After Funda Bachini, MD, a psychiatrist in Phoenix, Arizona, gave birth to her third child in 2017, she found herself irritable, struggling to sleep, and up at 3 AM writing emails to family members. Something was wrong, she told them. She wasn’t herself. “I was crying a lot, and I was anxious. I had intrusive thoughts of dropping my daughter or something horrible happening.”
Funda Bachini, MD
It wasn’t until 1 year postpartum that it dawned on her: Although Bachini treats depression and anxiety professionally, she had been explaining her own symptoms away as side effects of a stressful job and having three kids under age 5. In reality, she was experiencing postpartum depression (PPD) and postpartum anxiety (PPA), some of the most common but underreported, and highly treatable but undertreated, complications of pregnancy in the US.
These conditions could be even more common among doctors. A survey of 637 physicians and medical students presented at the 2022 American College of Obstetricians and Gynecologists (ACOG) annual meeting suggests that 1 in 4 new mothers in medicine experiences PPD, double the rate of the general population. Many who specialize in perinatal mental health suspect rates within this group could be even higher.
A Hidden Crisis
There is a general lack of awareness, understanding, diagnosis, and treatment of perinatal mental health conditions such as PPD and PPA. Postpartum psychosis, which occurs in 1 to 2 of every 1000 births and is a medical emergency, is also poorly understood. Some 60% of PPD cases in the US go undiagnosed, and 50% of people who are diagnosed do not get treatment.
Recent high-profile tragedies linked to the mental health of mothers in medicine have underscored the issue. In 2023, oncologist Krystal Cascetta, MD, and her 4-month old baby died in an apparent murder-suicide, and in 2021, both Radhika Lal Snyder, MD, and Gretchen Wenner Butler, MD, died by suicide. Snyder was 10 weeks postpartum. Butler was a mother of three, including an 18-month old. The deaths have brought forward a conversation around the culture of medicine and how it affects physicians who are also mothers.
It’s important to note that most physicians who experience a perinatal mental health condition do not die by suicide. However, suicide could account for some 20% of postpartum deaths in the US, and the ways in which physician mothers struggle in the workforce are many.
Does Medicine Leave Room for Self?
Many physicians agree that the culture of medicine is not always conducive to family-building. Medical school and residency, when many doctors start their families, involve the full gauntlet: high stress, demanding schedules, low pay, little sleep, and minimal paid leave.
“I think women who go into medicine, like many professional women, are used to operating and putting on a good face, even under extreme duress,” says Bachini. “For that reason, many of us look like everything is fine on the surface.” Bachini uses the classic swimming duck image. “You see the duck floating calmly on the water’s surface, but underneath, the little feet are paddling like crazy, just trying to stay afloat.”
Catherine Birndorf, MD
“There’s no room for self in the culture of medicine; it doesn’t allow for or promote self-health,” adds Catherine Birndorf, MD, a reproductive psychiatrist and co-founder of The Motherhood Center, a facility for perinatal mental health conditions. “I think that lip service is paid to ‘take care of yourself,’ but I don’t think that plays out in the sense of policies supporting parents.”
Simple standards of care for new parent physicians do not exist in medicine, Birndorf says.
For example, standard paid family leave policies or access to affordable childcare, two items that have been linked with improved maternal mental health, are not always available.
In 2021, the top 20 hospitals ranked by US News & World Report offered, on average, about 8 weeks of paid leave to birthing parents; less than the 12 weeks recommended by the American Academy of Pediatrics and far below the 18 weeks advised by the World Health Organization.
In a 2024 Medscape survey of 460 female physicians (to be released in an upcoming report), 33% said their employer offered no paid maternity leave at all.
Jessica Vernon, MD
Even physicians who do have access to paid leave often feel forced to get back to work, explains ob/gyn Jessica Vernon, MD, who experienced PPA and postpartum obsessive-compulsive disorder. A recent Doximity poll found that only 55% of women physicians eligible for parental leave took the total amount.
While pregnant with her first child, Vernon says her hospital department chair congratulated her and then related that she had worked through the end of her pregnancy, returning to work 6 weeks postpartum. Vernon says she “knew implicitly what the expectations were.”
Birndorf, who had her first child during residency, took less time off than she was allowed. “I felt much more skilled at being a doctor than a mother, and I knew I was burdening others being out. I knew that returning early would be rewarded in the sphere I understood. I didn’t know how to be a mother.”
The Struggle to Self-Diagnose
Perinatal mental health conditions can present in many different ways that don’t always match the textbook. But physicians, in particular, may struggle to identify their own symptoms.
“I had been taught only to look out for people who were suicidal or had depression severe enough they couldn’t get out of bed,” says Vernon, who thought the anxiety, insomnia, and intrusive thoughts she experienced were just her being a hypervigilant new mom. “I couldn’t multitask. I started to feel like a computer whose hard drive was crashing. I was drowning,” she says. “I started thinking that maybe it was my thyroid or an autoimmune disorder or cancer.”
