‘I could not stop crying’: Why postpartum depression rates have soared during the pandemic

When Kara Smith thinks of her pregnancy during the pandemic, there’s a word that seems to surface more than others: isolation. 

Other words come, too, words like panic and anxiety, but it’s the loneliness that seems to permeate her language the most. 

Which makes sense — Smith, a nurse who lives in Farwell, a small town of about 900 people in central Michigan, has had to navigate her third and final pregnancy in a pandemic. She wasn’t able to see friends or much family when she was expecting or after she gave birth. There was no baby shower; no one was able to come with her to many of her doctors’ appointments. Only her husband could be in the delivery room with her when she gave birth to her daughter on April 21, 2021.

“It’s been very isolating from the beginning,” said Smith, a mother of three. “I definitely felt alone.”

Once she had her baby, things didn’t improve. She felt wildly alone in a world dominated by sickness. She couldn’t stop thinking about how to keep her infant and herself healthy as the COVID-19 death toll continued to climb. 

“After she was born, I was trying to keep her healthy and away from everyone,” Smith said. “I was very emotional, very anxious.” 

Like people across the country and world, Smith was experiencing postpartum depression — a depression that lasts for weeks, months or even years after a birth. Postpartum depression has long been common but, as with so much of maternal mental health, is severely stigmatized. 

“There’s a lot of pressure to be like, I had a baby; I’m so happy,” said Claire Crowe, a social worker for the Maternal and Infant Health Program at the Central Michigan District Health Department. “But you’re not happy. It’s kind of like torture and you’re not sleeping.”

Prior to the pandemic, about one in eight new mothers had postpartum depression and between 5% and 7% had major depression, according to the U.S. Centers for Disease Control and Prevention (CDC). Those numbers soared during the pandemic, with one in three new mothers screening positive for postpartum depression during the early days of COVID-19 — nearly triple pre-pandemic levels — and one in five new mothers had major depressive symptoms, according to newly published information from University of Michigan researchers. 

“We knew prior to the pandemic that postpartum depression is a real and very critical health problem that affects many women,” said Clayton Shuman, a University of Michigan assistant professor of nursing and the lead author of “Postpartum depression and associated risk factors during the COVID-19 pandemic.”

“This pandemic provided the unfortunate situation where we could see and highlight the mental health struggles that postpartum women face.”

This rise has highlighted something those working in maternal and infant health have been saying for years: We are failing mothers and parents in general. Systemic racism and sexism has left mothers and fathers — especially individuals of color and people who are lower income — to face a world in which they’re not accessing the care they need, before or after birth. They aren’t receiving paid maternity or parental leave, affordable childcare is almost a myth at this point, and mental health concerns are downplayed or outright ignored. 

In other words: it wasn’t just the pandemic that caused postpartum depression rates to skyrocket; it was the pandemic colliding with institutionalized racism and sexism, Crowe explained. 

For example, Crowe said, there has been a baby formula shortage during the pandemic, leaving many in dire straits — but particularly individuals who are participating in the Michigan WIC program, which serves low-income women and children. Through WIC, participants can access nine cans of formula a month, but WIC only allows for certain brands of formula, further limiting low-income mothers’ ability to access food for their baby. 

And while many women want to breastfeed, they often don’t receive the breastfeeding education they need to do so successfully. That has been further complicated during the pandemic, when many new mothers weren’t seeing their health care providers in person, explained Taylor Davis, a breastfeeding peer counselor at the Central Michigan District Health Department who also works as a doula and recently co-founded the Clare County Breastfeeding Coalition with Smith.

“We started the coalition during the pandemic because Kara reached out to me when she was struggling with postpartum depression and milk supply,” Davis said. “She had to drive from Clare County to Ann Arbor to get breastfeeding support. This is not OK.”

That kind of stress emanating from not being able to breastfeed, feeling isolated from friends, family and health care providers, and not having enough food for an infant, University of Michigan researchers explained, can lead to depression.

For Smith, postpartum depression led to her “being very emotional.” 

“I could not stop crying,” she said. “I felt angry. I couldn’t breathe. I was very anxious. I felt like something was always going to happen to the baby. I don’t know how many times I’d wake up to watch her breathe to make sure she’s OK. I could not shut my mind off. I was so overwhelmed.”

Just before Smith was set to return to her job, she “had a big panic attack.”

“I was like, ‘I can’t do it,’ and I tried to go to urgent care, and they wouldn’t see me when I mentioned postpartum depression symptoms,” Smith said. “They were like, ‘You need to see your OB.’” 

Fortunately, she was able to see her obstetrician the next day, who prescribed her medication that has helped with her depression. Her doctor also recommended she see a therapist, but, likely because of the mental health field being overwhelmed by requests for therapy during the pandemic, has not heard back from the therapists she contacted.

