Understanding Maternal Mental Health: Suicide Awareness and the Importance of Informed Consent
Maternal mental health is often overlooked, but the reality is that many mothers experience significant challenges, including postpartum depression and anxiety. In severe cases, maternal suicide is a leading cause of death in the postpartum period. This blog explores the critical difference between intrusive thoughts and suicidal ideation, providing clarity for those who may feel overwhelmed by distressing thoughts.
Navigating the journey of motherhood can bring a mix of joy, fear, and overwhelming emotions. While this period is often portrayed as one of the happiest times in a woman’s life, the reality is that many women face significant mental health challenges during pregnancy and after giving birth. One such concern that is rarely talked about is maternal mental health and suicide. Tragically, suicide is one of the leading causes of death for women in the postpartum period. However, open communication with healthcare professionals, particularly therapists, can help prevent these crises from escalating.
In this post, we'll explore the difference between intrusive thoughts and suicidal ideation, why this distinction matters, and how to approach these conversations with your therapist — particularly through informed consent.
Note that while I typically use language that is less gendered (e.g. birthing person, parent), this week, September 9-13, 2024, is Maternal Suicide Awareness Week.
Understanding Intrusive Thoughts vs. Suicidal Ideation
Both intrusive thoughts and suicidal ideation are relatively common experiences among women dealing with perinatal mental health issues, but they are fundamentally different.
Intrusive Thoughts
These are unwanted, distressing thoughts that often pop into your mind uninvited. They may involve images or ideas of harm, but they do not reflect your actual desires or intentions. Intrusive thoughts are often related to anxiety and can occur during pregnancy or after childbirth. A common example is a mother fearing she might accidentally harm her baby, even though she has no intention of doing so. Intrusive thoughts are about fear, not intent.
Suicidal Ideation
This involves thoughts about wanting to end your life or feelings of hopelessness so deep that it leads to a consideration of suicide. Unlike intrusive thoughts, suicidal ideation indicates a much more serious mental health condition and requires immediate attention and support.
Why the Difference Matters
While intrusive thoughts can be extremely upsetting, they are often not dangerous. Many women feel ashamed of these thoughts and may avoid discussing them, fearing judgment or misunderstanding. It’s important to know that intrusive thoughts are common, and they do not mean you are a bad mother or that you want to act on them.
Suicidal ideation, however, reflects a deeper level of distress and risk. If you or someone you know is experiencing suicidal thoughts, it’s crucial to seek help immediately.
Recognizing the difference between these two types of thoughts can help you better communicate with your therapist. More importantly, it can also help you advocate for your needs when seeking support. Due to the complexity and specificity of maternal mental health, I highly suggest finding a therapist who has specific perinatal training.
The Reality of Maternal Suicide
Research indicates that maternal suicide is a serious concern in the perinatal period. According to a study in the UK, suicide is the leading cause of direct maternal deaths within the first year after childbirth, accounting for 23% of maternal deaths from psychiatric causes. In the United States, it is estimated that 1 in 7 women experience postpartum depression, a major risk factor for suicidal thoughts. The risk of suicide is also higher for women experiencing postpartum psychosis, with research showing that up to 4% of women with postpartum psychosis attempt suicide.
The Importance of Informed Consent: Asking the Right Questions
When you seek therapy, especially during such a sensitive time in your life, it’s vital to know your therapist’s approach to confidentiality and mandated reporting. This is where informed consent comes into play. Informed consent ensures that you understand the therapeutic process, including when your therapist may need to breach confidentiality to keep you or others safe. Similar to how I advocate for individuals to ask their therapist about their stance on abortion and other key issues, I also advocate for these key questions.
Key Questions to Ask Your Therapist:
When would you be required to report thoughts of suicide or harm to others?
It’s essential to understand the boundaries of confidentiality. In most cases, therapists are mandated to report if they believe there is an immediate risk of harm to you or someone else. Knowing this from the outset can ease your mind and allow you to speak freely during sessions.
What is the process if I disclose suicidal thoughts?
Therapists have different approaches to handling suicidal ideation. Some may work with you to create a safety plan, while others might suggest a higher level of care if they believe you’re at immediate risk.
How do you differentiate between intrusive thoughts and serious suicidal ideation?
Given that intrusive thoughts can feel disturbing, it’s helpful to know how your therapist will distinguish these from suicidal ideation. This can ensure that your fears are addressed appropriately without unnecessary interventions. It may also provide you with an understanding of how your therapist conceptualizes intrusive thoughts.
What should I expect in terms of support during times of crisis?
Understanding the steps your therapist would take during a mental health crisis can help alleviate the fear of being misunderstood or not receiving adequate support.
Breaking the Silence: Why Open Communication Saves Lives
Unfortunately, the stigma surrounding maternal mental health, especially around thoughts of suicide, often prevents women from seeking the help they need. Research shows that women suffering from perinatal mood disorders often feel misunderstood, and only 50% of women with postpartum depression seek help . By fostering open communication with your therapist and being proactive about informed consent, you can create a safe space where you feel comfortable sharing your feelings — no matter how scary they seem.
Remember, having a thought does not define you. Whether you're dealing with intrusive thoughts or battling suicidal ideation, you're not alone, and help is available. The first step is finding a trusted therapist who can guide you through this complex and emotional time with compassion and clarity.
If you're struggling with maternal mental health issues, know that it’s okay to ask for help. At Anna C. Maling Therapy, I specialize in perinatal mental health and are committed to providing safe, non-judgmental support for mothers. Reach out to us today for guidance and support — you don’t have to go through this alone.
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Resources for Immediate Support:
- National Suicide Prevention Lifeline: 1-800-273-8255
- Postpartum Support International: 1-800-944-4773
References:
1. Knight, M., et al. (2021). Saving Lives, Improving Mothers’ Care: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2017-19. National Perinatal Epidemiology Unit, University of Oxford.
2. Lindahl, V., Pearson, J. L., & Colpe, L. (2005). Prevalence of suicidality during pregnancy and the postpartum. *Archives of Women’s Mental Health*, 8(2), 77–87.
3. Maternal Suicide: A Leading Cause of Postpartum Deaths. (2023). Postpartum Support International.
4. Howard, L. M., et al. (2014). Non-psychotic mental disorders in the perinatal period. *The Lancet*, 384(9956), 1775-1788.
