In June 2011, Emma Cadywould gave birth to her first child, a first grandchild for her parents and a nephew for her sister. For the next 6 months, despite all appearances to the contrary, Emma suffered from severe postnatal depression that resulted in her death by suicide (Royal College of Midwives (RCM), 2017).
To many, Emma's name will not be familiar, and therein lies the problem. A woman dying in this way should be shocking and unusual—headline worthy—but instead, stories such as Emma's are common yet, paradoxically, underreported. While maternity-related deaths are declining, a study found that suicide accounted for 10% of women who died during pregnancy or up to 1 year after birth (de Lange, 2015). Despite these statistics proving the prevalence of maternal mental illness, the associated stigma precludes many women from admitting their symptoms, leaving them to suffer alone. In Emma's case, her effort to ‘keep up appearances’ prevented her from receiving the help she needed.
It was the weight of the taboos that surrounded Emma's illness and death that prompted her sister, Lucie Holland, to start a petition urging NHS England to review the support available for maternal mental health. The petition gained more than 55000 signatures, and almost 7000 comments, prompting the RCM to commission a report, Every mother must get the help they need (RCM, 2017), launched last month.
The report set out to analyse a sample of comments in order to explore broad themes, although this could hardly have been a difficult task: reading through, the demand for help is relentless, and the same ideas crop up again and again. There are testimonies from mothers who have survived maternal mental illness, from the professionals who try to help, and from those left behind. Although they vary in length, each comment has an unmistakeable echo of a pain that may never fully disappear. The responses are united in their cry for more: more awareness, more acceptance and, crucially, more mother and baby units (MBU) for women and their newborns to receive treatment. Survivors, and their families, credit MBUs with saving their lives, but the word that is used, almost universally, is ‘lucky’.
‘I was lucky enough to get a bed in a small specialist mother and baby unit […] It quite simply saved my life and kept my family together.’
Their recovery, however, is not due to luck, but to the availability of appropriate treatment. Facilities such as MBUs give women the care they need, but, by their very existence, go a long way to addressing the taboos surrounding maternal mental health.
The report needs to be translated into change, but it is a step in the right direction. Lucie's petition has highlighted the ‘Cinderella condition’ of maternal mental health and connected those who previously felt that the burden was theirs alone. Health professionals can offer the care and support that women and families need, but only when treatment can be provided—which needs a national change of approach. To prevent anyone else dying alone because they fear to seek help, we must continue the conversation, for this fosters understanding, awareness and, hopefully soon, a response.