Advocates say healthcare workers need better training.
By: Patricia Tomasi 02/13/2018
Note: At their request, HuffPost Canada changed the names of the three Canadian mothers who came forward with their stories. No other names have been changed.
When U.S. mom Jessica Porten made international headlines last month after she shared a shocking story — how, after Porten asked for help with postpartum depression, her nurse practitioner called the police — her nightmarish experience rang true for new moms across Canada, too.
“It happened to me,” said Lindsie Green of Toronto. “A public health nurse came to visit me, I explained how I was feeling and CAS (Children’s Aid Society) showed up at my door.”
The nurse was visiting Green on her first day alone with her four-week-old baby, she said. Green told the nurse she was feeling hyper-vigilant about little things, such as metal staples, and was constantly worried that a staple would somehow end up in her daughter’s throat.
“I wanted to be completely upfront about how I was feeling because I felt the more people I had helping me out, knowing exactly what was going on in my mind, the less alone and scared I’d be,” Green said.
“I explained that I was feeling alone and having frequent intrusive thoughts and obsessive-compulsive tendencies but that I had a myriad of therapists and psychiatrists helping me and although I was scared, I knew I was in good hands.”
Much to Green’s surprise, however, CAS workers arrived at her home later that afternoon. Green said she immediately contacted her psychiatrist and the case was closed three weeks later.
“I was totally shocked and felt utterly betrayed and even more alone,” Green said. “I trusted the public health nurse would have had training and experience to be able to help me deal with some of my postpartum depression issues rather than add problems and increase my self-doubt.”
Similar cases are happening across Canada
Catherine McKinley, also of Toronto, said she had a similar experience. After requesting a home visit by a public health nurse for help with exhaustion while dealing with her colicky baby, the nurse called CAS after McKinley stated she was at her “wit’s end.”
“It was one of the most traumatizing experiences I’ve ever had and honestly I think it fueled my postpartum anxiety,” McKinley said. “I wasn’t even having intrusive thoughts at the time but they came after. Having CAS involved was the catalyst for me going into a deeper crisis.”
In another case in Edmonton, Julie Grelo went to her doctor for help with intrusive thoughts but was told by her doctor that her children would be removed if she was having thoughts about harming them.
“I immediately felt like he wouldn’t understand that although the thoughts were relentless, I loved my children and wanted so badly for their safety,” Grelo said. “I didn’t know why I was having the thoughts, I never wanted to hurt them. I just wanted the thoughts to stop.”
And in a case paralleling what happened to Porten in the U.S., Sheila Duffy, director of the Pacific Post Partum Support Society in British Columbia, tells of a mom who reached out to a crisis line for support with intrusive thoughts only to have the police called on her.
“She called a crisis line for support as she was having a hard time one night and the person she spoke with did not have any education around intrusive thoughts and ended up calling the police who showed up at her door,” Duffy said. “This was hugely traumatic for her and her family and could have been avoided.”
Moms refuse help out of fear
One in five moms with a postpartum mental illness have refused help, fearing their children would be taken away, according to a newly-released survey by in the U.K.
While postpartum depression affects up to 15 per cent of women in Canada and can include symptoms of sadness, guilt, and worry, postpartum depression isn’t the only maternal mental health disorder a woman may develop in the postpartum period.
Though often less talked about, postpartum obsessive-compulsive disorder (OCD) and postpartum anxiety can include symptoms of intrusive thoughts that are unwanted, often violent, graphic and disturbing images or thoughts that can involve the idea of unintentional harm coming to the mother or her child.
Postpartum OCD affects four to nine per cent of women and, according to British studies, it’s often misdiagnosed in particular by nurses who end up unnecessarily reporting the mothers to child protection services believing they are dealing with postpartum psychosis, a rare, severe mental health emergency that affects one in 1,000 women.
Advocates are calling for better training
“If care providers are not educated about intrusive thoughts, misunderstand the person disclosing them, and think these were plans or intentions to act, CAS might be called,” said Kaeli Macdonald, a therapist from the Reproductive Life Stages program at Toronto’s Women’s College Hospital.
“It is critical that care providers be very clear and thorough in assessing the distinction between an intrusive thought and an intent to harm or an act of abuse.”
Maternal mental health advocates in Canada say nurses and other front-line health care providers are not being properly trained.
“Health care practitioners should be the ones to know about maternal mental health disorders but they’re just as much in the dark as the women who are experiencing them,” said registered psychologist Gina Wong, co-author of Moms Gone Mad and an expert witness in maternal filicide cases in Canada.
“The awareness is not out there and it’s the scariest thing that women can experience.”
The system is “supremely flawed”
Ashleigh Clarke, a nursing student in Barrie, Ont. who is currently dealing with postpartum depression, sais the system is “supremely flawed” with limited resources and a lack of proper training.
“While we most definitely had training on psychosocial care and screening for mental health issues,” said Clarke, “unless someone chose to specifically focus their clinical practice in a mental health area, there was very little coverage of how to best support vulnerable populations struggling with mental health issues.”
Postpartum depression is often taught as part of mental health education programs as undergraduate programs may not have a specific maternity module, according to Dr. Sharon Dore, President of the Canadian Association of Perinatal and Women’s Health Nurses. That said, she does believe “all caregivers would benefit from more training.”
“I am not certain that nurses, whose focus was perinatal care, would have the expertise to differentiate OCD and postpartum psychosis, however, I would not think their initial response would be a referral to child services,” Dore said. “They are far more likely to refer to a health professional who could offer a higher level of expertise on diagnosis and management.”
There’s a duty to report
Hoda Mankal, a nurse practitioner and director of communications at the Nurse Practitioners Association of Ontario representing 3,300 nurse practitioners across the province, said nurses are “not specifically trained” on postpartum OCD versus postpartum psychosis and more education would certainly be beneficial.
“We do have a duty to report as healthcare providers if we do feel like a baby is at harm but I don’t say that loosely,” Mankal said. “There’s a lot of information-gathering that goes into play.”
Neither CAS nor the nurse associations contacted by HuffPost Canada said they keep track of the number of calls made to CAS for reasons involving maternal mental health.
When a call is made to CAS, child protection workers are mandated to conduct an investigation to determine whether a child needs protection services. According to the 2013 Ontario Incidence Study of Reported Abuse and Neglect, on average, three per cent of cases involve children being removed from the home.
“I always try to explain to my families that I work with that by calling the child protective agency, it’s not to have your child taken away,” Mankal said. “They are an added support and have access to a lot of community resources.”
There are other ways to get help
But Claire Kerr-Zlobin, founder of the “Life With A Baby” support program, says nurses shouldn’t be reporting moms with postpartum depression to CAS in order for them to access maternal mental health resources. They should be referring them to their family doctor or a psychiatrist who can properly assess them and provide treatment.
“From what moms are telling us, it’s a huge problem,” Kerr-Zlobin said. “We hear from moms in the groups we run about this happening all the time. Proper training for nurses and health care providers is so important.”
To that end, she, along with other maternal mental health organizations in Canada, have started offering training for nurses and other healthcare professionals so moms like Green, McKinley, and Grelo are provided with help instead of being reported to child services.
“I honestly can’t believe that in 2018, we are still shocked and react inappropriately to postpartum depression,” Green said.
“A voice needs to speak for those of us who are too afraid. Too many women are suffering alone.”