Katherine Stone

is the creator of this blog, and the founder and executive director of Postpartum Progress. She has been named a WebMD Health Hero, one of the fiercest women in America by More magazine, and one of the 15 most influential patient advocates to follow. She is a survivor of postpartum OCD.

A Look at Pregnancy And Suicide During National Suicide Prevention Week

pregnancy associated suicideSince it’s National Suicide Prevention Week, I’d like to focus on a very critical issue: childbirth, pregnancy and suicide. (Trigger warning: If you are feeling fragile right now and think a discussion about the loss of new mothers will upset you, you can skip this one.)

I want to highlight an important statement made by Nancy C. Chescheir, MD, editor-in-chief of the journal Obstetrics & Gynecology, in her editorial in the September 2016 issue:

“… deaths from violent causes (motor vehicle accidents, homicide, suicide, and substance abuse) occur at a rate of about 15 per 100,000 live births, whereas deaths from the four leading pregnancy-related causes of maternal mortality (hemorrhage, embolic disease, hypertensive disease, and sepsis) occur at a rate of about 4.5 per 100,000 live births. Thus, the rate of maternal deaths from violent, pregnancy-associated causes was more than three times higher than those from the major pregnancy-related causes.”

These words in Chescheir’s editorial were made about a study conducted in the state of Illinois on the causes of death of women during the pregnancy and postpartum periods, but they are relevant to us all. Suicide leads to the loss of new mothers at least as often as some of the most common causes of maternal mortality. So why don’t we pay more attention to postpartum depression? Why don’t we invest more?

Part of the problem is in our country’s history of even tracking data on the death of pregnant and postpartum women.

It wasn’t until 2003 (yes, you read that right, 2003!!!!) that the U.S. Standard Certificate of Death began to include a checkbox to indicate whether a woman who had died had been pregnant within the last year. The checkbox was important because it helped to improve data on women whose causes of death might have had something to do with pregnancy or childbirth. Still, some states use that checkbox consistently and some don’t, which means we don’t have a completely accurate set of data.

Also, you might be surprised that the US doesn’t consider suicide in the first year postpartum as a pregnancy-related death. This is important because most of the news, awareness-raising and funding you see related to maternal mortality in our country has to do with pregnancy-related deaths.

What are those? The definition of pregnancy-related death is the death of a woman during pregnancy or within one year of the end of pregnancy due to a pregnancy complication, a chain of events caused by pregnancy or birth, or the worsening of an unrelated condition in the mother due to pregnancy or birth. This includes most of the things people talk about when they talk about maternal mortality, such as eclampsia, infection, embolism, and hemorrhage (bleeding out). Again, suicide in the first year postpartum is NOT considered as or counted as a pregnancy-related death in most places. Only causes of death that are “biologically related” to the pregnancy count.

Pregnancy-associated deaths, on the other hand, are deaths of women that occur during pregnancy or in the first year postpartum that are not necessarily “biologically related” to pregnancy and childbirth. They include motor vehicle accidents, homicide, substance abuse and … suicide.

I don’t know about you, but I’m having a hard time understanding why at least some suicides in the first year postpartum are not counted as biologically related to pregnancy and childbirth. I personally consider postpartum depression VERY MUCH a complication of childbirth. I don’t understand why suicide would be lumped into the same category as accidental car crashes when it comes to the death of new moms.

In some states conducting maternal mortality reviews, this thinking is starting to change. A recent Arizona maternal mortality report notes, for instance, that “… practice is evolving to the extent that if [a suicide death] occurred within the first 42 days postpartum and the woman had made suicidal threats or ideations, the [suicide] should be considered pregnancy related.”

So how does suicide rank when it comes to causes of maternal deaths?

A study published in Obstetrics & Gynecology in 2011 by Palladino et al found that the rate of death from suicide among pregnant and new mothers is 2.0 (2 out of every 100,000 births). Now compare: The rate of deaths due to hemorrhage/placenta previa is 1.7. For eclampsia/pre-eclampsia it’s 1.7.  And the rate of deaths due to amniotic fluid embolism is 1.1. This demonstrates that while there are still some complications of pregnancy that outrank suicide as causes of death among pregnant and new mothers, suicide is among the leading causes. And more and more states are finding this is true.

