The Need for Maternal Healthcare Restructure

With a postpartum psychosis case filling up the news and media outlets right now, it seems like a great time to remember our system needs restructure and to advocate for everyone.

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The Need for Maternal Healthcare Restructure

By now, we have all likely heard about the Massachusetts woman who killed her 3 children and attempted to kill herself as well. I will not mention her name because she does not deserve the shame. She was suffering from postpartum psychosis. She was a labor and delivery nurse. She was trying to get help, going to intensive therapy 3 times a week. Her husband was working from home in an effort to support her. What she did in her psychosis took less than 25 minutes while her husband went to pick up take out.

With the media coverage this case continues to get, it feels wrong as a healthcare worker not to speak on it.

This is an insurmountable tragedy, but not a criminal one. I don't know a single colleague who would say this mother deserves jail time, and I would be bold enough to question if anyone who would should be practicing in medicine.

Postpartum psychosis affects 1 in 500 mothers after giving birth1. This is further different from postpartum blues and even postpartum depression, which also need to be taken more seriously than they currently are. Postpartum psychosis includes severe depression, delusions, manic mood, paranoia, hallucinations, and more.

I will never forget when I was a nursing student in my OB course when my professor had a woman who had previously suffered from postpartum psychosis come tell us her story. I give her so much credit for being able to tell strangers these awful thoughts she had in an effort that it might make a difference for mothers in the future. This mom proceeded to tell us about intrusive thoughts she had, like when she was doing laundry would watch the washing machine swirl and imagine placing her baby inside, watching him drown and spin around along with the sheets. Years later, these were thoughts and missed moments with her son she was still mourning and trying to forgive herself for.

These mothers lose themselves to this psychosis and typically need extensive help, including therapy, hospitalization, anti-psychotic medications, mood stabilizers, anti-depressants, and sometimes other interventions. I imagine this is why this Massachusetts husband came forward to say he forgives her and to ask others to do the same because he knows it was not his wife who did these things. I also imagine once she gets the help she needs, she will need much more again to cope with what she did.

There are two key points to take away from this case and those like it. The first is that women need more care and support in the postpartum period. The second is that women's health needs more restructuring in general.

Many women experience a variety of issues and changes postpartum after what their bodies just went through. Between the hormone surges, pain, lack of sleep, taking care of a newborn, and missing out on events or regular socialization, amongst other things, many experience loss of self, anxiety, depression, and stress. Too often, they are not screened well or just brushed off with a, "Welcome to motherhood.” It is time to shift and see this as the real concern it is. Preaching self-care to people who actually need community care is how we fail them.

We as healthcare professionals need to not only be better advocates for our patients but work together to develop more resources for those who need them. This Massachusetts mother was in an area filled with more resources and medical professionals than some rural areas have in their entire state, and it still wasn't enough. It is not a failure on her but on the system.

This is sadly not surprising when looking at other staggering numbers in women's medicine. While the list could go on and on, a key crisis in the US is our maternal mortality rate. The US continues to have the highest death rate related to childbirth compared to any other developed country and even often exceeds that of third-world countries2. In fact, in 2020, the death rate in the US was 23.8 per 100,000, a large marginal beyond even the next highest, which was France at 8.2 per 100,000. This is even further troublesome when looking at deeper data, such as the higher rates of death in women of minority groups, race, and social income/class. These rates only continue to rise.

The maternal health system requires a lot of attention and restructure if we ever hope to see any of these rates go down and prevent deaths ranging from miscarriage to childbirth to the postpartum period across the entire continuum of care. It starts with access to care for all, followed by making changes to improve childbirth and prevent complications, and finally, ending with more support and resources in postpartum.

Our healthcare system is long overdue for a paradigm shift focusing on improving the health and wellness of women and mothers, starting with the most important task of saving their lives. Thus I hope the attention rendered from this case can shift its focus from blaming this one mother for these poor little lives lost and instead, use it as an opportunity to address all these underlying issues in our communities to prevent any similar outcomes in the future.

If there was ever a concrete call to action, this was it.

References/Resources

1 Postpartum psychosis: National Health Service

2The Worsening U.S. Maternal Health Crisis in Three Graphs: The Century Foundation

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nataliadab

About nataliadab, MSN, RN

Natalia Dabrowska, MSN-CNL, RN

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Specializes in NICU, PICU, Transport, L&D, Hospice.

We really only care about that woman of child bearing age when she is looking to terminate an unwanted pregnancy. All of the data demonstrates that neglect. 

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Specializes in NICU/Critical Care/Legal case review.

Thank you so very much for your comments. I, too, have thought how this poor woman must be suffering (and her whole family). I remember back to Andrea Yates in Texas when I think it was 5 children she killed and it was determined it was likely postpartum psychosis. Doctors and the legal system really weren't giving it much credence. The suffering just continued. It's time there was a big light shone on this subject and, as you've said, screening done into the postpartum phase well beyond discharge. I think there should be a visiting nurse program.

Netflix has a great documentary on the subject "When the bough breaks." Let's hope raising our voices will make for change.images?q=tbn:ANd9GcRTx3mbybOYRYVWLwaD0Kz

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Specializes in Certified Nurse Midwife.

Extremely sad situation for the family, community, and the state of our healthcare system. Your article goes very well with the one I wrote, yet to be published, about postpartum psychosis. I hope we can each find a way to bring light on this illness and push for changes. Thank you for drawing attention to this subject. 

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Specializes in Community Integrated Svcs, PeriOperative Svcs..

Poignantly dead-on article, Natalia. Thanks for sharing it. Huge agreement here... if this isn't a glaring call to action, what would be?! Bless those little souls & the heart of that Mama that now has to find some way to go on... ?

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Specializes in NICU/Critical Care/Legal case review.

Ruth Mielke, I'd love to read that article when you get published. It's a subject I'd love to learn more about.

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