Courtesy of Claire Mulkey
Lisa Abramson said even after everything she had gone through – the helicopter circled her house, snipers on the roof, and drove into the prison – she still wanted to have a second child.
That's because right after his daughter was born in 2014 – before all the problems began – everything felt amazing. Lisa fell in love, just as she imagined. He will look into the round of his baby, watchful eyes and feel the adrenaline flowing through him. He has a lot of energy. He is very excited.
"I actually think like, & # 39; I don't understand why other mothers say they are very tired, or this is very difficult. I got this, & # 39;" he said.
Lisa wants to be the perfect mother. He is ready to be the perfect mother. She and her husband live in San Francisco, and Lisa has worked as a successful entrepreneur and as a marketing executive for Silicon Valley technology companies. When it comes to starting his family, he is organized and ready to go. And the first week after the baby is born, everything goes according to plan. The world is nothing but love.
Courtesy of Claire Mulkey
Then the baby starts losing weight, and the pediatrician tells Lisa to feed her every two hours.
Lisa began to feel she could not follow.
"It burdened me as, & # 39; I have failed as a mother. I can't feed my child, & # 39;" he said. "I have to feed him – that's the most important thing. And my welfare doesn't matter."
He barely sleeps. Even when he can get deliverance from what feels like breastfeeding purgatory, he cannot relax. When he gets tired, he starts to get confused.
Lisa thought going to the spin class would help. This is something he usually likes. But after 10 minutes, he escaped from the room.
"The sound and strong volume of the spin class really worries me," Lisa said, "It feels like the wall is talking to me."
Then, at home, he saw a police helicopter circling in their apartment. "There's a sniper on the roof," he remembered thinking, "And there is a surveillance camera in our room and everyone is watching me. And my cellphone gives me a strange message."
Lisa waited for the police to rush in and take her away. But the next morning, he woke up in his own bed.
The police must have caught the nanny, he decided. That's wrong, Lisa thought to herself. The caregiver should not be punished I crime.
Lisa told her husband that it was unfair. He will jump from the Golden Gate Bridge.
And that's when her husband told her that she would take her to the police station by herself.
"It's like," Oh, okay, he accepted me and I think I was arrested, & # 39; " Lisa said.
Her husband, David Abramson, remembered it as one of the worst days of her life.
"I took my wife to the hospital and then examined her in the inpatient unit," David said, explaining what really happened that day. "That's really challenging."
Not a prison, but a psychic ward
There is no crime at all – and there were no snipers and no spy cameras. Her caregiver had not been arrested, and Lisa's goal for that day was not a prison cell, but a general psychiatric ward at the Pacific Pacific Sutter Health Medical Center in San Francisco.
Another patient was there for a drug overdose or alcohol withdrawal. People shouted. A patient thinks he is a dog, and crawls on all fours, barking. For David, that doesn't seem to be the right place for a new mother.
"That might be the most heartbreaking thing, having to leave that night with hospital staff," he said. "You can see in his eyes and body language that he is panicking."
For the first five days, said Lisa, she did not speak to anyone.
"I don't know if I can't talk, or I don't talk," he said, "but I'm quite afraid of the environment so I decided I wouldn't answer anyone's question."
Lisa doesn't remember a doctor or nurse telling her why she was there or what was happening. But he remembers, about a week at the hospital, her husband brought prints from online about postpartum psychosis.
The article says increasing hormones since giving birth – plus lack of sleep – can trigger confusion and paranoia. Lisa doesn't believe it – she thinks her husband is cheating, and spends hours in Photoshop, collecting fake articles.
"I really like, & # 39; No. I have heard of postpartum depression," he said. "No! I've never heard of postpartum crazy. "
New data about mothers who died of suicide
But postpartum psychosis is real. Studies show it affects about one or two women out of every thousand who give birth; some doctors now think more women than affected, but undiagnosed. Without proper care, some of the women eventually die – because of suicide.
California researchers have just finished their first major study of maternal suicide. The state's public health department has not published the findings, KQED was able to review some data: 99 new mothers in the country died of suicide for 10 years.
The researchers determined that of the 99 suicides, 98 could be prevented. Women may still be alive today if the health care system in California has screened better jobs for women, diagnosed them, and cared for them.
"The work we do here is less than 10 percent of what needs to be done," Dr. Nirmaljit Dhami, a psychiatrist at El Camino Hospital in Mountain View, California. He helped review suicide, but did not share data from reports with reporters.
Dhami is an expert in postpartum mental illness, and often handles cases of postpartum psychosis that are abused by OB-GYNs. Based on his clinical experience and observations, he said, many doctors do not know the initial signs of postpartum psychosis; they do not know that the symptoms increase and decrease.
"Many times patients will come very clearly, then at other times, they will present with acute confusion and disorganization," Dhami said.
That's what happened to Lisa Abramson – feeling as if she was thinking well one day, and then believing that the walls were talking to her later.
