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A Mom With Postpartum Depression Reached Out for Help – a Nurse Called the Police

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Earlier in January, Jessica Porten went to see her obstetrician for the first time since giving birth to her second child four months ago. As she thought she was supposed to, she let the nurse practitioner know she was experiencing postpartum depression (PPD) and it was manifesting in fits of anger. Although Porten knew she was safe, she was having violent thoughts and was interested in trying medication and therapy to handle what she knew to be mental health issues.

After a quick pelvic exam, the nurse practitioner left the room and called the police.

“I had a really hard time deciding whether I should post something about what happened last night, since putting it on Facebook wouldn’t help the situation,” Porten wrote in a Facebook post that has since been shared over 33,000 times. “But I don’t know, I feel like this has to be said out into the world so you can all see how little support mothers get from our healthcare system.”

I had a really hard time deciding whether I should post something about what happened last night, since putting it on…

Posted by Jessica Porten on Friday, January 19, 2018

After the police were called, Porten had to wait over an hour in the doctor’s office before the officers arrived. When she finally got to the ER, she again waited for another hour with a security guard. After providing a urine sample and changing into a hospital gown, she was finally seen by a social worker at 10:45 p.m —  more than eight hours after her initial obstetrician appointment. The social worker decided Porten did not need to be involuntary checked into a psychiatric hospital, and was discharged.

Porten wrote on Facebook:

Jessica and her babyI leave the ER at midnight, my spirit more broken than ever, no medication, no follow up appointment, never spoke to a doctor. This was a 10 hour ordeal that I had to go through all while caring for my infant that I had with me. And that’s it. That’s what I got for telling my OB that I have PPD and I need help. I was treated like a criminal and then discharged with nothing but a stack of xeroxed printouts with phone numbers on them.

I’m still processing all of the emotions that are coming with being treated this way. I’m not exactly sure what to do here. I will say I am deeply hurt and upset, and above all angry and disgusted and disappointed by how this whole thing went down.

Ladies and gentleman, our healthcare system.

When she initially saw the Facebook post, Ann Smith, President of Postpartum Support International, said her first reaction was to blame the nurse, who she says made the wrong call by calling the police. But now, she says this incident isn’t about one nurse who misjudged a specific situation — but about how dangerous it is that many professionals know so little about postpartum disorders.

“The shock was not that the police were involved,” Smith told The Mighty. “Yes, the police need to be involved sometimes. No, they don’t need to be involved all of the time. And professionals often aren’t trained to understand the difference.”

The difference when it comes to violent thoughts in new moms, she said, usually comes down to understanding the difference between struggling with intrusive thoughts and postpartum psychosis. Although it may be alarming to hear a new mother is having violent thoughts, thoughts of harming a newborn aren’t as uncommon as we might think. Intrusive thoughts are often a symptom of obsessive compulsive disorder (OCD), and one study found 11 percent of women met clinical criteria for OCD at two weeks postpartum.

One of the very common components [of perinatal mood and anxiety disorders] are something known as intrusive thoughts. Intrusive thoughts over and over again in your head, thoughts of something terrible happening at your own hand,” Smith said. “Woman with intrusive thoughts know they are just thoughts. These thoughts are painful to the mother, they are frightening to the mother and they cause terrible anxiety.”

According to Intrusive Thoughts, a project for people with obsessive compulsive disorder (OCD), 85 percent of people who don’t have OCD have experienced unwanted violent thoughts, including thoughts about harming themselves and loved ones. The difference is, for people with OCD (or a postpartum disorder in this case), “the presence and frequency of these thoughts is debilitating.” Importantly, the individual who has them is able to recognized they are unwanted, and doesn’t act on them.

For mothers with postpartum psychosis, the line between violent unwanted thoughts and real thoughts become blurred. “They think they’re being directed by something outside of themselves,” Smith said. Postpartum psychosis is rare — occurring after .1 to .2 percent of births — and the onset is usually sudden, most often within the first two weeks after a child is born.

