When a young mother takes her own life – and sometimes the lives of her children – their deaths are lamented as senseless tragedies. But maternal suicide needs to be understood on a more profound level, as something that is both preventable and perhaps much more common than we think.
Shockingly, Canada has no system for analyzing how many maternal deaths (that is, mothers who die in the first year after their baby is born) are caused by psychiatric illnesses such as postpartum depression. Nor is there a consistent screening system to determine whether a new mother is suffering from postpartum depression – a debilitating condition that affects about 13 per cent of new mothers – even in cases where it doesn't end in death.
Canadian health-care authorities must make screening a matter of routine practice. Primary-care providers should consistently check to see whether women show signs of depression when they bring in their babies for routine inoculations, for example.
Sometimes it's difficult for women to recognize the signs of postpartum depression on their own. There is also an unfair stigma that continues to discourage women from stepping forward.
Women who are poor, those with no family support, new immigrants and, surprisingly, those in cities are especially isolated, so the system needs to figure out a way of reaching out.
Maternal health needs to be treated as seriously as the health of infant children; in fact, the two are intertwined. Postpartum depression can severely impact childhood development trajectories. The Public Health Agency of Canada should also audit maternal mortality and thoroughly investigate maternal deaths in this country, in order to figure out where the system is failing – because clearly it is.
For now, we are limited to fleeting snapshots of the depth of darkness that some women endure. Police are currently investigating whether postpartum depression figured into this summer's terrible death of Lisa Gibson, the 32-year-old Winnipeg mother whose body was found in the Red River three days after her two young children were found unconscious in a bathtub. They later died.
How did Ms. Gibson "fall through the cracks," like so many others? Susan Murie. Suzanne Killinger-Johnson. Krystal Coombs. Their stories are high-profile because they killed their own children. But how many mothers have killed only themselves, unable to cope after having a baby? At the moment, Canadian health-care authorities haven't got a clue.
The United Kingdom offers us hints. In contrast to Canada, Britain has rigorously analyzed maternal deaths for more than 50 years to sift out contributing factors. The findings are astonishing. When maternal deaths between 2000 and 2002 were examined, for example, psychiatric illness accounted for the majority of those deaths. Put bluntly, more mothers died by committing suicide than by succumbing to any other medical complication, such as hemorrhage or heart disease.
The Canadian Medical Association Journal has rightly argued in a recent editorial that these findings in Britain should raise red flags here in Canada, which does pitifully little to capture equivalent data. While leaps and bounds in modern medicine have lowered many risks for mothers in the developed world, psychological illness remains a big killer.
Canada could do much more to prevent these deaths, the CMAJ points out. "At the moment it's helter-skelter," is how Canada's current approach to finding cases of postpartum depression is described by Dr. Cindy-Lee Dennis, Canada Research Chair in perinatal community health and a professor at the University of Toronto.
Pregnant women who have previously shown signs of depression are likely to be screened into programs, such as Ontario's "Healthy Babies. Healthy Children," where they can access excellent treatment. But trying to predict which mothers will experience postpartum depression is an inexact activity at best. "What causes depression in one mother doesn't cause it in another," says Dr. Dennis.
So she advocates a systematic approach for finding cases of postpartum depression after a baby is born and treating them. Obstetrical care ends six weeks after a baby is born. Visits from midwives tend to drop off as well. In the year following the birth of a child, primary-care providers should test women for postpartum depression as a matter of routine, during the same doctor's visit when their baby's health is monitored, for instance.
The Edinburgh Postnatal Depression Scale – a 10-item questionnaire – is considered an effective and easy-to-use depression screening tool. It asks women to describe their levels of anxiety and gauges their ability to feel joy. It would take about five minutes to ask a woman these 10 questions – five minutes that could save her life.
It's time to move beyond the stigma of postpartum depression. This affliction needs more serious attention than the dismissal of a new mother's sadness as "baby blues."
Last year, more than 49,000 Canadian mothers experienced depression within the first 12 months after giving birth, putting at least 80,000 children at risk for poor development. These women, and their families, deserve better than the status quo.