Colorado found that suicide is the 3rd leading cause of death in the first year postpartum, ahead of pulmonary embolism and hemorrhage. A 2012 study in the state of Georgia of pregnancy-related and pregnancy-associated deaths found more women died from suicide (8) than from hemmorhage (7), hypertension (4), cardiac problems (4) and embolism (4) during or in the year after pregnancy. A Michigan study of data from 1995-2005 found that deaths due to intentional self-harm (11%) were at a similar rate to amniotic embolism (11%) and greater than hemorrhage (7.1%) and obstetric blood clot embolism (4%). A Wisconsin review found that suicide represented 13% of all pregnancy associated deaths.

We HAVE to pay attention to this. We have to track it better. Something must be done. Here’s how Postpartum Progress looks at it: Would the mother have died if she had not been pregnant or had a baby? Did the suicide happen as a result of the symptoms of a maternal mental illness? If it did, we consider it pregnancy related.

We wish more organizations deeply involved in maternal child health included maternal mental illness and suicide prevention in their programming. So do the authors of this fantastic paper from 2013 called Grand Challenges: Integrating Maternal Mental Health Into Maternal and Child Health Programmes when they stated, “Addressing mental health concerns such as maternal depression could play an important role in achieving the Millennium Development Goals set by the United Nations (three out of the eight goals refer specifically to women and children). However, mental health care remains conspicuous by its absence in large scale global maternal and child health (MCH) programmes.” So. Very. Conspicuous.

You won’t find maternal or pregnancy-related/associated suicide mentioned even once by Merck for Mothers, a 10-year $500 million initiative focused on improving the health and well-being of mothers during pregnancy and childbirth. It’s also not an area of focus in the Bill & Melinda Gates Foundation’s Maternal, Newborn & Child Health strategy. And yet we KNOW the health of children, including their mental health and development, is linked to that of their mothers.

Over my years of advocating for maternal mental health I’ve had more than one person say to me, “I’m sure postpartum depression is important. But there are other maternal health issues that are so much more so. I mean, no one dies from PPD.”

Oh yes they do. Indeed they do. And we can prevent it.


Postpartum Depression And Social Media: 6 Things You Need to Know

postpartum depression and social mediaYou might be grateful, if that’s the right word, that at least you struggled with postpartum depression or anxiety in the age of social media. You probably haven’t met anyone in your neighborhood who has had a maternal mental illness. You might not be aware of any friends who’ve had it. But you can find thousands of moms just like you by searching the internet, and that’s awesome. Postpartum Progress started out as a blog (we’re now a full-fledged national nonprofit in case you didn’t know) so we’re big fans of social media.

Still, we believe it’s important to use social media carefully when you’re in the midst of struggling with PPD or related illnesses. Or for that matter, when you are in the midst of struggling with life. Hopping on Facebook or Instagram can make you feel connected, understood and supported. And sometimes it can also make you feel like crap.

With that in mind, here are six things we want you to know about postpartum depression and social media.

6 Things You Should Know About Postpartum Depression & Social Media

#1 – Comparison is the thief of joy.

It’s a known fact that many people present a more idealized version of themselves on social media. There’s actually a term for it now called “duck syndrome.” Duck syndrome means appearing cool and calm as you glide along the surface while at the same time hiding the fact that you are paddling furiously beneath the water, struggling to keep up. If you think everyone else in the world is doing great and you’re the only one who is struggling, you’re wrong. We’re just showing you our feathers and not our duck feet.

Along with unfounded feelings of failure, social media also can create a false pressure to achieve. Say there’s a mama on Facebook talking about how she had postpartum depression and she’s grateful she got help early. She found the exact right treatment and is already better and about to wean off her medication at 8 months postpartum. Your baby, on the other hand, already had her first birthday, you’re miserable, and you’ve only recently reached out for help. Or maybe you’re being treated but now feeling like you should have already weaned off your medication like the mama you saw on Facebook.

Here’s what we need you to do: Stop. STOP THAT RIGHT NOW. (Pretty please?) There is not nor has there ever been one right way to get better. There’s no magic pill or potion or therapy that works in the same way for each person. There’s no correct amount of time it should take you to recover.  You don’t get a medal for quitting treatment early, and in fact it’s not good for you. You do you.

#2 –  Other people’s stress and fighting can affect your mental health, even on the internet. 

Not all of it is unwarranted, of course, but there’s a lot of negativity and anger on social media. Spend an hour on the internet and you’ll no doubt see people arguing back and forth, threatening each other, blocking each other. Believe it or not, the more awareness you have of other people’s stress and upset, the more it can impact your own mental health.

According to the Pew Research Center, “… awareness of other people’s problems is associated with a range of negative outcomes, such as depression. The ‘cost of caring’ associated with awareness of other people’s stressful events may be a negative consequence of social media use because social media may make users more aware of the struggles of those in their network.” In other words, all the outrage and arguing and upset you’re seeing can affect your mental health.

