From the outside looking in, my pregnancy with twins was a complete success. Throughout my journey, from preconception to delivery, my care team helped me overcome each significant physical health challenge I encountered.
When I was diagnosed with polycystic ovary syndrome, a predominant cause of infertility, my fertility doctor prescribed medication that enabled me to conceive. When I started to experience contractions in week 19, my OB/GYN prescribed medication to prevent preterm labor. At week 25, when it looked like my water could break any minute—a “very scary situation,” my doctor said—I was put on strict bed rest and a regimen of Motrin.
A few weeks later, when my blood pressure began to soar and my weight suddenly increased, he diagnosed preeclampsia and took steps to manage and monitor my condition. And finally, at week 33, when my doctor discovered that the umbilical cord of one of the babies was hanging beneath his feet (cord prolapse), I was admitted to the hospital to prevent a potentially catastrophic emergency delivery.
Due to the exceptional care I received throughout my pregnancy, my delivery by cesarean section (C-section) went smoothly, and the babies, born six weeks prematurely, were healthy.
But I was not.
Undetected anxiety during pregnancy
It wasn’t just that I could barely walk from the pain of a C-section and putting on more than half my body weight during pregnancy. It wasn’t that I was covered in hives due to an allergic reaction to the pain medication. And it wasn’t that I felt physically exhausted after not exerting myself while on bed rest for 10 weeks.
Far worse than any of these physical conditions was the unrelenting anxiety that had been building for months undetected by me or my doctor. By the time the babies and I went home from the hospital, my anxiety felt overwhelming, which made caring for two newborns even more difficult than it already is for a first-time mother.
Deep postpartum distress
I wasn’t prepared for the battles against my own mind in those early days and weeks of motherhood. I developed a consuming fear of knives and had visions of the babies floating away from me. One night I woke up screaming and grasping at the air above me as I tried to save them. I had a recurring nightmare about failing to make a critical phone call that would mean the difference between their life and death. In daytime hours, I tried to micromanage everything yet felt helpless at the same time. Sleep deprivation likely played a role in my distress.
Hiding my struggles from everyone
Shame and fear kept me from revealing the depth of my struggles to family, friends, and even my husband. After all, we had two healthy babies—a dream come true—and I didn’t want anyone questioning my ability to care for them. I might have divulged my secret had my primary care physician asked about my mental state at my follow-up appointment, but she didn’t.
Eventually, over the course of several months and returning to work, I recovered. The visions and nightmares became less frequent and finally stopped. So did my need for control and my feelings of helplessness.
Years later, I would learn from a friend that infertility, trauma/posttraumatic stress disorder (PTSD), and unplanned C-sections are risk factors for perinatal mental health challenges. She had experienced infertility and an emergency C-section. Without knowing my story, she told me of her own visions of a knife-wielding woman coming to get her newborn son.
Perinatal mental health challenges are common and mostly untreated
Sadly, mental illness affects an alarming 1 in 5 women during pregnancy and the first year after delivery—the perinatal period. Perinatal mental health challenges span anxiety, depression, obsessive-compulsive disorder, PTSD, and eating disorders, and can range from mild to severe.
The potential causes of perinatal mood and anxiety disorders also vary. In addition to infertility, unplanned C-sections, and trauma, hormone fluctuations, a lack of support, stressful life events, a history of mental health challenges, sleep deprivation, and a lack of self-esteem are some of the more common causes of perinatal mental health challenges.
Regardless of the cause, the majority of women who experience perinatal mental health disorders (70%) hide or underplay their challenges, just as I did. It’s not surprising, then, that an estimated 75% of maternal mental health conditions go untreated.
3 ways employers can help support women’s perinatal mental health and well-being
Employers can help women get the support they need for perinatal mental health challenges. Here are three ways.
1. Offer online mental health screenings to your workforce
Mental Health America (MHA) calls for consistent mental health screenings in a healthcare setting during pregnancy and the postpartum period using the Patient Health Questionnaire (PHQ-9), a screening for depressive symptoms, or the Edinburgh Postnatal Depression Scale.
