Why isn't anyone talking about maternal suicide?

Untreated mental illness can lead pregnant women and new moms to take their own lives. While their deaths are often preventable, shame and stigma sometimes stop them from getting help in time.

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Clare Zeschky sobbed as she pushed the stroller through Vancouver’s Stanley Park in an attempt to get her 18-month-old daughter, Lara, to sleep. She wondered what would happen if she left the pram on the path and vanished into the woods, never to be seen again. Somebody will find her, she thought. She’ll be better off without me.

Zeschky’s husband and their friends, who were visiting from the United Kingdom and had a baby just a month older than Lara, were at the nearby aquarium and they were starting to worry because she had been gone so long—she’d left to try to get Lara to nap. The visit had sent Zeschky spiraling: her friends seemed so happy and their baby actually slept, unlike Lara, even after a transatlantic trip. Since pregnancy, Zeschky had been suffering from untreated depression, which intensified after her daughter was born due in large part to extreme sleep deprivation. On the drive to the park, she had willed the car to crash and end it all.

“I was so envious and so resentful and just so defeated,” she says. “My friend seemed to be so good at being a mom, whereas I was just this cranky, torn-up ball of anger. I felt as though I was doing something terribly wrong that I couldn’t have what they had. It completely broke me.”

Why pregnant women and new moms contemplate suicide

In Canada, suicide is one of the leading causes of death during pregnancy and the postpartum period, though it’s rare as the maternal death rate overall is low. A study published in 2017 in the Canadian Medical Association Journal found that the perinatal suicide rate in Ontario from 1994 to 2008 was 2.5 per 100,000 live births, accounting for one in 19 maternal deaths. This falls between the rates found in the United Kingdom and the United States—two and three per 100,000, respectively. Although other major causes of maternal death, such as hemorrhage and infection, have declined over the years, maternal suicide rates have held steady.

“Maternal suicide is rare but serious,” says psychiatrist Simone Vigod, lead of the Reproductive Life Stages Program at Women’s College Hospital in Toronto and one of the authors of the paper. “It’s a devastating outcome for the woman, for her family, for her living children and for society.”

About 20 percent of new moms have some sort of postpartum mental health issue, which increases the risk of suicide. Of those women, about one to two in 1,000 have psychosis, which typically shows up in the first two to four weeks postpartum and is marked by paranoia, delusional thinking and extreme mood swings. “When you have depression or psychosis, your mind may not be able to see other options for yourself,” Vigod says. “Depression makes people feel and think negatively—their brains are wired to not have hope.”

In Vigod’s study, most of the 51 women who were classified as perinatal had a mood or an anxiety disorder and none had a psychotic disorder, highlighting the fact that the consequences of postpartum depression should not be underestimated. The largest number of suicides happened in the last three months of the first year postpartum followed by the last trimester of pregnancy, suggesting there was time for intervention. While there’s a perception that suicide is the result of an unanticipated psychotic episode soon after giving birth, that’s certainly not always the case.

On top of the risk factors for mental illness in the general population—such as a major life change, trauma or stress—pregnant women and new moms have unique vulnerabilities. For example, women who have unplanned pregnancies, intend to have an abortion or are victims of intimate partner violence are more likely to consider suicide, and women with well-treated mental illness may stop taking their antidepressants due to fears the medication may harm their babies, and subsequently relapse.

In the postpartum period, some new moms are biologically sensitive to the hormonal changes and develop mental health problems for the first time, which they may have difficulty recognizing.

“In addition to that, there’s sleep deprivation, which can exacerbate a mental health issue, and there’s the psychological transition to parenthood and the negotiations in your relationship if you have one,” Vigod says. “Having a 24-hour dependent and not necessarily knowing what to do all the time can exacerbate people’s vulnerabilities and affect their self-esteem and their capacity to manage.”

For some, the pressure put on them as new moms is just too much to bear. For instance, women are bombarded with messages that “breast is best,” and a study published in 2015 in the Maternal and Child Health Journal found that not being able to breastfeed as planned increases the risk of postpartum depression.

