Valerie* felt well prepared for childbirth. She had done several labor and child-birthing courses. She had employed the services of a doula. She was ready. She also had no idea what she was about to face: a marathon labor that began with a home birth on a Thursday afternoon and escalated to a cesarean delivery by Saturday evening.
During the long and arduous 54-hour labor, Valerie contracted an infection and experienced severe swelling (a condition called edema). She left the hospital over 30 pounds heavier than when she checked in. “My bones hurt in my body because the swelling was so intense," she says. "I couldn't walk because I couldn't bend at the ankles. I had a hard time breathing; there was so much pressure in my chest. It was awful.”
The whole experience left her shaken. “It was the total opposite end of the spectrum from what we had planned,” she says. “It was the most wonderful experience and the worst experience of my life, both at the same time.”
“It’s really hard to admit that you might not be in control of your mind.”
Traumatic birth experiences like Valerie’s are a risk factor for postpartum depression and postpartum anxiety—conditions an estimated 15% and 10% of postpartum women experience respectively. An estimated 9% of women experience PTSD following childbirth, and an estimated 3% to 5% of new mothers—and some new fathers—will experience postpartum obsessive compulsive disorder.
Valerie’s swelling eventually resolved, but her postpartum complications weren’t over. Only a week after giving birth, she started to experience anxiety and intrusive thoughts. “These thoughts come from absolutely nowhere. You're like, Why am I thinking of this? Why did I just have this thought? Am I going to hurt myself? None of it makes sense,” she says. “It's really hard to admit that you might not be in control of your mind.”
Like so many women, Valerie didn’t know how to get help or how to talk about it with her ob-gyn. “I was afraid for a few reasons,” she says. “I didn't want to seem like I couldn't handle it. I didn't want to seem like I was ungrateful for my daughter. I didn't want to be judged or not deemed fit to care for my child.”
That fear of being judged often keeps women silent. “One of the reasons we think that there's undertreatment [of perinatal mood and anxiety disorders] relates to stigma and shame,” says Simone Vigod, M.D., a psychiatrist at Women’s College Hospital in Toronto and a clinical researcher in pregnancy and postpartum mental health at the Women’s College Research Institute. “Women may not be feeling comfortable accessing care and may not even know that they have something going on with them that could even benefit from treatment.”
A major issue? Screening for postpartum depression and anxiety typically takes place at the standard four- to six-week postpartum visit, but according to the American College of Obstetricians and Gynecologists, as many as 40% of women never attend one.
What Happens When Help Comes to You
Valerie did know that she needed to seek help. “This was just the most beautiful thing in my life, which was blowing up in front of my face,” she says. “I wanted to make sure that I could be there as best as possible.” She contacted a therapist she had previously used when living abroad in Sweden, who offered to conduct sessions via videoconferencing—a form of telemedicine.
The familiar relationship made it easier for Valerie to open up in her treatment, and the tech made it possible for her to get treatment at all. Valerie was able to do sessions from her bed during the first month while she was still physically recovering, sometimes even while breastfeeding. Once a week, for 55 minutes, over the course of six months, Valerie and her therapist worked through the guilt and trauma she felt after her challenging birth (and a miscarriage she’d experienced prior).
“Being able to have this [type of medicine] allows a mother to talk to her health care provider about anything that's going on without even having to get out of her pajamas, let alone packing up a newborn baby,” says Mariea Snell, assistant director of the Online Doctor of Nursing Practice program at Maryville University and a tele-health clinician. “They're going to be more likely to receive care because they're going to be more likely to engage in it.”
Telemedicine is particularly crucial for women in rural areas, where patients tend to seek out care only in emergencies, says Curtis Lowery, M.D., director of the UAMS Institute for Digital Health & Innovation in Arkansas, and founder of ANGELS, a Medicaid-funded tele-health program for high-risk pregnancy patients that serves rural populations. “We have connectivity all over the state of Arkansas,” he says, “so that psychiatrists can do online clinics and start medication.” Patients can also use the telemedicine service to connect with lactation consultants who are not readily available across Arkansas.
Having early and convenient access to treatment was life-changing for Valerie. "[My therapist] assured me that this was actually something very common that happened to women who were suffering from postpartum depression,” she says. “Just knowing that made me feel, like, just 10 times stronger and more secure.”
Is Telemedicine Making a Real Difference for Moms?
Research on telemedicine for new moms is still fairly new, but so far the evidence suggests the tech is a game changer. Several studies that examine the effects of using telemedicine to treat perinatal depression report an “improvement in maternal mood following intervention.” As far as the American Psychiatric Association is concerned, “tele-psychiatry is equivalent to in-person care in diagnostic accuracy, treatment effectiveness, quality of care, and patient satisfaction.”
If there’s any issue with telemedicine’s effectiveness, it’s access. Even though telemedicine can be much more accessible for moms than in-person care, it’s not currently offered universally by medical practices or large hospital groups. Additionally, no two states treat tele-health alike with regards to Medicaid reimbursement and private health insurance coverage. Women like Valerie often end up paying out of pocket for individual sessions.
“Telemedicine made it possible for me to enjoy the part of the whole experience that was meant to be enjoyed: my daughter.”
Solutions are coming. Kate Ryder, founder of Maven and a new mom herself, developed the app to allow easy access to a whole team of care specialists like lactation consultants and mental health professionals who can work together to flag issues. (Maven’s maternity care plan is currently available only to employers. Current clients include Snap Inc. and the global law firm Cleary Gottlieb.) And legislation introduced by presidential candidate Senator Cory Booker and Congresswoman Ayanna Pressley in May 2019 intends to contribute to current research and tackle the issue of access. The MOMMIES Act, among other initiatives to improve material outcomes, will fund the study of telemedicine. If passed, the bill would require a government accountability office report on states that are currently providing this coverage and recommendations for increasing access to telemedicine for pregnant women.
Like most interventions, telemedicine isn’t a magic bullet for new moms, nor is it a one-size-fits all treatment for postpartum depression and anxiety. But for Valerie it was exactly what she needed. “I was able to take care of my child with the possibility of physical and emotional comfort in a time in which everything was hard," she says. "By being able to manage my postpartum anxiety, telemedicine made it possible for me to enjoy the part of the whole experience that was meant to be enjoyed: my daughter.”
*Names have been changed.
Courtney Biggs is a freelance journalist in New York City covering disparities in women’s health care. Follow her @cr_biggs.
Originally Appeared on Glamour