‘Normalize it as something that happens’

If there’s anything the public should take away from the University of Michigan study, it’s that postpartum depression is common. Individuals should not feel guilty, or be made to feel guilty, about being depressed — which is a medical condition — and society should provide better education around postpartum education and resources for those who are struggling, Shuman said.

“We need to normalize it as something that happens,” Shuman said of postpartum depression. 

“Postpartum depression comes with an incredible amount of stigma,” Shuman continued. “If you have a baby, there’s this idea of why isn’t the baby making you happy? Our society stigmatizes many mental health issues, including postpartum depression.”

That stigma, Shuman said, is dangerous. It makes women resistant to reaching out for needed help and, as Davis and Crowe said, can include medical professionals and society at large downplaying mothers’ mental health. 

“It makes my blood boil: I would call a mom with a one-week-old baby and a two year old, dad has to go back to work, she’s home alone, and she’s really sad and it’s wintertime,” said Davis, who does outreach to new mothers as part of her work. “A couple weeks go by and she’s sadder; she’s miserable. She calls her health care provider and she’s told to wait until her six-week check-up. I’ve been told that quite a few times; it really bothers me.” 

To lessen this stigma, Shuman said education about postpartum depression is critical — which is what he’s hoping comes in part from his paper. For the paper, researchers collected survey data between February and July 2020 from 670 postpartum patients in the United States. From this data, they found that individuals who fed infants formula had a 92% greater chance of screening positive for postpartum depression and were 73% more likely to screen positive for major depressive symptoms compared to those who breastfed or bottle-fed with human milk. 

Shuman emphasized this result should in no way be taken as shaming people who use formula, but rather that there are a number of challenges those using formula have faced during the pandemic. Those challenges include the formula shortage and limited access to breastfeeding education and health care providers. Because women were having to learn about breastfeeding through telehealth, as opposed to in person, due to the pandemic, they reported they were either unable to breastfeed or were ending breastfeeding early, which in turn could lead to depression, Shuman said.

Mothers who also were concerned that they would contract COVID-19 had a 71% greater chance of screening positive for postpartum depression, according to the study.

“We found that moms were reporting they felt guilty no matter what they did in the pandemic,” Shuman said. “They felt guilty if they’re staying home all the time and not exposing [the babies] to playdates, but then they felt guilty if they did those things because they’d think that may be the reason my baby will come down with COVID-19.”

Smith said this is exactly what happened with her. 

“You feel guilty about going out because you think, ‘What if I just exposed my baby?’” she said.

‘Can we do a society mom shower?’

Part of addressing maternal mental health is a need to shift the way we view pregnancy and infant care, everyone interviewed by the Advance said. Those who are pregnant can feel overwhelmingly alone — and not just during the pandemic. 

That, Crowe said, is a function of women feeling abandoned by everyone from policymakers who refuse to provide paid family leave — the United States is one of six countries in the world without any national program — to institutionalized racism and classism leaving women of color and lower-income women to navigate systems that are often aggressively antagonistic towards them.

“Can we do a society mom shower where we get paid maternity leave, affordable childcare, partners who are socialized to be supportive, equal pay?” Crowe said. 

Shuman noted that “mothers handle a lot of the responsibility for an infant’s health, well-being and development” when there are many others around her who should be stepping up to help.

“We need to make sure families and communities surrounding these mothers take responsibility for the well-being of an infant as well,” Shuman said.

Part of that community is the medical field, Crowe said. Right now, a woman who has just given birth doesn’t see her health care provider until she’s six weeks postpartum — something that she and Davis said should change to better support individuals as they navigate their lives that have been entirely upended. 

“They’re at home, experiencing symptoms [of postpartum depression], having longer exposure to symptoms without getting help,” Crowe said. “We have to recognize this is the medical system.”

And it’s not just additional medical visits that would help, Crowe and Davis explained. It’s about expanding who insurance covers as part of pregnancy and postpartum treatment. The more insurance covers people like doulas — people who provide physician and emotional support during pregnancy, childbirth and in the postpartum period — and midwives, the better, they said.

“I’ve had more clients recently use midwives or want to,” Davis said. “They talk about their midwives and how they listened to them, to their stories.”

It’s that idea — one of women and mothers being listened to — that needs to take center stage, everyone interviewed for this story said. 

That way, Smith said, perhaps when people like her go to urgent care when they’re having a panic attack as a result of postpartum depression, they won’t be turned away. 

“The pandemic has really taken a toll on a lot of people’s mental health,” Smith said. “But I want people to know there is support. There are resources out there, and they aren’t alone.”