After giving birth in the summer of 2016, New Westminster, B.C., mom Florence Leung struggled with breastfeeding. At one point, according to CTV News, the registered nurse confided in her mom that she wanted to die and told her husband, Kim Chen, “I can’t do this.” Her son, Aiden, was two months old and she had recently started treatment for postpartum depression when she left home without telling anyone, triggering a desperate search. Three weeks later, her body was found in the ocean near an island.

Two months after his wife was found, Chen wrote an emotional post on Facebook. “For all the new moms experiencing low mood or anxiety, please seek help and talk about your feelings. You are Not alone. You are Not a bad mother,” he wrote. “Do not EVER feel bad or guilty about not being able to ‘exclusively breastfeed’, even though you may feel the pressure to do so based on posters in maternity wards, brochures in prenatal classes, and teachings at breastfeeding classes.”

For every woman who completes suicide, several more make attempts that result in severe injury and thousands more have suicidal ideation. One study found that up to a third of all pregnant women have suicidal ideation and data from research by Vigod suggests that up to 20 percent of women with postpartum depression have at least some thoughts of not wanting to live anymore. Research also shows that in the general population, a third of people who contemplate suicide actually make a plan and 29 percent make an attempt.

“A lot of moms have suicidal ideation, but they’re usually fleeting thoughts: I want to escape, I want to run away,” says Kerry O’Donohue, a counsellor and group facilitator at Pacific Post Partum Support Society (PPPSS) in Burnaby, B.C. “They don’t have any intent. Unfortunately, when people are having these thoughts, they can feel very alone.” And there’s always a risk of suicidal thoughts and feelings getting worse if a mom does not get help or support.

Some studies have found that suicidal ideation during pregnancy is associated with low birth weight, and suicide attempts are linked to preterm birth, respiratory distress syndrome and congenital anomalies of the circulatory system. In the postpartum period, having suicidal thoughts can erode a woman’s mental health and make it difficult for her to bond with her baby, which can lead to emotional and developmental challenges for the child.

Alt text This new mom opened up about her depression and what happened next will shock youAbout five or six months after giving birth, Zeschky started having suicidal ideation, usually when she was lying awake in the middle of the night, breastfeeding Lara or letting her suck her finger. “I would plan an escape,” she recalls. “I’d think about just walking off and never coming back and not really caring what would happen to me.”

Even more troubling, she had thoughts of intentionally harming Lara. They were intrusive thoughts, with no plan to act, followed by intense feelings of guilt. She didn’t know it at the time, but research shows that about half of all new mothers experience intrusive thoughts of purposely hurting their children—along with distress and shame—and have no intention of acting on them. “I was so scared that one day I would snap and that would be it,” she says. “I was living in constant fear of myself. There were times when I would feel such a terrible person, that it would be a relief if something happened to me.”

During the long days that seemed to run together in one big blur, Zeschky would dig her nails into the palms of her hands or her legs, pull out strands of her hair and contemplate other ways of hurting herself. She also drank too much alcohol, which she describes as “a socially acceptable form of self-harm.”

“I was punishing myself for not being good enough, not being the mom that I want to be,” she says. “I felt as though I was failing constantly as a mother: my baby couldn’t sleep, I wasn’t enjoying it. What sort of person didn’t enjoy this?”

Where to find help

Despite the significant distress she experienced, Zeschky never sought help. When Lara was one, she started working at her midwife’s office and would give women pamphlets on postpartum depression and encourage them to seek help if they needed it, though she could never bring herself to take her own advice. She would go to mom and baby groups and plaster a smile on her face. She never even told her husband the extent of what she was going through. And she’s not alone: the majority of women who suffer from a maternal mental illness hide or downplay their symptoms, and research shows that up to half of cases of postpartum depression go undetected.

“There’s a lot of shame and feelings of inadequacy because motherhood is put up on a pedestal and women think it should be the happiest time of their lives,” says O’Donohue, who has been working with postpartum women for nearly three decades. “When reality is clashing with that expectation, you so can just feel so alone. Breaking the isolation is one of the most important factors.”