"This is a symptom that doctors who are not trained in this field can easily lose," said Dhami, "because when they see patients in their offices with family, they can think that patients are normal and may suffer deprivation sleep – and send them home . "
That's how women can end up dead. In the US, mental health problems are one of the main contributors to maternal mortality, according to the 2018 report from the CDC initiative called U.S. Capacity Building to Review and Prevent Maternal Death. In the list of reports of causes of death among new mothers, mental health problems (including drug overdoses) are seventh – almost related to complications of high blood pressure. For white women, mental health problems are the number four cause of death.
Even when new mothers get referrals for psychiatric care in the days and weeks after the birth of their child, Dhami said, care is often inadequate or inappropriate. The doctor prescribes the wrong medicine. Insurance companies push patients out of psychiatric units before they are ready. And psychic unit staff, generally, are not trained in these diseases, Dhami said, and may not be equipped to care for even the most basic physical needs of new mothers.
For example, when Lisa Abramson first arrived at the mental ward, her husband told the medical officer who claimed that he thought Lisa was suffering from postpartum psychosis. The resident said to him, "Postpartum What? "
Then, a few days after staying at Lisa, she complained of pain in her breasts. He stopped breastfeeding as soon as he left home, and it didn't seem to happen to anyone that his breasts would grow.
Her husband had to negotiate with the staff to bring Lisa's breast pump from home.
He remembered that when he wanted to put it down, he had to use a room with soft walls that looked like solitary confinement – "what you imagine from a terror movie," Lisa said.
But the worst of all is not being allowed to see her baby girl. The inpatient unit has a strict policy: There are no babies or children on the ward. The hospital said this was intended as a security measure, for everyone.
His family lobbied in his name.
"They say, & # 39; he's a new mother and he needs to see his baby. That keeps this bond going, it's important," Lisa recalled, tearing up. "That's the hard part, can't see it."
About five days there, Lisa's family can negotiate permission for an hour's visit with her daughter, but they are watched by someone who keeps looking at her watch.
Lisa's family was very unhappy with her care at the hospital, so her husband decided he needed to take her out of there. They find Dhami and ask him to take care of Lisa.
Dhami listed Lisa in the comprehensive outpatient program she runs at El Camino Hospital, called the Maternal Outreach Mood Services (MOMS) program, where new mothers can bring their babies during an appointment.
The California Pacific Medical Center refused to comment on Lisa's case specifically, although Lisa allowed the hospital to discuss her medical records. Director of hospital psychiatric hospitalization, Dr. Stephanie Wilson, said breast pumps are now available for women who need them, and health care providers review the wishes of new mothers to see their babies on a case-by-case basis.
"We fully consider all the conditions and details of that patient, the baby – and really see what, if any, benefits or even potential hazards, which can occur to the mother," Wilson said. "Once the symptoms of depression and psychosis start to improve, that's when I will start allowing more visits."
Different types of care for mothers
There has been a lot of research, since the 1940s, about the ideal protocol for hospitalization for postpartum mental illness. The gold standard is to receive mothers and their babies together in hospitals, in special mother-baby units, where they are treated as partners.
Part of maternal therapy in this unit is getting guidance on how to read baby cues, and how to meet baby's needs – as well as their own needs. At night, babies sleep in a supervised baby's room, so the mother can sleep without interruption.
In the UK, there are 21 psychiatric units for this mother-baby. In France, there are 15. They are in Belgium and New Zealand. There is even one in India.
But in U.S., there is zero.
The closest estimate can be found in North Carolina, 3,000 miles from Lisa's residence, at a hospital at the University of North Carolina at Chapel Hill.
Perinatal psychiatric units here are provided specifically for pregnant women and new mothers.
"There is a need for them to see other mothers undergo what they are experiencing," Dr. Mary Kimmel, the psychiatrist who runs this unit. He wore a denim jacket and black suede boots, and every time a patient wanted to know if he was a mother too, he said yes, he had two children.
Each room has a hospital level breast pump, said Kimmel, and there is a lactation consultant who helps breastfeeding women. This unit has a special refrigerator for mothers to store pumped milk.
April Dembosky / KQED
The most distinctive feature about this program is visitor policy.
"Babies can come to the unit and we really encourage it," Kimmel said. "We encourage older children to also come to the unit."
Most afternoons, toddlers run around the afternoon room, or coloring, play with toys and play with each other. The women carry their newborn babies, swing them, feed them.
Babies are not permitted to stay overnight. Unlike the units in Europe, there are no nurseries here. The main reason for the policy is the limitation of U.S. insurance packages.
Kimmel said there were no insurance companies in the US that would pay healthy babies to be hospitalized.
"The baby does not have special needs to be treated so that it is impossible to collect for babies in the hospital," he said. And without that, the hospital is unable to run the nursery.
Days in the UNC unit very structured, with various treatments. There is one on one therapy and many group classes: parenting and time management lessons, for example, where women practice asking for their partner's help; relaxation class; and spiritual counseling.
Alice Sarti said the mother unit at UNC was the first place to give her hope as a new mother. After giving birth to his son, he was hit by mania. He had dealt with depression several times before, he said, but it had never been like this.
