Pregnancy, postpartum can be key times for mental health challenges

After giving birth to her son in March, Justine Hofsiss lay in the fetal position on a couch at her Franklin Square home unable to function.

Ringing in her ears, heart palpitations, sweating, shaking — those were among the symptoms she shared with her best friend, a nurse, who tried to provide remedies until realizing the salve might be mental health treatment.

“It was a very scary, very overwhelming time in my life, where I felt like I had no control of my body whatsoever,” said the mother of two who had already eschewed driving because of her emotions. 

With a referral from the friend, Hofsiss in April turned to the North Shore Child & Family Guidance Center, crying in an intake call but finally hearing a voice to help make sense of her feelings after a traumatic birth and pregnancy.

“I hung up the phone and just cried because I'm like, ‘OK, this isn't going to be forever. I'm going to be OK. I'm gonna get help,'” she said.

The North Shore Child & Family Guidance Center's maternal health and wellness program is among a handful of places on Long Island working to treat pregnant people and those who have recently given birth for mental health issues such as anxiety or perinatal depression, which is common but can impact a woman’s ability to function — and even be life-threatening.

Roughly one in eight women in the United States said they experienced symptoms of postpartum depression since the birth of their babies, according to the Centers for Disease Control and Prevention.

Mental health conditions are the leading cause of pregnancy-related deaths, the CDC said, citing data from 2017 to 2019. That figure includes suicides and overdoses related to substance use.

In New York, mental health issues made up 15% of pregnancy-related deaths in 2018, or the third-leading cause, the state Department of Health said.

The overall number of women in the state who asked for help for depression after giving birth has steadily increased from 2017 to 2020, moving from 7.7% to 11.3%, the Department of Health said.

Meanwhile, the number of women who said a health care provider had asked them about depression symptoms at a postpartum visit moved from 76.1% in 2016 to 82.4% in 2020, the DOH said.

Childbearing is often perceived as a joyous moment, but it is also a moment of immense physical and emotional change that can leave people in anguish, experts say.

“The expectation is this should be such a wonderful point in your life,” said Dr. Sue Cohen, clinical psychologist and a clinical director at the center.

She later added: “Everyone, maybe their parents say to them, ‘Oh, you should feel so grateful you have a healthy child,’ but they're not feeling it.”

Barriers to getting mental health care

And while in the throes of mental health ailments, many women also face barriers to getting care, including the stigma of such illness and long waits to see providers, said Dr. Brittain Mahaffey, a licensed clinical psychologist and director of the Dialectical Behavior Therapy at Stony Brook Medicine.

In addition, some psychiatrists will not prescribe medication to people who are pregnant or breastfeeding out of fear of harming the child. Other times, women will forgo their prescriptions while pregnant.

The North Shore Child & Family Guidance Center maternal program seeks to be a bridge for women seeking care, taking referrals from OB/GYNs, pediatricians and word-of-mouth.

They then do a screening call to ensure the women don’t need to be taken to a hospital. Within a week of that call, the parent is seen.

“We treat it like an emergency because these moms are at risk, and the babies could be at risk,” said Cohen, later noting: "We need to make sure everyone's safe.”

Cohen said many of the program’s clients have had a traumatic birthing experience. A depressive or anxious history is sometimes the case. 

The patients go into individual therapy or with a partner. A staff psychiatrist works to provide care for women who are pregnant or have just given birth. Parents can bring their children if they come in for visits, as evidenced by the toys and children’s artwork in the offices.

The sessions usually take place over a year but can last longer.

“Some women just need a little support to get through this period and you know, are grateful that they've gotten this, and they can go back to their level of functioning,” Cohen said.

Anxiety after difficult delivery

While pregnant with her son, Hofsiss was hospitalized multiple times because her blood pressure spiked. During delivery, the baby’s heart rate dipped, and she was given oxygen.

After the birth, she stayed in the hospital for a week — away from her daughter, 5, and unable to adjust to everyday life.

“I had a full-blown anxiety attack because I was afraid that my blood pressure was not going to get better. It was constantly going to be high. I was never going to go home. We have this new baby now, we need to get adjusted. And my anxiety just got bigger and bigger.”

She reached out to the North Shore Child & Family Guidance Center, where she was diagnosed with postpartum depression and anxiety.

There, she met a therapist who gave her strategies to promote her care and mindfulness. One of the tools that she holds close is the idea of kintsugi. The Japanese technique mends broken pieces of pottery but still shows the seams, demonstrating both beauty, imperfections and endurance. 

“It's a different version of what you were, but it's going to be a better version. And it's OK that it's different than what you were used to,” said Hofsiss, who is also on medication.

Mahaffey said the stress that mothers experience before they become a parent is one of the most important predictors of depression and anxiety.

Young parents may have more stress because of financial difficulties and mothers who have had a traumatic pregnancy could be also more prone to anxiety.

“I want people to know that mental health problems don't just magically start in the postpartum; it usually starts during pregnancy and then worsens into the postpartum,” she said.

Depression deepens during pregnancy

After struggling to get pregnant, Dhipinder Walia said she felt “embarrassed” when depression crept back up while she was pregnant.

“I always just sort of felt like something was wrong with me because it is something I was asking for. So why, why couldn't I just figure it out?”

Walia, 35, of Lynbrook, eventually told her OB/GYN that she was depressed, only for her to be given providers who had a long waiting list.

Meanwhile, she said, her feelings of depression were stronger and deeper than when she was a teen and in her 20s.

“Whereas before I just felt like I was unable to, like, find joy in things and like, I just needed help and getting there," she said. But this time, "it was like, physical and mental pain.”

She got mental health care only after her child was born, after she mentioned her feelings to the child’s pediatrician, who called a social worker and put her in contact with the program.

Once in therapy, Walia said she learned how not to lean into distorted thoughts or how to set herself up for a good cry when she was feeling weepy.

By 18 months into therapy, she had better structures in place, aiding her overall health and giving her a clearer sense of her purpose. 

"My purpose is to, you know, be a good mom and to support folks who need support," she said. "But, I also feel like I've gained a lot of confidence and … understanding — all these abilities that I didn't ever think I could have."

By Tiffany Cusaac-Smith

tiffany.cusaac-smith@newsday.com@T_Cusaac

Education: Howard University 

Tiffany Cusaac-Smith came to Newsday in 2023 after being a race and history reporter at USA TODAY, where she wrote enterprise and spot articles examining how the past shapes the present. Previously, she worked as the race and justice reporter at the USA TODAY Network of New York, covering issues such as criminal justice reform, housing, environmental justice, health care and politics. At The Journal News/lohud.com in Westchester County, she covered Yonkers, the state's third-largest city. She also worked at The Associated Press in Atlanta.

Honors and Awards: Criminal justice reporting fellowship with the National Press Foundation;  New York News Publishers Association award for distinguished investigative reporting;  Contributed reporting for Best of Gannett honor; Member of Table Stakes, a program funded by the Knight-Lenfest Local News Transformation Fund and managed by the American Press Institute to transform local news.