Why All Pregnant And New Moms Should See A Therapist

"Society expects you to be happy when you're a new mom with a beautiful brand new baby, but I felt like the saddest person in the world," says Andrea Fagundez, mom and participant in new perinatal mental health study called The SUMMIT (Scaling Up Maternal Mental Health care by Increasing Access to Treatment) Trial.

Can you relate? You can try to prepare for parenthood, but there is no one-size-fits-all handbook for navigating postpartum life. Reading baby books and stocking up on postpartum and newborn essentials can help, but every pregnancy, parent and baby are different. Maybe that's why new motherhood can feel so isolating—and one of many reasons why all new moms should see a therapist.

According to CAMH, approximately one in five pregnant and postpartum people experience anxiety and depression, but only 10 percent receive proper treatment. The SUMMIT Trial shows that with the right support, these numbers can change for the better.

The silent struggles of new motherhood

Caring for a baby can be as exhausting as it is rewarding—especially when you throw hormones in the mix. The normal decline in hormone levels after a baby is born (often called baby blues) can wreak havoc on an already exhausted new mom.

Fagundez says that she spent a lot of time crying at the beginning of her postpartum period, craving alone time that she knew was no longer an option.  "The hormonal changes that your body goes through are enormous," she says, "people don't talk about it enough."

Gemma Van-Slyke, founder of The MotherFlock, a growing Vancouver-based community and online resource for new moms, says that most of the planning for parenthood revolves around the baby only. "We spend all our time thinking about and planning our pregnancy and birth, but not that much time planning for postpartum."

Van-slyke surveyed a sample of people from The MotherFlock community about postpartum struggles and support. The results were consistent with both Fagundez's and Van-Slyke's perspectives:

• 58% of moms didn't receive enough support postpartum
• 68% felt like they didn't spend enough time on their own
• 98% felt like they could do with more mom-friends.

Luckily, researchers are now starting to venture into postpartum territory, seeking out causes and solutions.

The SUMMIT Trial

The SUMMIT Trial is a North American study that included 1230 women. The study increased access to mental health services for pregnant and postpartum individuals and tested the efficacy of different types of talk therapy. It is currently one of the largest psychotherapy studies in the world.

Head researcher Daisy Singla said the study examined two innovations: telemedicine (virtual treatment) and training non-specialist providers to deliver talk therapies.

"The goal of the SUMMIT trial was to address the large and growing treatment gap for talk therapies," says Singla.

The non-specialist therapy providers (nurses, midwives and doulas) received two days of training. Singla says the training module included information on perinatal depression and anxiety and safety protocols. She highlights that these providers also received weekly supervision from a clinical expert.

From January 8, 2020, to October 4, 2023, participants were split between one of four arms: nonspecialist-telemedicine, specialist-telemedicine, non-specialist in-person, and specialist in-person. Over six to eight weeks, all participants were led through weekly one-hour guided sessions that focused on targeting primary mechanisms of coping and patient activation—one's ability to confidently manage one's own health.

Fagundez, whose weekly sessions were conducted online, says that the sessions helped equip her with some of the tools she still uses today. She highlights one exercise as especially helpful, which involved filling in a four-circle Venn diagram with various members of her support system based on closeness and overall relationship dynamics. She says this exercise helped her realize that although she often felt very lonely during her postpartum period, she actually wasn't alone at all.

"This (the exercise) made me realize who my network is, who I can call and ask for a coffee, to bring lunch, or to join me for a walk," she says. Fagundez adds that the Venn diagram exercise, along with a variety of others, helps her see her glass as half full instead of half empty.

Trail findings and efficacy of telemedicine

At the end of the trial period, results showed that regardless of treatment provider, participants reported a considerable improvement in symptoms of anxiety and depression. Singla also reveals that client satisfaction was equal between the specialist and non-specialist groups.

"These results offer hope to the many parents who are experiencing these common conditions of depression and anxiety," she says. "They offer hope in the sense that there are solutions to address this barrier to mental health for parents, that means being screened, and if symptomatic, being referred for appropriate services.

Singla adds that many in this population prefer telemedicine over in-person care. "It overcomes common barriers to accessing care in person due to transportation and scheduling difficulties, especially as a new parent.

The ultimate goal of those who created this study is for every pregnant and postpartum person to receive access to brief talk therapy.

Postpartum resources and barriers to access

Van-Slyke highlights how the postpartum period after her second child was much more difficult, attributing part of the reason to the absence of local support in the place she gave birth. When Van-Slyke had her first child in Melbourne, Australia, she was put into a group with her mental health nurse starting at six weeks postpartum.

"Straight away you're thrown into a group of other moms who've had babies around the same age, so you basically have this little friendship group right from the start," she says. "Everyone from Melbourne has that opportunity." However, when Van-Slyke had her second baby in Vancouver, she was surprised to see virtually no support for new moms—giving her the idea to create The MotherFlock.

While the community is based in Vancouver and all meetings are currently being held in person, there is a page on The MotherFlock website called "Matrescence Tales" where moms from anywhere can share their birth stories, as well as their process and transition into motherhood. The online element of this community hub makes accessing some sort of postpartum support a possibility for moms who otherwise may not be able to.

Postpartum therapy—like many other kinds—is pretty pricey, with most one-on-one sessions costing between $100 and $200 each. Considering all the other costs associated with raising a child, this price tag may exceed the budget of many new parents.

Fagundez believes cost is one of the biggest barriers to postpartum support for new moms, which shouldn't be the case.

"It should be like going to your family doctor; you just have access to help," she says. " It's so fundamental for the health of society that it should be easily accessible to everyone."

Postpartum depression vs. postnatal depletion

It's important to recognize that postpartum challenges are normal and don't necessarily indicate that you'll meet the criteria for a postpartum depression (PPD) diagnosis. Common symptoms of PPD include:

• Depressed mood or depression with anxiety
• Anhedonia, which involves a loss of interest in things that would normally bring pleasure, including the baby
• Changes in weight of appetite
• Sleep disturbance and fatigue
• Physical feelings of being slowed down or restlessness, jumpiness and edginess
• Excessive feelings of guilt or worthlessness
• Recurrent thoughts of death or suicide

If you're a new mom and are feeling low but not to the extreme ends, you may be feeling something that could be in line with a less severe term - which Van-Slyke says can sometimes be difficult to identify.

"What's tricky is identifying the difference between postpartum depression and postnatal depletion," she says, "just acknowledging how much of it is just motherhood the way it is, and what point we need help and support."

Dr.Oscar Serrallach first coined the term 'postnatal depletion,' defining it as "the combination of physical, hormonal and emotional depletion that a mother can experience after giving birth." Likely a partial result of hormone depletion, this condition reduces energy, often making you feel overwhelmed and exhausted. Serrallach believes that over 50% of moms suffer from some degree of postnatal depletion.

What's important, though, is that you don't suffer in silence. If you're a new mom and are feeling symptoms of depletion and/or depression, it is crucial to seek support from either your own internal support system or an external one—for the sake of both yourself and your baby. If in crisis, there are 24/7 hotlines for postpartum depression, such as the National Maternal Mental Health Hotline.