Giving birth is not always a joyous occasion.
Health experts say childbirth can trigger negative emotions that women are not expecting and are not prepared to handle.
While they won’t comment specifically about a Fresno mother accused of drowning her 7-month-old baby in a bathtub on Christmas Eve, they say depression, anxiety, obsessive-compulsive thoughts, and very rarely a condition known as postpartum psychosis—a dangerous break from reality—can follow childbirth.
Women and medical professionals have not been educated about the conditions and what to look for during pregnancy and after birth, the experts say. The result is that women often are too ashamed to get help.
But the mood disorders can be safely treated, they say. And without treatment, the consequences can be devastating for the mothers and their babies.
Postpartum psychosis can put mothers at risk for harming themselves or their babies. Mothers with psychosis may hear voices, have hallucinations or delusions. Women who have had mental illness, such as bipolar disorder, before giving birth are at greater risk for postpartum psychosis.
Lisa Brown, 30, of Fresno, told police she killed her daughter because the baby was possessed by demons and the devil made her drown the baby. A friend of Brown’s said Brown told her she had been diagnosed with schizophrenia.
Postpartum psychosis “is a true medical emergency,” said Dr. Conrad Chao, chief of obstetrics and gynecology at the University of California at San Francisco-Fresno Medical Education Program.
But this condition is very rare, happening with only one to two births per 1,000, he said. And it’s even rarer for mothers with postpartum psychosis to commit violent acts against their babies, Chao said.
Chao said more often doctors see women with postpartum depression, which affects their ability to take care of themselves and their babies: “One out of six women will have this problem.”
Postpartum depression differs from the “baby blues,” Chao said. More than half of women giving birth experience a short-lived depression with milder symptoms that usually lifts after a week or two. But for 10% to 20%, the birth of a baby triggers a more severe form of depression that can develop a couple of months or longer after childbirth and last for months without treatment, he said.
Chao said women with depression during pregnancy and after giving birth can be safely treated with antidepressants and psychotherapy.
He takes issue with claims by the Citizens Commission on Human Rights, a Scientology-affiliated group that sent out news releases saying Brown’s case in Fresno “may be the latest in a string of psychiatric drug-induced infanticides.”
Brown told police she was taking Paxil, an antidepressant.
Chao said a 2001 Irish study found no evidence that antidepressants known as selective serotonin reuptake inhibitors increased the risk of violence.
“If anything, what they do is reduce someone’s propensity to commit violence against oneself or another,” he said.
Dr. Markham Kirsten, a psychiatrist at Kaiser Permanente in Fresno, said antidepressants typically are the treatment of choice for postpartum depression. Other, mood-stabilizing drugs are often prescribed for psychosis.
Kirsten said the drugs can be effective.
Anyone who has seen the relief women experience “would be quite convinced of the usefulness of the medications,” he said.
The problem is not with the treatment for pregnancy and postpartum mood disorders, said Patricia Neufeld, a Fresno marriage and family therapist who specializes in treating women during pregnancy and after birth.
Women are afraid to get help, she said.
“There’s a huge stigma about pregnancy and postpartum,” Neufeld said. “Women are told this is a time they should enjoy.”
Too many of the women she sees have waited to seek help until they no longer can function and are in crisis, she said.
“I want women to know there’s no shame in getting the help you need,” Neufeld said.
Medical providers need to be trained how to screen for pregnancy and postpartum mood disorders—and how to treat them, said Pec Indman, a trainer at Postpartum Support International, an organization created in 1987 to educate people about the emotional changes women experience during pregnancy and after giving birth.
“There’s just still an incredible amount of ignorance in terms of providers,” Indman said.
Chao has teamed with Neufeld to increase his medical residents’ awareness of the mood disorders women can experience.
The UCSF-Fresno Medical Education Program also is bringing Dr. Shaila Misri, an expert in reproductive psychiatry from Vancouver, British Columbia, to speak to the medical residents in March.
Misri, who sees about 6,000 pregnant and new mothers each year, will give a lecture March 26 that will be open to the public.
In a telephone interview, Misri said mood disorders affect women regardless of race, ethnicity, social or economic status. Yet too few women know about them.
“We need to give accurate information,” she said. “And the final aim would be in your community to have specialized care available. I know it sounds all too lofty, but it needs to be done.”
The reporter can be reached at banderson@fresnobee.com or (559)441-6310.
By Barbara Anderson / The Fresno Bee