Did you know that stress can be contagious? If you feel like all the personal upset you’re seeing is dragging you down, take a break. It doesn’t mean you can’t be supportive of others. It just means you might need to step back from from it every so often.

#3 – Too much of a good thing isn’t a good thing.

Think about how many people you can touch and see in person on a regular basis. How much do you know about what’s going on in their lives? Every single thing? Probably not. On the internet, however, we get to know lots of people and we end up learning MUCH more about them than we might ever have offline. We see what their likes are, what their dislikes are, what they had for breakfast, what their kid did, what their job is like, what their politics are … the internet is hyperpersonal.

What does this mean for you? You might meet a mom or group of moms online who you connect with because they have a perinatal mood or anxiety disorder at the same time you do. You are all good people. You support each other. You end up adding each other as friends. Months or years later you might see this person with whom you felt very safe and attached saying things on Facebook that upset you. Those things might go against your beliefs, or your political views, or your expectations. Sometimes internet connectedness leads to knowing so much about people that you can begin to feel divided rather than unified.

Try to remember that there is much more to each Warrior Mom than PPD. We can care for each other and love on each other but we are not going to agree on everything. Ever. Try to give as much grace as you can.  And should you need to, remove yourself from more personal connections with people and stick with the maternal mental health-focused groups.

#4 – There are times when all these people end up making you feel more alone. 

Some of us have 3 followers and some have 13,000. Some of us share our experience with postpartum depression on social media and get tons of loving responses, while others share and no one says anything at all. It’s easy to equate your worth with how many followers you have or how many comments of support you receive, but it isn’t healthy.

Maybe people didn’t open Twitter that day. Maybe it was a big news day and their Facebook stream was flooded with memes and too many other things. There is a whole host of reasons why you might not get the support or feedback you expected, but one of them is NOT that you are unworthy.

#5 – Bad advice and unsolicited comments are everywhere.

Not everyone has training on how to provide the best support for moms with maternal mental illness. They don’t know, for example, that you shouldn’t force your own beliefs about parenting styles or baby feeding on someone who is struggling.

We believe you shouldn’t tell a mom that a certain medication, specific natural supplement or one type of therapy is the best way to go and that you know it will work for her because it did for you. We think you shouldn’t expect that every mom you are trying to support has health insurance, or has the finances to be able to afford therapy, or understands or talks about perinatal mental illness in the same way you do in your culture. This is one reason Postpartum Progress works to provide all of its peer support volunteers with a variety of free trainings, such as Mental Health First Aid.

One good rule of thumb? If someone on the internet isn’t really listening to you, is judgmental of you, or acts like they have alll the answers, they’re probably not someone who should be giving you advice.

#6 – Social media can drain away the limited time you have for self care.

If you have a baby, or kids, and are working in the home or outside of it, you already have no time to yourself. If you feel like you have to be on Facebook or Instagram or Twitter nonstop so you can keep up with everything that is going on, you’ll end up using some of your valuable self care time staring at a small, glowing screen instead of doing things just for you. Like sleeping!!

We want you to make sure you prioritize your rest and your nutrition WAYYYY ahead of social media. Some tips: Don’t plug your phone in right next to your bed. If you put it in another room overnight you won’t be tempted to pick it up, and the buzzing sounds won’t prevent you from sleeping. Also, try to put down all smartphones, computers and iPads for an entire hour before you go to bed. It helps your mind slow and calm down so you can rest.

None of this is to say, of course, that you should cancel all your social media accounts and run for the hills. Postpartum depression and social media can work together. Connecting to resources and support online is a great thing and it will remain a great thing. But if you have one of those days, or even a period of time, where it starts to feel like being on social media is hurting more than it helps, step away. Give yourself time to step back and regroup. It’s okay to take time off. We’ll all be here when you get back.

Maria Shireen Partners To Support Maternal Mental Health

Charity TiesWe’re so excited to tell you about a brand new maternal mental health partnership between Postpartum Progress and Maria Shireen™, the fashion accessories company famous for developing the Hair Tie Bracelet. The company was co-founded by Shireen Thor, who experienced first-hand the difficult challenge of postpartum depression following the birth of her son last year. As someone who has come through the experience of PPD and launched a successful accessories business in the process, Shireen and her husband, company co-Founder Arni Thor, have decided to support women through programs that address moms with perinatal mood and anxiety disorders.