"Every minute I have to fill in the task: research the day I care, work on and work on my budget," he recalls. "I won't queue for three bottles – I'll queue for 17 bottles."
He loves how productive he is. He is a business analyst and likes to get things done. But then, everything starts to spin.
"There are definite shots," he said. "I started screaming about things that didn't make sense. That made sense to me."
For his family, that was just unclear anger. They called the police and took Alice to the nearest hospital that had an available bed – not a maternal unit at UNC, but a public health ward, several cities away.
"You see people who can't talk, who can hardly walk," he said. "People are sent home in that condition."
Alice refused to take any medicine, and that made her unpopular with staff.
"I did have a social worker who told me that I would lose my child if I didn't pull it together, & # 39;" he said.
During the three weeks he stayed, he saw his son once, for 20 minutes.
"I can't touch it at any level. He was in the seat of his car and I grabbed it and I was cursed," he said.
It was difficult for him to admit how it felt to return to him, after he was fired.
"It feels like a burden," Alice said. "It feels like, & # 39; How can I do this? & # 39; I hug her, bathe her, and I do everything – but the relationship is not there. I lost time with my son and I will never get it back . "
Alice was treated in two different hospitals, never felt better, before she ended up at the psychic unit of the mother at UNC Chapel Hill.
Finally, everyone seemed to understand what he was experiencing, he said – the pressure he felt and guilt. He saw his son regularly, and the staff helped him begin to re-establish his bond with him.
"That's an extraordinary nurturing environment," he said. "That changed the trajectory of my life, and the life of my child."
However, even in this seemingly perfect place, everything can go wrong. When Alice is stopped, the mania is clean. But then he slipped inside, the darkest, deepest depression he had ever known. He checked himself back to UNC, fearing he would commit suicide.
With Alice, and with other patients, doctors are under a lot of pressure to bring mothers home quickly, so that sometimes they overload drugs, Kimmel explained. Some of the pressure comes from the mothers themselves, who want to be with their children, but also from insurance companies.
UNC mother units pay bills like other hospitals – they take commercial insurance and Medicaid to cover maintenance costs.
But the longer a patient stays, the more insurance companies have to pay, and that's not good for their bottom line. Kimmel and other doctors say that once a patient leaves a suicide watch, the insurance company starts calling, asking when he can go home.
"Our average length of stay ranges from one week to two weeks," Kimmel said.
And in Europe? "About 40 to 50 days is the average length of stay there," he said.
That means that some US doctors can start their patients with new drugs, but don't have time to see if they work well. Or, they should start the woman with the most intense drug immediately – a drug that forces her to stop breastfeeding – instead of therapy that works more slowly which can give the mother more time to breastfeed her baby.
This also means that patients like Alice can be hospitalized four times before they get the right care they need to really recover.
Insurers insist that the decision to leave is not only about costs, but about what is best for the patient.
Hospitals are not necessarily the ideal environment to ensure stable medicines, said Kate Berry, senior vice president of Clinical Innovation for the American Health Insurance Plan, a trade group for insurance companies.
"There are other arrangements where care can be continued," he said, "such as partial hospitals or intensive outpatient care arrangements that might be more supportive of the mother and her baby together."
Alice Sarti said the mental hospital in the US was just a warehouse for people. Only the mother unit feels like a place of healing.
"This is a different place," he said. "This is a type of mental health care that must be accessed by everyone – not just mothers. That is what mental health care should be like in this country. And it is not close."
At present, UNC is the only hospital in the country that has a special psychological unit for pregnant women and new mothers. A hospital in New York has a special unit for women. And El Camino Hospital, where Dhami practices in California, will soon begin the construction of a psychic unit specifically for women, focusing specifically on the needs of new mothers. This is scheduled to open in 2019.
Ready to try again
Lisa Abramson plays catch with her daughter, Lucy.
"Ready? Set? Go!" Lucy shouted, and Lisa rolled a small rubber ball.
Lisa feels like she's returning to her normal self. But he had thought a lot about his experience with postpartum psychosis.
Apart from everything, he decided to have another baby.
"It was the bravest moment of my life," he said. "Without knowing anything [about] how this will really work, let's try again. "
He was afraid, that psychosis would return.
"They say there is a 50 percent chance," he said. "I can try to set a more optimal situation, but you also don't know – and that is out of your control, which is difficult."
The number one thing he wants to avoid is returning to the hospital.
"Hospitalization is probably the most traumatic [aspect] from all experience, "Lisa said.
At present, he likes to be a mother, he said. Lucy is 5 years old now. His second daughter, Vivian, is 18 months old.
Psychosis does not return after Vivian's birth, partly because of all the precautions that Lisa did. He made sure he slept enough. He gave himself permission to stop breastfeeding, if too much.
"We have so many messages about self-sacrifice," Lisa said. "& # 39; Do everything for your children." # Drop everything. That's what it means to be a good mother. "And for me, that's not what makes me a good mother. That makes me mess.
"I try to put myself first – free from guilt – and know that that make me a better mother. "
This story is part of the NPR reporting partnership with KQED, California Report and Kaiser Health News.