The deaths of a 32-year-old woman and her two children have prompted an outpouring of grief in Winnipeg and raised questions about how communities can better support mothers struggling with their mental health.
Lisa Gibson's children – Anna, 2, and Nicholas, three months – were found in a bathtub last week and pronounced dead in hospital. Police found Ms. Gibson's body in the Red River on Sunday.
Though it has not been confirmed Ms. Gibson was suffering from postpartum depression, police say they are investigating whether the disorder played a role in the deaths. Manitoba's chief medical examiner announced Wednesday that a decision on whether to call an inquest will be delayed until late fall, after police more fully understand what happened. The chief medical officer said a few months would be needed for the investigation.
On Thursday, a candlelight vigil will be held at The Forks of the Red River, near where Ms. Gibson's body was recovered. The vigil's organizer has invited people to throw white flowers into the river. A memorial service has also been planned at a local funeral home.
The deaths bring renewed attention to a condition that affects 13 per cent of Canadian women within the first 12 weeks of childbirth.
"You're always going to have a small percentage of people who aren't going to get the help that they need," said Tracy Henning, birth centre health educator at the Women's Health Clinic in Winnipeg. "I think a lot of it might be the stigma of not wanting to get help or not thinking you need help."
"There's definitely a stigma – nobody wants to be seen as the mom that isn't doing everything right."
Ms. Henning said another problem is that regular checkups don't always happen after the first three or four months, but symptoms sometimes show up later.
"Mothers in the postpartum period need to be assessed for perinatal mood disorders and not just within that first week postpartum by public health nurses, but this should be something that's ongoing throughout the first year," said Cindy-Lee Dennis, professor at the Lawrence S. Bloomberg faculty of nursing at the University of Toronto and senior scientist at the Women's College Research Institute.
The condition can appear in numerous forms including anxiety, inability to sleep and obsessive-compulsive actions. A more severe form, known as postpartum psychosis, can bring mood disturbance, mania, and hallucinations in which a woman sees herself hurting her baby.
"This mother [in Winnipeg] might have been severely depressed and suicidal, so it might not be psychosis, it could be just severe postpartum depression," Dr. Dennis said.
Risk factors for women to develop postpartum depression include previous psychiatric episodes, depression before or during pregnancy, or a history of being anxious.
"There is no strong relationship between the number of children you have and postpartum depression," Dr. Dennis said.
There are psychosocial factors that lead to PPD though, Dr. Dennis said, including a lack of support, a weak marital relationship, being young, having a low income.
"Having a baby changes everything in your life – your physical, mental, social well-being," Ms. Henning said, "and if you don't get support you can get wrapped up in the moments that are negative and can't get out of the hole that you might be in."
"A lot of people lose their identity," Ms. Henning said. "Once you give birth, a lot of people stop asking 'How are you doing' and only ask 'How is your baby doing?' "
Dr. Dennis said triggers that may make PPD more severe differ from person to person. It can be brought on by something as simple as having a fight with someone.
She said if someone believes a person may be suffering from PPD, the person should call the local public health department to send a nurse over for a visit.