“If it was broken you would be screaming”: The hidden cost of being a “good” postpartum patient
49% of Canadian mothers and birthing parents reported experiencing emotional or mental health challenges during pregnancy or postpartum.
Only 36% reported receiving professional help (2024 Parental Experiences Survey, Statistics Canada).
We know that individuals from marginalized communities are also less likely to report postpartum challenges for various reasons, including a mistrust of the system and a general lack of healthcare in Canada.
So, how many birthing parents are struggling and staying silent? My guess is that it’s a lot more than these already high numbers from the Parental Experiences Survey indicate.
With this, I want to talk about growing up as a woman or a woman-identified person in this day and age, and the pressure to be “fine.” I want to talk about masking, not only neurodivergent traits, but masking when it comes to all mental illness… because women are really, really, good at it. Under patriarchy and heteronormative norms, women almost have to become good at it. Most of us don’t realize we are doing it until we are knee-deep in a situation like postpartum that fights so hard against the mask. Where all hormonal changes, lack of sleep, and the pressure of a massive life transition pushes women over the edge and into a space where they are forced to confront their own needs (and whether they are being met, or not).
My Story - Before
I was born into this world as a deep feeler. Throughout my life, my mind, body and spirit interacted with the world and experienced certain things that I believe danced with my predispositions and biology to create the mental and physical diagnoses I’ve carried.
I spent a large portion of my twenties navigating my way through a lot of these, always coming up against the same thing from a variety of providers… the feeling that I just was “not sick enough.”
This was probably the most difficult when it came to finally admitting I needed help with my eating disorder. The difficult part about this was that quite frankly, I didn’t want to ask for help, but my physical health was starting to deteriorate to a point that deeply scared me. This became an uphill battle to get healthcare providers to take my concerns seriously - because I didn’t look sick enough. I didn’t act sick enough. I was consuming the daily caloric intake of a toddler, experiencing debilitating headaches, vomiting blood, visiting the ER frequently due to chest pain… but I wasn’t dangerously thin, AND I still presented put-together and polite.
I was lucky to find support outside the public healthcare system and to have the opportunity to largely recover from my eating disorder.
My Story - Birth
Years later, I became pregnant. I was wildly ill my entire pregnancy. 9 months later, I gave birth to my perfect baby girl after a grueling 76-hour labour and a broken tailbone.
After the shock wore off, I knew something was seriously wrong. Sitting down absolutely took my breath away. I knew something was broken.
I want people to understand something.
As a woman in the setting of a healthcare system, you automatically feel as though you are burdening everyone around you.
If I were to go through this again three years later, I would go into it knowing that I am entitled to respectful and diligent care, and I would advocate for that. But back then, I was terrified of inconveniencing someone, and very focused on maintaining my image as “an easy patient.”
I finally told the nurse about my severe pain, and she brought in a doctor to do an exam.
As the doctor pushed on my tailbone I felt an absolutely splitting sensation that all but made me blackout. I held my breath and squeezed my eyes shut so to not appear “dramatic.” She asked how it felt. I said it hurt a lot.
The doctor replied, “if it was broken, you would be screaming.”
“If it was broken, you would be screaming.”
NO. Because I would never be screaming as long as I had a white knuckled grasp on control.
Eventually, I went on to get medical confirmation that my tailbone was in fact broken, and once again ended up paying for private healthcare to address it. That was one example of many that makes me want to scream when we see stories in the media of postpartum emergencies getting brushed off until it is too late.
Women often try to be a “good patient", and appear put together and polite… even when the situation is dire. We are diligently socialized to do this and scolded when we don’t.
My Story - Postpartum
My postpartum experience is still blurry to me, even to this day. What I will say is that the experience of a traumatic birth and the subsequent exhaustion, paired with a highly sensitive, colicky baby, plummeted me into postpartum depression with a very unwelcome side of postpartum OCD.
I’m not going to get into examples of what these thoughts were because it is still so raw, but I will say that I was TERRIFIED of my own mind.
I experienced intrusive thoughts and imagery that were so disturbing and upsetting to me that the most I ever told anyone, until three years later, was “I’m scared.”
I was so scared of my own mind.
…So scared of how exhausted I felt.
…So scared that if I asked for help, someone would take my baby, or separate me from my baby.
…So scared someone may hurt my baby.
…So scared of getting “sicker” or losing control.
And yet, to an outsider looking in, I was just a tired, new mom.
I still went to mommy and me group meetings at Piccaroons, almost weekly.
I took my new baby and my dog for long hikes at Woolastock Park by myself.
I ran my private practice from my computer while my velcro baby slept on my chest.
When I attended my checkups I mentioned “a bit of depression and anxiety,” but once again, I felt the need to be a “good new mom” and a “good patient” which seemed to absolutely rob me from the ability to really ask for help. This is a pattern I see in certain devastating cases in the media, and I wonder how prevalent this feeling is for new mothers.
Thankfully for me, when things got a little bit scarier I had people to step in and support me. MANY of the moms I work with did not or do not have these resources and must rely on mom/baby checkups and healthcare providers in the public system.
So, where do we go when we have an under-funded, crowded healthcare system paired with the new parent’s (particularly mother’s) need to appear polite, put-together, and “good” when in Canada the reported prevalence of maternal mental health concerns is so high:
23% of birthing parents report postpartum depression or anxiety
4-9% report postpartum OCD
approximately 1 in every 600 births reports postpartum psychosis
Compared to the women and birthing parents I know in real life, these numbers are staggeringly low. Most new parents I know report undeniable struggles during the transition into parenthood that cannot and should not be ignored by the system, or downplayed especially by women as we experience it.
Potential Resolution
I guess I have two points. One for the healthcare system, and one for new parents (especially women/women-identified people).
We deserve help before postpartum mental illness becomes a crisis.
We deserve care that is preventative, integrative, and ongoing. We deserve care that pushes past our self-protective urge to be a good patient to the detriment of ourselves and our families.
More screening: I believe women should be screened for postpartum mental illness several times, not just at the 6-week check-in. Mental health can deteriorate in a matter of weeks, and multiple screenings can catch it more effectively and ahead of time. I know for me, it was much easier to admit things were harder than they appeared via a pen-and-paper assessment than to speak the words outloud.
Screening that connects birthing parents and mothers with interdisciplinary treatment teams. Maternal mental health is multifaceted and requires a multimodal approach including psychology, nutrition, MDs, at times OTs, lactation consultants and more.
Training all providers in PPD, PPA, PPOCD, PPP and how to distinguish each condition to ensure positive treatment outcomes.
Believe women.
Women/Women-identifying people,
You don’t gain anything by fighting to take up less space within the healthcare system. It not only prevents you from getting the help you need, but it removes pressure on the system to improve. If you aren’t there reporting your challenges, there is no way for the system to respond to a need.
People might not take you seriously at first. Fight anyway. You don’t get a medal for being an easy patient. You can be kind, diplomatic, grateful even (!!) and still advocate that your issues are taken seriously.
Lastly, if you have been through any of this, I want to tell you how strong you are and how proud I am of you for being here today, working toward a better world for postpartum parents and working to be a better advocate for yourself.
With love,
Sara