But even a vast majority of woman with postpartum psychosis don’t go on to hurt their child, and Smith emphasized moms experiencing psychosis do recover with proper support. According to Postpartum Support International, of the woman who develop postpartum psychosis, 4 percent go on to kill their babies. Five percent die by suicide. 

This information — all important — isn’t something doctors or nurses are often taught. “[N]obody learns it, that’s why we’re here,” Smith said. “Nobody learns it in medical school. Nobody learns it in residency. I’m a nurse practitioner, I didn’t learn it. It’s a very specialized thing.”

Joy Burkhard, the director of 2020Mom, a nonprofit which aims to close the gaps in maternal mental health care through education, advocacy and collaboration, said there isn’t a screening tool OB/GYNs and primary care providers can use to detect OCD in the perinatal period. “Anything more than the run of the mill mild-moderate depression would require specialized treatment,” Burkhard added. “If there is a fear the mother may be of harm to herself or baby, they would provide a warm handoff to the ER.”

Unfortunately, sometimes the opposite occurs. While some mothers get sent to the ER or are hospitalized, others aren’t given proper help at all. Just this week, a 30-year-old California woman was arrested after killing her 3-year-old daughter. The woman’s mother told ABC30 her daughter had repeatedly reached out for help. The mental illness diagnosis the woman struggled with has not been specified, but Burkhard said that’s also part of the problem.

Not appropriately diagnosing disorders, naming them correctly (i.e. postpartum psychosis is an emergency, but anxiety including OCD, and postpartum depression generally are not), we perpetuate stigma. Women are caught in an awful predicament. They are not informed of the potential for these disorders which can cause confusion and shame, and if they do speak up something devastating can happen.

The possibility that woman won’t speak up about their postpartum mental health after hearing stories like Porten’s is a consequence both Smith and Burkhard fear. For mental health advocates like Jess Stohlmann-Rainey, though, police involvement for anyone who is deemed a danger to themselves or others by a mandated reporter is problematic, and not just for people who are “only” experiencing intrusive thoughts. For example, it’s not uncommon for police to get involved when someone expresses suicidal thoughts, and people can be hospitalized involuntarily, even though, as one study concluded, “the science of suicide prediction is dismal.” 

“Meeting people who look for support with shaming punishment and undignified treatment certainly doesn’t encourage disclosure,” Stohlmann-Rainey, a suicide attempt survivor herself, told The Mighty. “Situations like this communicate a clear message to people who are struggling: suffer in silence; if you don’t, things will get far, far worse.”

Involuntary treatment and mental health-related police interaction also disproportionally affect people of color and those living in low-income areas. In her Facebook post, Porten acknowledged this. “I may be marginalized as a woman, but I am white and heterosexual and hold privileges in these places. I am scared for our mothers of color and our LGBTQ mothers who seek out help in these situations,” she said.

For now, organizations like Postpartum Support International and 2020Mom fight to get more information in front of frontline providers, to reduce incidents like what happened to Porten, and to get every mom struggling the help she deserves. In March, Postpartum Support International will begin offering training material for medical professionals — which can be used both in-person and online — to get better postpartum disorder information into the hands of more people.

Porter told The Mighty since sharing her story on Facebook, people are reaching out to her spreading similar stories. If you’re struggling with your mental health after giving birth, or even while pregnant, Postpartum Support International has a warmline that can provide you with support and resources. You can reach them at 1-800-944-4773.

“We need to get doctors the resources they need to properly diagnose and treat the spectrum of maternal mental health disorders,” Porten said. “We have so, so much work left to do as a country to end the stigma surrounding mental health, and to get those afflicted the proper and compassionate treatment they deserve.”

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or reach the Crisis Text Line by texting “START” to 741741.

If you or a loved one is affected by postpartum depression or other postpartum disorders and need help, you can call Postpartum Support International‘s hotline at 1-800-944-4773.

Lead image provided by Jessica Porten

Originally published: January 30, 2018
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