Healthcare professionals can be incredibly high-functioning despite being depressed or anxious, explains Birndorf. But there are warning signs.
Pooja Lakshmin, MD
Perinatal psychiatrist Pooja Lakshmin, MD, has noticed physician patients getting behind on work-related tasks such as charting; isolating socially; or having escape fantasies, such as daydreaming about getting into a car accident — all issues that can point to a perinatal health condition.
As a licensed clinical social worker, Paige Bellenbaum, LCSW, founding director of The Motherhood Center, who works alongside Birndorf, was trained to recognize mental illness. But after her son’s birth in 2006, she found herself unable access any of that knowledge.
Paige Bellenbaum, LCSW
In the grip of severe anxiety and depression, Bellenbaum ruminated about her son’s health. She couldn’t sleep. She lost more than 40 pounds in 6 weeks. “I began fantasizing about buying a one-way ticket to another country and leaving my husband and son behind because surely, they would be better off without me,” she remembers.
Then, the thoughts got darker. “I found myself on the cold floor of the bathroom night after night, my body wrapped in the fetal position, staring at the medicine cabinet, wondering what combination of pills would end my life,” Bellenbaum recalls. “I felt like a total failure, consumed by guilt, shame, grief, and embarrassment. I knew I needed to get help, or I was going to die.”
Barriers to Care
Many healthcare professionals feel tremendous amounts of embarrassment, shame, humiliation, and failure around their own health conditions. “Physicians are up against the idea that they’re supposed to be the caretakers, not the patients,” says Birndorf.
Seeking mental health care as a provider can too often feel like “turning yourself in as opposed to asking for help,” says Birndorf. In some states, physicians worry about being reported to a board for seeking mental health care.
Unless young physicians have “specific mentorship around how to make motherhood and being a physician work,” they will probably wind up “sucking it up” and “sacrificing both their physical and emotional health,” says Lakshmin. But that support would require structural changes in the medical field and beyond.
What Healthcare Professionals Can Do
Advocates for maternal mental health in medicine point to five areas where increased support and awareness could have a positive impact.
Advocate for policy change. New federal laws such as the PUMP Act and the Pregnant Workers Fairness Act currently provide protections for pregnant and postpartum workers that can benefit mental health. Paid family leave policies and access to affordable childcare may be the next steps toward progress. But policies won’t be enough. Physicians in leadership positions must also normalize and model taking paid leave so that others feel safe doing so.
Lakshmin adds that she’d like to see more national action groups and committees such as the Dr. Mom Foundation specifically addressing mothers’ needs in medicine.
Increase education. Perinatal mental health must be a more central part of the standardized curriculum in undergrad, medical school, and residency, Birndorf says.
“We focus on hypertensive emergencies and postpartum hemorrhages. Every ob/gyn is taught ad nauseam how to manage these crises, but very few know how to recognize, talk about, and properly escalate psychiatric emergencies,” agrees Vernon.
Vernon notes she is working with the National Curriculum in Reproductive Psychiatry to train more physicians in talking to patients about their mental health in pregnancy and postpartum.
Promote risk factor awareness and mitigation. All perinatal mental health conditions have risk factors, including a personal or family history of mental health conditions, lack of social support, high stress, advanced maternal age, and others. Vernon notes that the personality traits of many physicians: “type A, high-achieving, perfectionistic, caregiving, nurturing, or people-pleasing” are on the list. So are high-risk pregnancies, for which a 2021 JAMA study suggests many physicians have an increased risk. But few doctors are aware of these risk factors or how to mitigate them.
Improve provider-to-provider appointments. ACOG recommends that all new mothers be screened for perinatal mental health conditions. Still, many mothers report that postpartum mental health is not brought up specifically at appointments and that healthcare professionals are uncomfortable discussing it.
Navya Mysore, MD
At provider-to-provider medical appointments in particular, “there can be a lot that’s glossed over because you assume that the other person is going to tell you [if something is wrong],” says Navya Mysore, MD, a family physician in New York City. At Mysore’s 6-week postpartum follow-up appointment, although her doctor did ask her how she was feeling, perinatal mental health wasn’t addressed explicitly. Meanwhile, Mysore had become so isolated and anxious she rarely left her house.
Make treatment more accessible. All perinatal mental health conditions are treatable. And new medications are currently on the market. Last year, the US Food and Drug Administration approved zuranolone, the first oral medication indicated for people with postpartum depression. But providers must be educated about and aware of the latest treatment options, including therapy, medication, and social support.
Resources such as those from Postpartum Support International, which has a nationwide database of providers specifically trained in perinatal mental health, as well as information for partners and families and a multitude of support groups, must be publicized widely.
Still, the general culture of medicine around mental health, self-care, and family priorities may be harder to shift. Many physicians say these attitudes begin as early as medical school, and in residency, they become overwhelming.
“I think residency trains us not only to be able to deal with emergencies and make complex diagnoses on little to no sleep, but it also trains us to treat ourselves like robots. We just keep going until we get the job done,” says Vernon. “The problem is, with babies, the job is never done.”
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