A friend once told me approvingly that someone she knew had talked his schizophrenic adult son into having a vasectomy. I read “talked into” as “coerced.” I didn’t say anything. Instead, I thought: maybe I shouldn’t be a mother.
A woman with a history of overdoses, which included running away from a group home, consuming Benadryl tablets like M&Ms while drinking Budweiser and driving in a blackout, pursued pregnancy even after having a psychotic break following the cessation of her antipsychotic medication. She feared she might pose a threat to a child.
The Numbers Behind the Silence
Every year in the United States, more than 100,000 women who suffer from serious mental health issues give birth, as reported by Maria Muzik, a professor of psychiatry and obstetrics and gynecology at the University of Michigan and director of its Perinatal and Reproductive Psychiatry Clinic. According to her account, roughly thirteen percent of all pregnant women take selective serotonin reuptake inhibitor antidepressants (SSRIs).
Suicide and homicide together are the top cause of death among mothers in the United States. Just 6 percent to 8 percent of women with peripartum depression get proper psychiatric care.
What the Gaps Look Like
A stay at an inpatient psychiatric facility usually lasts between five and seven days. Outpatient psychiatrists and therapists often don’t accept insurance, and even when they do, copays can be substantial. Large parts of the country, especially rural areas, lack adequate psychiatric care and reproductive psychiatric care. According to Muzik’s estimate, there may be as few as six to 10 reproductive psychiatrists currently working in the whole state of Michigan.
A university medical center was where the author and her husband turned for guidance on the safety of her medication plan during pregnancy and her risk of relapse. Such specialized care is unavailable to many women living with serious mental illness, a group that includes 20 percent who lack insurance coverage.
The Workaround That Isn’t Enough
Specialists staff phone lines such as UMass Chan Medical School’s Lifeline for Moms and the University of Michigan’s MC3 on Fridays through Muzik, which enables primary care doctors, nurse practitioners, and OB-GYNs to get real-time guidance from experts. This arrangement builds clinicians’ confidence in their practice.
These markers stand in for the skilled labor force the nation has failed to build. Lauren Osborne, the vice chair of clinical research in the Department of Obstetrics and Gynecology at Weill Cornell Medicine, laid out the issue plainly:
- Anybody can hang out a shingle and say, “I’m a reproductive psychiatrist,” and there’s nothing to say that somebody is or is not.
- People who have more severe versions of these [mental health] disorders, who are seeking out help and expertise, find somebody they think is qualified, and that person isn’t, and things get missed, and there can be tragic consequences.
Why the Specialty Is Stuck
There is no formal reproductive psychiatry subspecialty or standardized national training pathway in the United States. Expertise in this field is concentrated at universities, where training is inconsistent. To become formally approved, the American Board of Psychiatry and Neurology requires a general psychiatry subspecialty to meet a specific threshold of fellowships and trainees.
To meet the minimum requirement, there must be at least 25 fellowships in place with 50 trainees enrolled altogether. At present, 18 such programs exist within reproductive psychiatry, and nearly every one of them has just one trainee while remaining distinct from the others.
“It’s probably 15 or 20 years, even as quickly as the specialty is growing, before we could reach that [threshold], and maybe even longer because there’s no money to support these fellowships,” Osborne said.
The Case That Made People Pay Attention
Lindsay Clancy’s story became a tragedy that made reproductive psychiatry visible. When she started spiraling into postpartum psychosis, her husband, Patrick, didn’t understand the danger, as he said Sunday night in a “60 Minutes” interview: “I could piece together what it was like to be really, really anxious or depressed. But I didn’t know how to manage a postpartum illness.”
The author’s own journey — a master’s degree, a writing career that included Psychology Today essays, a successful marriage, a decade of treatment adherence and stability — did not shield her from doubt. She worried she would be too unstable to parent.
“Anybody can hang out a shingle and say, ‘I’m a reproductive psychiatrist,’ and there’s nothing to say that somebody is or is not.”
What hurts women most is the brokenness of the system itself. The hotline model stands as a significant advance, yet it must not be confused with a solution. Women ought to receive far more than mere telephone contact with individuals styling themselves as specialists.
Until then, women like the author will continue to manage the spaces between the cracks on their own.
Source material: “Opinion: Mentally ill women deserve more support to have children,” STAT.
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