Individual and group therapy can be helpful, alone or in combination with anti-anxiety and anti-depressive medications your doctor may prescribe.  Some women who know they are at risk for depression because of prior experience with anxiety or depression may be put on medication during pregnancy or after delivery.

Turning Pain into Power

In all honesty, I would never have imagined that I would be involved in advocating for awareness on issues of maternal mental health. Six months ago, I only had a mild and passing interest in the topic of pregnancy, motherhood and depression since I had not been personally affected by it. While discussing the issue with a friend, she expressed her views, perhaps similar to others out there, that postpartum depression was a rich white woman’s affliction, like that of Brooke Shields or Peggy from the Real Housewives of Orange County.  Her views changed however, after hearing Kimberly Wong speak at our women’s leadership and volunteer organization.

Ms. Wong is an attorney with the Los Angeles County Public Defender’s Office in Los Angeles and serves as Special Counsel/Legislative Analyst to the Public Defender.  She’s a tough cookie, and a self-described Type A personality.  Prior to the birth of her daughter, she never suffered from depression or had any other mental health disorders. After the birth of her daughter, Ms. Wong suffered from severe postpartum depression. She was suicidal and spent a month in a psychiatric ward. She was lucky enough to get the help she needed to get well and feel like herself again. Ms. Wong’s experience prompted her to form the Los Angeles County Perinatal Mental Health Task Force whose mission “is to remove barriers to the prevention, screening and treatment of prenatal and postpartum depression in Los Angeles County.”

Perinatal Depression in Minority Communities

After hearing her speak, my friend and I later had lunch with Ms. Wong and Dr. Caron Post, a clinical psychologist specializing in maternal mental health and perinatal mood disorders and Executive Director of the Task Force. We discussed the shame many mothers probably experienced because of their depression, and I wondered how this disorder affected minority communities, such as the Korean and South Asian communities, of which my friend and myself were a part. After our lunch, Ms. Wong forwarded us some articles related to perinatal depression in the Korean and South Asian communities.

Reading those articles was eye-opening and informative – this definitely was not a rich white woman’s disease. Maternal depression cuts across all racial and socioeconomic lines. Immigrant and minority communities often lack access to maternal mental health resources. There still remains a stigma regarding mental health issues, and this stigma can be even greater in minority communities. Some issues, like depression, people simply do not feel comfortable talking about.

Perinatal Depression is a Family Issue

Needless to say, losing a mother or wife to perinatal depression or psychosis can devastate a family. During my visit to Sacramento, one of the speakers was a widower who lost his wife to perinatal depression. Raul Martinez shared the story of his wife Kelly, who suffered from a severe case of postpartum psychosis. His wife lost her battle with depression and psychosis and took her own life three months after the birth of their daughter Melina. 

I had heard Mr. Martinez speak once before at a fundraiser dinner supporting perinatal depression awareness and education. Hearing his story a second time made it no less powerful. At this dinner I was seated next to Roger Hernandez, the California State Assemblyman who helped chapter into law Concurrent Resolution Number 53 aimed towards perinatal depression prevention. Concurrent Resolution Number 53 is also known as the Kelly Abraham Martinez Act, after Mr. Martinez’s wife. 

Since his wife’s passing, Mr. Martinez has become an outspoken advocate for improvements in perinatal depression awareness, prevention, and treatment.  At some point Mr. Martinez will have to explain to his daughter why her mother is not around.  Right now she does not understand where her mommy is, and constantly asks, “Where is my Mommy?”

From stories like these and countless others, one can see that maternal mental health is not just a woman’s issue. Additionally, infants with depressed mothers may exhibit delayed psychological, cognitive, neurological, and motor development.  Luckily, children improve once their mothers are successfully treated.

Help is Available

A person experiencing depression can feel lonely and isolated, but there is help available. Talk to your doctor or other trusted health care professional for a referral to a psychologist or psychiatrist. 

Postpartum Support International is the world’s largest nonprofit organization dedicated to women suffering from perinatal mood and anxiety disorders.  They have information and resources for all 50 states. Call 800.944.4773 or visit their website.  Also available is a link to the Edinburgh Postnatal Depression Scale, which is a screening questionnaire used by health care professionals.  It can be a useful tool, but you should not use it to self-diagnose. The Los Angeles County Perinatal Mental Health Task Force’s website is also a great resource of information.

A good friend of mine from law school had a baby last year. When I was helping plan her baby shower I became so engrossed in the details of the décor and the event, from the “cute as a button” theme down to the mint-colored tablecloths and napkins. Sure, I would ask my friend how she was feeling, but it did not occur to me to ask her how she was doing mentally and psychologically. While every new mother-to-be deserves a beautiful baby shower, I know I’ll focus on the expectant mother a little more next time around. 



 I  also participated in a conference about the correlation between food and health, including our mental health. Some things I knew about this issue, but there were many other things to learn how to eat healthy to prolong your life. I try to respect these principles, I even go regularly to the doctor and do from time to time a nighthawk radiology scan to the heart and head. But most of the time I feel that I have to do more to maintain my health. I want to be a healthy person.

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