After giving birth to her oldest daughter eight years ago, Jamie Belsito of Topsfield, Mass. knew something was wrong. The new mother was full of anxiety and struggling to fall asleep.
Belsito was experiencing perinatal depression, which can occur during pregnancy and for up to one year after giving birth. Perinatal depression both precedes and includes its better-known counterpart, postpartum depression, which occurs after giving birth. Depression affects as many as one in seven new mothers, making it one of the most common complications of childbirth.
Yet during Belsito’s prenatal visits her doctors never discussed her mental health. “I’d absolutely heard nothing about it a day of my life,” Belsito says.
Many people erroneously conflate postpartum and perinatal depression with the so-called “baby blues,” which refer to the 10-day period after birth when many women experience irritability, fatigue and anxiety. After this period, these feelings usually resolve themselves, according to the United States Preventive Services Task Force. The USPSTF, a volunteer panel of physicians that makes recommendations about how to improve health and well-being, recently prepared draft guidelines about ways to prevent perinatal depression.
“As someone who has treated pregnant women for 25 years, that transition from pregnancy to the postpartum period is hard,” says USPSTF member Dr. Aaron Caughey of Oregon Health and Sciences University in Portland.
Prevention of depression is critical because it impacts new mothers as well as their children. For example, in its guidelines the USPSTF reports that children of mothers with perinatal depression are more likely to be born prematurely or at a low birth weight. One study referenced by the USPSTF shows that children of women with perinatal depression are much more likely to develop psychiatric problems such as panic attacks or obsessive-compulsive tendencies than children whose mothers were not depressed.
Given these findings, the USPSTF argues preventing perinatal depression — to the greatest extent possible — is critical. The guidelines suggest women with a previous history of depression, as well as younger mothers or those with limited financial resources, are more susceptible to perinatal depression. The USPSTF encourages physicians who work with women in high risk groups to ask how they are feeling and inquire about their history of depression, but acknowledges no screening tool will identify everyone who is susceptible to perinatal depression.
Physicians could provide therapeutic services themselves if they are qualified to do so, or refer new mothers to clinicians with the appropriate expertise. The USPSTF recommends two types of counseling for women at high risk of perinatal depression: cognitive behavioral therapy and interpersonal therapy.
The first aims to reframe negative thoughts and increase attention to positive actions. An example of CBT is the Mothers and Babies program, which offers counseling support during and after pregnancy. One study found that women who participated in Mothers and Babies were less than half as likely to have a depressive episode than the control group.
The second recommended therapy, interpersonal therapy, aims to improve a new mother’s communication skills. In one study, participants in an interpersonal therapy program known as ROSE were 75 percent less likely to experience perinatal depression than mothers who did not participate.
Stigma remains a primary challenge for addressing perinatal depression, according to Dr. Tiffany Moore Simas of the University of Massachusetts Medical School in Worcester. There is a “public perception that pregnant women should be happy,” she says, even though “every aspect of life as you know it changes.”
While Moore Simas is pleased with the USPST’s focus on preventing perinatal depression, she worries that in many places there are not enough therapists available for new and expecting mothers. Caughey added that he hopes that the new guidelines will spur more insurance coverage for counseling services for pregnant women and new mothers.
“Suffering alone is not the way to go,” Caughey says.
Jamie Belsito’s daughters are now six and eight years old, but she will never forget the unanticipated challenges she faced after their births. After struggling to receive mental health services during her own pregnancies, Belsito has since become a passionate advocate for maternal mental health. In 2017, she founded a LLC called Effie’s Grace, which seeks better maternal mental health resources at state and national levels.
Although Belsito herself experienced depression as “a secret thing that nobody talks about,” she says she’s now determined to break that silence.
Update: On Feb.12, the U.S. Preventive Services Task Force published the final version of its guidelines for preventing perinatal depression. Now, under the Affordable Care Act, insurers will be required to offer no-cost counseling services for new and expecting mothers at high risk of perinatal depression.
*Correction, Feb. 5: This article has been updated since its original publication. An earlier version incorrectly identified the location of the University of Massachusetts Medical School. It is in Worcester. It also mischaracterized Effie’s Grace, which is a limited liability company (LLC).