For each Charity Ties bracelet dedicated to postpartum depression and maternal mental health that is sold, Maria Shireen will donate $10 to the nonprofit organization Postpartum Progress. These awesome bracelets have ‪#‎BANDOFSTRENGTH‬ engraved on them and come with a white hair tie corresponding to the specific cause of maternal mental illness. You can remove the hair tie whenever you need to put your hair up, and then put it back into this gorgeous bracelet rather than just wearing a hair tie directly on your wrist for hair emergencies. I have long hair, and I have to tell you I love mine!

Maria Shireen bracelets have been featured everywhere from InStyle and Pop Sugar to the Today Show and Allure magazine. Since the company’s debut in 2015, more than 110,000 bracelets have sold around the world in 40 countries.

I got to meet Shireen Thor recently while on a business trip. We sat together and talked for hours and she shared her own story with me of her recent experience with postpartum depression. Like most of us, she was completely shocked to go through it and now that she’s coming out on the other side she doesn’t want other mothers to feel alone and ashamed. I loved getting the chance to spend time with her and hear her story, and I’m thrilled that she’s decided to use her success with Maria Shireen to help Warrior Moms and support the work of Postpartum Progress. We believe it’s so important for women leaders, entrepreneurs and CEOs to recognize that maternal mental illness is exceedingly common and yet the majority of those who have it never get the help they need. We won’t be able to succeed with our organization’s vision — Every pregnant and new mother with a perinatal mood or anxiety disorder will quickly recognize her illness, know why treatment is important, seek help and fully recover thanks to having access to the information, services and support to help her through. — without the support of leaders like Shireen Thor, CEO of Maria Shireen, or Cotton Babies CEO Jennifer Labit, who has also experienced PPD.

charity_ties_2-2Click here to order a Maria Shireen Charity Ties bracelet to support Postpartum Progress.



Katherine Stone: That’s a Lot of Hats

Katherine Stone: That's a Lot of Hats | 8th Annual Mother's Day Rally for Mental Health -postpartumprogress.com

postpartum depression, mother's day rally, maternal mental healthDear New Mom,

You might be sitting there right now, on Mother’s Day of all days, feeling like a total mom failure. I remember that feeling. I had only just gotten started, was at the very beginning of motherhood and I’d already blown it. I was a sobbing, anxiety-filled, hysterical mess. It was clear there was no way I’d make it through the next five minutes much less the next 18 years.

Since starting Postpartum Progress, I think I’ve probably spoken personally with at least 10,000 women who’ve had maternal mental illnesses and 99.9% of them have said the same things. Used the same words and phrases: Failure. Bad mom. Can’t do it. Never should have had a baby. Useless. Will never get better. Horrible person.

And then they learned what I learned: We have an illness. Nothing more and nothing less. It’s a really horrendous, devastating jerk of an illness that comes at the worst time possible and happens to the nicest and loveliest people possible … and is fully treatable.

Hundreds of thousands of moms in the US alone experience maternal mental illness every single year. If every mom alive on this planet who has ever had postpartum depression, anxiety, bipolar, psychosis or depression/anxiety during pregnancy put on a special hat and went about their business today, and you got out of your house and went around town to look, you’d see those hats everywhere. There’d be hats in the grocery store checkout line, at the bank, in front of classrooms, in office cubicles, in bleachers, out jogging, on the playground, sitting in traffic. EVERYWHERE. I promise you this is true.

There are 85.4 million moms in the US right now. With 1 in 7 of them having had a maternal mental illness that’s about 12 million women who’d be walking around with hats. That’s a lot of damn hats. You’re not alone. You’re among 12 million mothers alive at this moment who thought they were failures too.

(Oh, and if you don’t live in the US, there are 2 billion moms worldwide. If we estimate that at least 10% of them have had PPD, that’s 200 million women on the earth at this moment that have been right where you are. We’re not even talking about all the mothers who have ever lived. Just the ones living right now.)

One of the hardest parts of perinatal mood and anxiety disorders is feeling like you’re the only one. You need to know that you aren’t some rare defect of a mother. You are someone who is among likely more than a BILLION women in human history who’ve struggled with this. I feel lucky that we live in a time where we can connect with each other through Postpartum Progress, share our experiences, and find help and support from others who have been there. We are your tribe, mama, and we love you.

~ Katherine

The Annual Mother’s Day Rally for Moms’ Mental Health is presented by Postpartum Progress, a national nonprofit that raises awareness & provides peer support for women who have postpartum depression and all other mental illnesses related to pregnancy and childbirth. To see some of the ways we provide moms support, visit http://postpartumprogress.org/community/.