Adrienne Griffen says it took another six months after a doctor threatened to call Child Protective Services before she got help for postpartum depression in 2001. The warning came when she told the doctor the "baby blues" after her second child were not fading and were getting much more intense. "I am here to get help, so I don’t hurt my children," she recalled saying. The doctor answered, "Well, we don’t want another Andrea Yates," referring to the Texas mom who drowned her five children in the bathtub that same year.
That exchange lays bare the machinery mothers run into when they ask for care. Instead of support, Griffen got surveillance. Instead of treatment, she got a threat. "It was like banging my head against a brick wall," Griffen, now CEO of the Maternal Mental Health Leadership Alliance, told CNN.
Who Gets Help, and Who Gets Watched
Twenty-five years later, Griffen says a lot has changed, but not enough. Conversations about maternal mental health, once kept in hushed tones, have broken into mainstream consciousness amid the ongoing trial of 36-year-old labor and delivery nurse Lindsay Clancy, who says she strangled her three young children while experiencing postpartum psychosis, and the death of actress Hayden Panettiere, who was outspoken about her struggles with postpartum depression.
Women are telling their stories on the internet, at work, at home and in public. Experts say that’s long overdue, and that the system has neglected mothers in need. For many people, Clancy’s trial is the first time they’ve heard of postpartum psychosis, a severe and rare mental health condition that can affect up to 2 of every 1,000 women after childbirth. But mental health issues, whether depression, anxiety or psychosis, affect as many as 1 in 5 women in the US during pregnancy and in the year after birth.
Some experts say a culture of shame has kept serious problems undiscussed, undetected and untreated. That shame doesn’t appear out of nowhere. It grows in institutions that treat mothers as risks to manage instead of people to care for.
Panettiere said in a podcast interview in May, "There’s a lot of stigma around postpartum, and there’s a lot of misunderstanding. It’s on a spectrum. It’s on a scale, and fortunately, I never felt any hostility or negativity towards my child, thankfully, but I wasn’t connecting with her the way that I knew I should be." She also said she was fired from a decade-plus brand deal with Neutrogena after speaking out about postpartum depression in a 2015 interview on national TV.
Neutrogena later released a statement saying the company is deeply saddened by her death. "We are proud to have partnered with her and understand that we made her feel unsupported during a very difficult time. This is not what Neutrogena stands for or who we want to be," the company said in a statement posted Thursday.
The System at the Bedside
That same day, hundreds of women gathered outside the courthouse where Clancy is standing trial, wearing bright pink, in an attempt to raise awareness around maternal mental health. The groundswell of support has been echoed by women across the nation who have seen some of their own experiences reflected in Clancy’s descriptions of her postpartum mental health struggles and difficulty navigating the system to get help.
Griffen said most new mothers are lying in a hospital bed, recovering from birth with their hormones out of whack, and immediately handed an infant to care for. "In no other situation do we have one hospital patient, the mother, caring for another hospital patient, the baby," she said. Care coordinators, the health professionals who help patients navigate the medical system, are often assigned to people diagnosed with cancer or other serious health issues, but they’re rarely made available to postpartum mothers.
With all the attention focused on the newborn, struggling mothers can fall through the cracks. Griffen said the lack of support and resources can make matters worse. The American College of Obstetricians and Gynecologists has guidelines for how healthcare providers can screen pregnant and postpartum mothers for mental health issues, but Griffen said these have yet to be practically implemented across the US health system. A lack of reporting requirements also makes it difficult to know how often the guidelines are being followed, she added.
Dr. Andrea Diaz Stransky, assistant professor of psychiatry and behavioral sciences at Duke University, said maternal mental health issues like anxiety and depression are more common than better-known conditions such as gestational diabetes. "Even though we have guidelines for how to screen for both conditions — gestational diabetes as well as perinatal mood and anxiety disorders — we don’t have the same level of implementation," Diaz Stransky said. "If I screen and it’s positive, the waitlist for therapy is so long that this patient might not be able to access that soon enough," she said.
That’s the gap in plain sight. Screening exists. Access doesn’t keep up.
What They Call Care
Diaz Stransky said it takes a village to raise a child, and it’s important to prepare the whole village, not just the mother, for the perinatal experience. In North Carolina, where she practices, doctors can call a specialized phone line to consult a reproductive psychiatry expert and ask for resources. She said letting mental health conditions go untreated is a risk to both the pregnant parent and the baby. Untreated anxiety and depression are linked to increased risk of preeclampsia and preterm birth.
For those who need help, treatment can include specialized therapies or medication, she said. Partners and family members should also be prepared for the massive life transition that comes with having a child, including their own mental health challenges. Diaz Stransky added that it’s possible for partners to experience postpartum depression themselves.
Joy Burkhard, CEO of the Policy Center for Maternal Mental Health, said many people living in the US struggle to access any kind of regular healthcare because of a lack of insurance, logistical challenges, fears over immigration enforcement and more. Even those with insurance can be affected by a fractured system, she said. The majority of obstetric providers are paid one flat rate for all the care they provide, from when pregnancy is confirmed to six weeks postpartum, and that structure was created 30 years ago, Burkhard said.
"There’s been disincentives to address mental health, because mental health was never considered part of these bundled payments at the outset, 30 years ago," she added. Burkhard’s organization advocates for changes to this and other policies, like a bill currently being considered at the federal level, aiming to lower the out-of-pocket cost of perinatal care for mothers.
That’s the reform lane. It exists inside the same system that leaves mothers waiting, rationing care, and navigating a maze built by insurers, hospitals and bureaucracies. The National Maternal Mental Health Hotline, 1-833-TLC-MAMA, provides free, confidential 24/7 support via phone, text and chat in English and Spanish. Postpartum Support International provides free support to new mothers and families impacted by maternal mental health conditions.
Dr. Noelle Santorelli, a licensed clinical psychologist, said women who are typically high-functioning are often able to hide the fact they are struggling. "You can use compensatory mechanisms to sort of cover up what you’re experiencing," she said. Women also fear being separated from their children if they report what they’re really experiencing, Santorelli said. She advises people who are struggling to talk to someone trusted and to be specific about the thoughts and feelings they’re having so loved ones can advocate for them. "Just being honest can help," she said.
Hundreds of women in bright pink outside a courthouse. A hotline. Free support groups. A doctor’s warning that turned into a threat. The contrast is hard to miss.