In Vigod’s study, only 40 percent of the women who died by suicide had contact with a healthcare provider regarding their mental health in the 30 days prior to their deaths. “Unfortunately, there are some women who are afraid to get help for symptoms of depression or serious symptoms of anxiety because they’re afraid that when they admit that they’re not doing well or that they have suicidal thoughts, child protective services might be called,” Vigod says, adding that having depression and anxiety does not mean that you are unsafe to care for your child.

Indeed, this was one of Zeschky’s biggest fears. “I was so scared that if I told somebody what was going on in my head, they would take Lara away from me,” she says, adding that sometimes she felt like that would be a relief. “I’d think about calling the ministry on myself: Maybe they’ll come and take my baby away, I’ll go to prison and this will all be over.”

Tragically, when women’s children are taken into care by child protection services, they are significantly more likely to attempt and complete suicide, according to a study of women who had their first child in Manitoba between 1992 and 2015.

It can be hard to see the signs that a new mom is struggling when she’s trying to hide her feelings, however there are some things you can look for. In addition to the common signs of depression—changes in sleep or appetite, irritability and a hopeless outlook, for instance—new moms may seem extremely anxious about their baby and fixate on certain things, like whether or not the infant is warm enough. She may be afraid to be alone with her baby or not let anyone else hold the infant. Signs of suicidal ideation include self-harm, reckless behaviour and excessive sadness or moodiness, sudden calmness, withdrawing from loved ones and friends, making preparations (such as giving away possessions), talking about feeling hopeless or being trapped, and feeling like a burden to others.

If you think a loved one way be experiencing postpartum depression or suicidal ideation, Vigod recommends starting the conversation by using the Whooley Questions, which are used for depression screening, as a guideline: During the past month, have you often been bothered by feeling down, depressed or hopeless? And, during the past month, have you often been bothered by little interest or pleasure in doing things? If the person answers yes to one or both of the questions, you can ask them if they would be willing to get some help and then support them in finding it.

Fortunately, there are many people who can help. Women can start by speaking with their maternity care provider, family doctor or a public health nurse. They may be offered psychotherapy, medication or referral to a psychiatrist or counsellor. There are also lots of peer support groups and telephone support services, such as those offered by PPPSS. “The powerful piece of it all is women sharing their stories in a safe place and being able to be honest about what they’re feeling without being judged,” says O’Donohue. “Women have told us that coming to our groups or phoning us saved their lives.”

When a woman brings up thoughts of suicide with a PPPSS volunteer or employee, they follow a protocol to ensure she’s safe, which involves assessing the level of risk, ensuring someone else knows about her thoughts and, if necessary, calling her doctor or getting her to the hospital emergency department.

Zeschky’s husband eventually found her on the path that day at Stanley Park, still safely pushing Lara around. Several more dark months followed until Lara turned two, and the couple decided to sleep train her. As Lara started to sleep more, Zeschky’s slowly felt her depression lifting and her intrusive thoughts evaporating. Not long after, she saw an ad for a volunteer orientation event at PPPSS and decided to go.

At the gathering, women started sharing their stories, and Zeschky wept as she realized for the first time that she wasn’t alone in her thoughts. Today, six years later, Zeschky works at PPPSS as a counsellor and group facilitator. “The most healing part of me has been hearing all these stories and sharing my own,” she says. “Reach out. It doesn’t have to be so lonely. We’re here to listen. If I had just gotten some help earlier on, it would have been much better.”

To find help for postpartum mental illness in your area, call Postpartum Support International at 1-800-944-4773 or visit www.postpartum.net. Women across Canada can call the Pacific Post Partum Support Society at 604-255-7999 or toll-free at 855-255-7999. If you’re experiencing suicidal thoughts, call 911 or the Canada Suicide Prevention Service at 1-833-456-4566.

Read more:
5 strategies for talking to your child about their mental health
Parenting through severe postpartum depression

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