Britney Asbell knew something was wrong.
Four months after giving birth to her second child, Asbell awoke in the middle of the night, tingling all over. She thought she might be having a stroke.
“I was running through almost every worst-case scenario possible,” Asbell said. “And I told my husband, ‘I think I need to call 911.’”
As Asbell struggled to describe her symptoms to an emergency operator, she feared she sounded crazy.
“I couldn’t pinpoint any single thing,” Asbell said. “But the thought in my head was, ‘Don’t die in the house. The kids are here.’”
Asbell soon learned she’d just suffered the first of many panic attacks. Months later, a psychiatrist diagnosed her with postpartum depression and anxiety.
With a diagnosis, Asbell could finally seek help. But finding resources near her home in Kathleen wasn’t easy.
About one in seven women suffers from postpartum depression, according to the American Psychological Association. Researchers estimate anywhere between 13 and 40 percent of mothers experience postpartum anxiety. But postpartum mental health care can be hard to find in Georgia.
In Macon, it’s nearly impossible.
“It’s a really serious problem in Georgia as we recognize that there’s just less and less access to care,” said Elizabeth O’Brien, president of the Georgia chapter of Postpartum Support International (PSI). “And, you know, it’s a public health issue. When we don’t take care of our mothers and babies, the community suffers.”
Postpartum depression and anxiety reach beyond the typical mood swings that most mothers experience after childbirth. It is a crippling mental disorder that hinders mothers’ daily functioning and can have dire repercussions if not properly treated.
“Postpartum depression is different than something called baby blues, which is pretty common, and it’s driven from hormonal shifts that occur after giving birth,” said Jennifer Barkin, associate professor of obstetrics and gynecology at Mercer University School of Medicine. “Postpartum depression is more persistent. It can last longer. It has consequences attached if it is unchecked, and it is the most common consequence and complication after childbirth.”
With help from a psychiatrist, a therapist or even an online support group, mothers can fully recover from their post-pregnancy depression. But outside of Metro Atlanta, resources are scarce, and mothers can fall through the cracks.
‘They just couldn’t find resources here’
O’Brien first noticed Macon’s shortage of postpartum mental health providers when Middle Georgia mothers, including Asbell, started calling the PSI helpline seeking resources nearby. She couldn’t find anyone to help them.
“That’s representative of the whole state, quite frankly, except for some of the metro areas,” O’Brien said. “And even though you could consider Macon a metro area, we were striking out and not finding services. And so, you know, some of the folks in Macon, they’re doing distance therapy with folks in Atlanta because they just couldn’t find resources there.”
Mothers typically receive little follow-up care after childbirth, and postpartum depression or anxiety can go undiagnosed if they aren’t screened.
Most moms only visit their OB-GYN for one postpartum appointment six weeks after childbirth.
Macon OB-GYN Keisha Callins said those appointments can be telling. She pays close attention to her patients’ body language and asks questions when a mother’s behavior seems off.
“When I see my patients postpartum I’ll say, ‘Hey, you know, have you thought about throwing your baby out the window?’” Callins said.
If they chuckle at her absurd question, Callins knows they’re OK.
“But if I have someone that does not laugh, if they’re quiet, then I’ve identified someone that’s struggling, and they have had a fleeting thought of frustration that could have gone otherwise,” she said.
Patients aren’t always forthcoming when struggling with their mental health. It’s up to doctors to earn their trust, Callins said.
“The key is, we have to ask the question,” she said. “We have to make patients feel comfortable sharing.”
Callins practices at Community Health Care Systems, a nonprofit health care organization with multiple behavioral health professionals on staff at its locations across Georgia, including one in downtown Macon.
Though Macon’s onsite counselor doesn’t specialize in postpartum mental health, Callins knows that there’s at least someone who can support her postpartum patients diagnosed with depression or anxiety. But she knows that not all OB-GYNs have that luxury.
Callins thinks new mothers should receive more frequent follow-up care outside of the OB-GYN’s office, just like their infants.
“Women’s health in the first year postpartum should mirror the pediatric schedule,” Callins said.
The American Academy of Pediatrics recommends that pediatricians screen mothers for postpartum depression at their patients’ one-, two-, four- and six-month visits. Some have adopted the practice, but the new protocol is not yet universal.
Many pediatricians are reluctant to screen or treat mothers for postpartum mental health disorders, Barkin said.
“The mother is not their patient. That’s what they’ll say,” Barkin said.
Some don’t feel comfortable diagnosing or prescribing medication for newborns’ mothers, because they don’t have access to their medical records. Others hesitate when there are no local resources to help moms who receive a diagnosis.
Even in those cases, though, Barkin thinks screening serves a crucial purpose.
“When you screen the mother, you are putting her mental health on the table as a priority,” Barkin said. “So, in my opinion, it sends a signal in and of itself that this is important enough for us to ask you about.”
The importance of self care
Maternal wellness often goes overlooked after childbirth, Barkin said. Once the baby is born, doctors quickly switch focus to the infant’s health.
“Childbirth is still a shock to the body in a lot of ways. But, because it’s thought of as a natural process, it’s not treated as much like a recovery as it should be,” Barkin said. “And it’s a recovery process for the mom, too. And while she’s recovering, she’s also learning to be a mother.”
Barkin thinks mothers should be encouraged to prioritize self care.
“Women are not socialized or taught to prioritize their needs once they have a child as a part of good mothering,” Barkin said. “There is still a lot of sentiment out there that once I have a baby, it’s all about them. I’ve got to give up everything I love.”
But when mothers’ own needs are met, she added, they’re better able to nurture their kids. If mothers don’t take care of themselves, however, the health of the entire family can suffer.
“As the mom goes, the family goes, a lot of the time,” Barkin said. “And if the mom’s not functioning well or if she, you know, has depressed mood, she’s not at her best, the entire family feels that impact.”
Barkin doesn’t want to see more mothers suffer silently. She, Postpartum Support International, and a group of local maternal health care specialists plan to host a training in May to educate Middle Georgia clinicians and mental health care providers about postpartum mental illness and build a pipeline of providers with postpartum expertise.
It’s important for women to have access to counselors who understand what they’re going through, Barkin said.
“That’s why it’s important that we develop this specialty in this area, she said. “And apparently there’s a demand for it.”
Asbell certainly wishes she’d had more options during her last two bouts of postpartum depression and anxiety. She spent months searching for a psychiatrist or therapist with postpartum expertise. She even tried naturopathy.
“But no one ever just sat and talked to me like I was a postpartum mom,” Asbell said. “They talked to me like someone who had been battling mental illness for years. It was almost — they didn’t take into account the fact that postpartum was tagged in front of it.”
Asbell finally decided to call Postpartum Support International for help. Though the organization couldn’t find any mental health providers in Middle Georgia who specialized in postpartum care, they connected Asbell with a local psychiatrist and a therapist who could better relate to her experience.
That was in February of 2017. Now, Asbell is 38 weeks pregnant with her third child and preparing for whatever lies ahead.
Over the summer, she re-read old journal entries from her battles with postpartum depression and anxiety.
“Look how far you’ve come,” she assured herself.
“It shows a level of strength that I didn’t know I had, and in the time I really didn’t think I had,” Asbell said. “But it makes me hopeful for this time, because I’ve done it before. If it gets bad this time, I can do it again.”
Samantha Max is a Report for America corps member and reports for The Telegraph with support from the News/CoLab at Arizona State University. Follow her on Facebook at https://www.facebook.com/smax1996 and on Twitter @samanthaellimax. Learn more about Report for America at www.reportforamerica.org.