Employers can build on this foundation by offering access to online mental health screenings that pregnant women or new mothers in their workforce can complete anytime, anywhere, rather than relying on or waiting for a healthcare visit. (Pregnant women typically see their doctor monthly for the first 28 weeks, biweekly from weeks 28 to 36, and weekly from weeks 36 to 40.)
With Calm Health, a secure, HIPAA-compliant platform, your organization can give employees 24-7 online access to a screening that is a combined version of the PHQ-9 questionnaire and the Generalized Anxiety Disorder (GAD-7), a screening for anxiety symptoms. At the conclusion of the questionnaire, Calm immediately recommends a combination of mindfulness content, clinical programs, and/or external resources aligned to the individual’s screening responses.
If an employee signals through the screening that they’re having thoughts of harming themselves, they’re directed to crisis support, either the national 988 line or an alternative crisis response configured by your organization in the Calm Health app.
(Note: The Calm Health mental health screening is not intended to diagnose depression or anxiety, nor is it a substitute for care by a physician or other healthcare provider. It is available only to US residents age 18 or older. )
2. Help navigate women to appropriate mental health support
MHA also advocates for mental health professionals to be co-located in healthcare settings where mental health screenings are conducted to offer immediate treatment. Unfortunately, despite the proven effectiveness of integrating mental health care and primary care, adoption of collaborative care models has been low.
At the same time, over half of employees (51%) feel overwhelmed when they try to figure out how to navigate the healthcare system, and fewer than 20% use their mental health benefits.
To fill these gaps, employers can turn to digital mental health solutions that guide employees to mental health support that’s appropriate for their needs.
Calm Health does this by centralizing and integrating with a wide spectrum of mental health resources, such as your organization’s employee assistance program and other mental health benefits; external resources, including SAMHSA, ADAA, and NAMI; and clinical and mindfulness programs in Calm Health. Specific programs and resources are recommended to an individual based on their screening responses and the goals and topics of interest they specify in the app.
For example, an employee whose questionnaire results indicate they may have severe symptoms of anxiety or depression would receive a recommendation to seek support from a therapist and links to external resources for help finding one. Alternatively, if their questionnaire results indicate they may have mild symptoms of anxiety or depression, they might be encouraged to try Mental Health for Pregnancy and Postpartum, a clinical program on Calm Health. Someone interested in getting better sleep might be directed to explore Calm Sleep Stories or programs about sleep hygiene by sleep experts.
3. Provide condition-specific, evidence-based tools to support mental health and well-being
Last, MHA recommends that employers provide education about and resources for perinatal mood and anxiety disorders. But the challenge is making sure employees use them.
I had plenty of information at my fingertips but never consulted it. What I really needed was to connect with someone who understood what I was going through, who would assure me I wasn’t alone, and who would offer effective tools to help me find some relief and balance in my thoughts and feelings.
Amid mental health provider shortages, digital mental health solutions can fill a vital gap. Mental Health for Pregnancy and Postpartum is an evidence-based audio program on Calm Health that uses principles based on cognitive behavioral therapy to help women navigate the mental and emotional challenges of pregnancy and early motherhood. Developed by a clinical psychologist with deep subject-matter expertise and narrated by a mother, the program helps women understand perinatal anxiety and depression, explore thoughts and beliefs about parenting, shift negative thoughts, and learn how to calm themselves in challenging moments.
Employers can also help reduce the stigma
For too long, women have hidden the mental and emotional struggles that are a part of pregnancy and early motherhood. While many women experience mild and brief cases of the baby blues, others experience moderate or even severe mental, emotional, and sleep challenges that can take a significant toll on their own and their family’s well-being.
Employers can help break through the stigma by offering targeted mental health resources for pregnancy, postpartum, and parenting; by communicating more openly about these challenges, and by encouraging women at all levels of the organization to share their personal stories.
