Suicide is one of the leading causes of death among new moms. Experts explain warning signs, the link between postpartum depression and suicide, and how to get help.

By Beth Ann Mayer
July 31, 2019
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There's a cliché: The day your child is born is the best moment of your life. But regardless of feelings in the delivery room, the period that follows can be fraught with stress, anxiety, and depression. Left unchecked, these emotions can turn tragic.

A study published in the American Journal of Obstetrics and Gynecology in June examining maternal death 12 months after delivery, looked at more than a million women who gave birth in California hospitals between 2010 and 2012. It found 300 had died during follow-up—and suicide was the seventh leading cause.

It's a reality affecting mothers across the nation: Research published by JAMA Psychiatry in 2013 found suicide is the second leading cause of mortality in postpartum women in the United States. But even as reports of high rates build, the issue of perinatal women dying by suicide remains taboo. It has left women and those who love them with fewer answers as to why mothers are taking their own lives.

"The stigma associated with this topic has been part of our lack of understanding [and research]," says Sona Dimidjian, Ph.D., the director of the Renée Crown Wellness Institute at University of Colorado Boulder and author of Expecting Mindfully: Nourish Your Emotional Well-Being and Prevent Depression During Pregnancy and Postpartum.

Though experts don't have all the answers to why postpartum suicide occurs, they have pinpointed warning signs and treatment options. Three of them shared what is known and the work that still needs to be done.

Who is most at risk?

Women who die by suicide regularly have comorbid disorders. Depression was the most common found in the 2013 JAMA study at 68.5 percent. Anxiety and bipolar disorder were also common.

Women with fewer financial means are most at risk for developing postpartum depressive symptoms, researchers found in 2010. A woman without the "village" and means it takes to raise a child may feel increasingly overwhelmed and isolated, a common thought in many suicidal individuals.

"Even women who have had to go back to work [experience isolation]," says Sherryl H. Goodman, Ph.D., a professor at Emory University who co-authored Expecting Mindfully with Dimidjian. "If they are so stressed about making ends meet…even if they are surrounded by people, they may not be taking in a connection to other people."

What are warning signs and reasons for postpartum suicide?

Fatigue, sleep deprivation, and stress could be signs of suicidal ideation, but they are common postpartum. It's a red flag when these emotions accompany constant crying, irritability, and the inability to find joy in life.

"When [a woman] can't see past…the postpartum period or understand more broadly that she has a new addition of joy, that's a sign," says Kimberly Herrera, M.D., a maternal-fetal medicine specialist at Stony Brook University Hospital.

The pressure to be perfect doesn't help. Even former First Lady Michelle Obama debunked the idea women can "have it all," but the truth is they are still expected to do it all.

Women perform the bulk of housework and childcare, though three-quarters of mothers of children under 18 are employed full-time. It can leave a mother feeling she has too many balls in the air and ashamed she can't juggle them. "People think it's normal to be happy all the time postpartum, and that can fuel some women to think, 'What's wrong with me?'" says Dr. Herrera.

Where can mothers turn?

Women experiencing suicidal thoughts should always seek help from a medical professional. Doctors typically screen for postpartum depression four to six weeks after delivery. Women who are concerned can reach out for an earlier appointment to discuss options, including therapy and medication.

More resources are becoming available across the country. In Colorado, for example, a peer-to-peer support program called Alma trains and pairs mothers who have been depressed during the pregnancy and perinatal periods with those in the thick of it. "It's a pretty powerful example of how women can support one another," says Dr. Dimidjian.

Dr. Dimidjian and Dr. Goodman say mindfulness training could also be effective. "[It helps] people develop a different relationship to thoughts like feeling sad, embarrassed, or ashamed, so they are not as captured by them," adds Dr. Dimidjian.

In the meantime, loved ones can provide support. "Say things that are [non-judgemental like], 'How can I help you with the baby?'" advises Dr. Herrera. And if the woman struggling hasn't sought professional help yet, it's important to suggest she does and advocate for help, adds Dr. Herrera.

What can medical professionals do to prevent postpartum suicide?

Medication can be a successful way to help curb depressive and suicidal thoughts, but women need choices. "If the only option [a woman] gets [from her doctor] is a prescription, there's a chance that won't work because she might opt not to take it," warns Dr. Goodman. "Then she may feel like, 'So much for that…where does that leave me?'"

Dr. Herrera believes more awareness is crucial. Media coverage is one means, but doctors cannot control the headlines. Grassroots efforts, such as providing information in support groups like La Leche, can reach women directly.

And more research into treatment methods and the reasons behind postpartum suicide will save lives. "There are literally life and death questions to which we don't know the answers, and that is unacceptable," says Dr. Dimidjian.

If you or someone you know is having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255. The Crisis Text Line provides free, 24-hour support. For help, text HOME to 741-741 for free.

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