“Why Are We Letting Our Mothers Die?” A Conversation About Postpartum Treatment

Last week, new mother Jessica Porten wrote a Facebook post about her experience seeking help for postpartum depression that quickly went viral. After telling the nurse practitioner during her first postpartum checkup that she had "postpartum depression that is manifesting in fits of anger," and that she was "having violent thoughts" and needed medication and therapy, the medical staff informed Porten that they would have to call the police. Porten was then escorted by the police to the emergency room with her four-month-old and placed on a psychiatric hold. Her story horrified mothers and those who are already wary of a healthcare system that has the worst maternal mortality rate in the developed world, at 26.4 deaths per 100,000 births, according to The Lancet.

Porten's story touched a nerve not just because maternal care is in crisis — with as many as 20 percent of new moms experiencing postpartum mental health issues according to the World Health Organization — but because her unfathomable treatment resulted from her efforts to speak openly about her symptoms and seek treatment. They resulted from Porten doing exactly what she was supposed to do, and the system's protocols kicking into action.

As a society, we don't know how to talk about perinatal mood disorders, and the following conversation is illustrative of the way in which language around and awareness of postpartum depression can assist in advocacy for new mothers. Seeing, and being seen by other mothers who have experienced postpartum depression or postpartum anxiety, can be healing.

Ashley Stoney, who has written about her postpartum experiences with the U.S. healthcare system for New York Magazine and Romper, talked to Porten by phone, touching on their individual postpartum stories, the care gap, stigmatization of maternal mental health disorders, and the way forward. Their moving conversation shows that it isn't enough to "process" women suffering perinatal disorders in drafty examination rooms; we need to be able to listen, share, and exchange our experiences with empathy. — Romper

I went along with it because that was what I was told I needed to do to get help.

Stoney: Can you tell me about how you definitely knew, when you had your "six-week appointment" at four months, that this was definitely postpartum depression?

Porten: So, my symptoms included irritability, a short temper, anger, and rage. I was just an angry mom, and I knew that it fell under the scope of maternal mental health disorders, because as a mother I subscribe to a bunch of mommy blogs I get weekly emails from BabyCenter, so I had just read a ton of literature on it in my time as a mom. When I started to exhibit the symptoms, I could name it and I knew what it was.

Your husband was super supportive in terms of recognizing the symptoms and getting you to go to the doctor, correct?

So he actually had to advocate for me. As you know, when you have a maternal mental health disorder it’s really hard advocate for yourself. I was so upset when the doctor kept cancelling my appointment. I was not in the best frame of mind, and [my husband] actually called to schedule my last appointment for me.

I think there is a bit of a difference in my situation, which is going on four years ago now. I definitely had done a lot of reading, and in communities of color a lot of times there is a stigma around mental illness and mental health, but I did go to my doctor and say, "Hey, I'm not doing so hot, I’m not feeling great, I feel a little sad."

I think that I was latching onto the feeling of sadness as the umbrella for postpartum depression, but not really realizing that rage fell into that category. And so my doctor said, "This is probably the baby blues. When you go back to work, if it doesn’t go away maybe we can put you on something, but take it easy for now."

So I went back to work, I kept having the symptoms, and I never went back [to the doctor] because I just didn’t know what was going on. I thought maybe it was my own personal thing that was tied to postpartum depression or maternal health, and it went undiagnosed for a year.

I’m so sorry. That’s terrible.

Thank you. So, what you did, though, is a great example of what you should do when you go to the doctor. You say, “I’m having these symptoms, I know they’re not normal and they’re not going away.” I don’t think I was as assertive, and because you were assertive, the worst happened, which was horrible. Can you talk about it?

I was not surprised by the police. Because I used the term “violent thoughts,” they were legally obligated to call the police, so they warned me before they called the police, they said, "You’ll have to go to emergency room, the police will have to come and take you there, and we can’t leave you alone with the baby."

I went along with it because that was what I was told I needed to do to get help, and I said, “Well, why didn’t you tell me to go to the emergency room a week ago when my husband called and told you the same exact symptoms that I told you?" If the emergency room was where I need to go to get care, I would have done that a week ago.

And so I thought it was completely excessive and unnecessary, but I went along with it because I was told the emergency room would take care of me.

And was the emergency room helpful?

No. They did their best though, I will say that. It’s not that these are bad people, it’s that they don’t have the proper training, and they don’t have the proper resources, and there is no follow-up in place for emergency room doctors to prescribe mental health medication, and that’s why I walked away with nothing. Not because they did anything wrong, but because there is nothing right for them to do.

The social worker literally looked me in the face and said, 'You need to advocate for yourself on this.'

There is no procedure for them to schedule a psychiatric appointment for me. There is no procedure to reach out to my general practitioner to reach out to me for a follow up if they prescribed me medication. And that’s what we need, because [the social worker] handed me these pamphlets of a ton of really valuable resources in our community, but that’s not the point.

We should not be expecting any mothers with postpartum depression or any form of of mental illness to advocate for themselves, and yet the social worker literally looked me in the face and said, “You need to advocate for yourself on this.”

That’s horrible.

I agree, and I think the system is damaged and that’s what needs to change. I don’t want to demonize the workers in the hospital. They were following protocol, but in my opinion that protocol is shit.

Why are we letting these women die? Why are we letting our mothers die?

In hindsight, would you have used the word “violent?”

I don’t think that people should have to lie to doctors about their symptoms to get care, so, yes, I would still use that and try to get the system changed than walk on eggshells trying to navigate through it.

I hear you completely. I just gave birth to my second daughter in November, and around that time there were all these reports about Black women dying during childbirth and postpartum. And so I was very candid with my doctors about my fears and apprehensions and spoke up a lot more than I did with my first child, just because you want to feel like a hospital setting, a doctor’s office setting is a place where you can be totally open because your life is on the line. So I totally hear you on not wanting to kind of couch the words that you are saying.

And It just baffles me that women of color are so much more likely to die in childbirth because it’s not biological. Why are we letting these women die? Why are we letting our mothers die? That gets me fired up. Because you know there are laws in place that protect women of color and LGBTQ communities, any minority, any marginalized community, there are laws in place saying that they cannot be discriminated against. but unfortunately de jure does not always translate to de facto, and so we still have these communities not getting the care that they need, and that translates to women of color just not going to the doctor.

Just like you said about the community stigma with mental health. Part of the reason that stigma is there is not because of culture, it’s because when [Black women] go to the doctor they are being dismissed and they’re not being listened to.

Look at us sitting here on the phone talking about our experiences, and that can be healing too.

Yes. Are you getting help now? Do you feel like you have gotten a response since the first awful response.

Yes. I will say that neither the doctor’s office nor the hospital has reached out to me, so I am getting help but not through them. For me, this whole thing going viral and having this platform and spreading awareness has been extremely healing for me. It’s practically talk therapy, look at us sitting here on the phone talking about our experiences, and that can be healing too.

Have you been contacted by any organizations?

Yes, I’m working with the 20/20 Mom project right now to get legislation passed here in Sacramento. There are four bills that are being proposed with language that is extremely inclusive that will make it so that a perinatal woman can go to pretty much anybody. They can go to an obstetrician, a pediatrician, a general practitioner, a psychologist, a pastor and they can tell that person what they are going through and they can get the help they need, whether that be medication like SSRIs, or talk therapy, or whatever, because treatment is different for everybody.

But there is a lot of outreach involved in the bills, too. Basically the goal is to end the stigma, and make sure our mothers are getting the care they deserve.

Were you involved in this movement at all prior to having a personal experience with it?

Not on any major level. You know I had shared a couple Facebook posts here and there prior to experiencing postpartum depression trying to normalize it. I remember I shared one, it was so sad and extremely unfortunate, that a mother had taken her own life when her child was four months old, and I shared it like “If you have this we need to talk about it. You can reach out to me you can reach out to your doctor. We need to normalize it, you’re not a bad mother, you’re not weird. It’s normal." One in five women will get a maternal mental health disorder, and I think it’s more than one in five, I think that statistic is skewed because so many people don’t talk about it.

I totally agree, and this is your second child, correct? I’m assuming you had a normal postpartum experience the first time, you were able to better recognize the symptoms this time, would you say?

I don’t want to use the term "normal" to describe not getting a maternal mental health disorder. The only time you want to talk about "abnormal" is with medical stuff, like if you’re passing clots that are too large, you need to go into the emergency. Because maternal health is normal. So for with my first child I did not get a maternal mental health disorder that time, I will say that—

—I didn’t mean to use a reducing term.

No, no! I’ve been using the umbrella term "PTD" until yesterday. I’m a big proponent of the idea that language is important, but you’re bound to slip up. I mean I’m a white lady, and I try and make it as intersectional as possible, and I’m terrified of saying the wrong thing, because words matter.

I agree, words are super important. Are you back at work?

I work from home super flexible hours, so I’m not leaving the house, but yes, I’ve been back at work for a while.

And did your employer see any of this go viral? I write about maternal health, so I’m pretty sure some folks might know the things I’ve gone through. Are your employers aware, because I think that’s part of the normalization of the process, making sure that your community — and that includes the people you work with — kind of knows what’s going on.

Since the post went viral — and it was on the news last night at 10 — I haven’t spoken to them directly, because I have multiple employers. But I know they are compassionate people, so I’m not afraid to tell them.

I feel like you went viral at an also very vulnerable time for you. You’re still dealing with the symptoms that made you go viral.

The symptoms have really subsided. Like I say, I can’t really describe how healing this has been. So I haven’t had any episodes of rage, I’m not sure if it's because I’ve been so busy, and [then] there was one night I was getting ready for bed and I got really sad, so I think my hormones are starting to balance themselves out.

I will say that the symptoms have drastically reduced, but I can only speculate as to why.

I am thrilled that you are getting a loving response — motherhood is no joke, it is the most important job that we do. I thank you for being an advocate for all of us moms who have experienced postpartum depression, and wish you well on your journey.

This interview has been edited and condensed for clarity. Cover photos courtesy of (L) Facebook/Jessica Porten, (R) Ashley Stoney.

If you are experiencing postpartum depression or anxiety, you can visit Postpartum Support International to find local support groups and area coordinators, or call 1-800-944-4773.