Preventing Suicide in the Perinatal Period

“Any thread of sanity I was still holding onto disappeared. I snatched the block, and without thinking, threw it back at my son. I watched in horror as it hit him in the head. . . . He erupted into sobs and the tension broke. I pulled my little boy to my chest and apologized over and over again while internally berating myself for being a horrible mother. I didn’t deserve this child. I didn’t deserve any children. I was the worst mom ever born. No other mother would ever have behaved as badly as I had—rinse and repeat.”*

These are the moments that can bring deep shame and despair to new mothers. Unless mothers are extremely brave (like Christine Walker, who wrote the words above), they rarely share these toughest moments, feeling too embarrassed to let others know who they “really are.” And yet these scenes, some a little more intense than others, happen not infrequently, when new moms are under extreme stress and struggling with depression and anxiety.

At their most extreme, these incidents, followed by harsh self-talk and judgment, can lead to thoughts (or even acts) of suicide. Other times, a deep malaise sets in, the mother convinced that she’s made a huge mistake or that she isn’t fit for motherhood. Complicating the picture, even the mom doing fairly well, with normal insecurities and apprehensions, can at times question her ability and worthiness to mother her child.

All mothers are vulnerable to feeling like bad mothers. The reality of motherhood rarely matches the fairy tale images we see on greeting cards or in story books. Mothers rarely realize beforehand that they will miss their freedom. They think only of the bliss and pure mother love that never fatigues, never resents, and always knows instinctively what to do. Then reality hits.

How can a provider distinguish new mom insecurity from something more serious? How do we know when we should worry about perinatal suicide? The mother who is in trouble does not feel relieved by ordinary reassurances. Complicating the picture, many mothers do not share with their provider (or will even deny when directly asked) that they are having these dark thoughts and feelings. A good question to ask is, “How bad do you really feel?”** This question presupposes that the mother is struggling, with the task then becoming to figure out the degree of struggle. Another technique is to take the time to really talk to the mother, normalizing that many mothers have these thoughts, giving the mother the space and safety to share what often feels like the “unshareable”. Of course, any positive affirmation for suicide (even a mild one) on a depression screening including the Edinburgh should be taken seriously and discussed thoroughly.

Paying attention to the client’s presentation also matters. Sometimes, the mother will present as disheveled. This could be depression but it could also be sleep deprivation and lack of self-care. Sometimes an impeccable presentation is actually more cause for concern as the mother may be hiding behind her perfect appearance. A flat, lifeless presentation or one with confusion and strange thoughts should be taken very seriously and queried for suicidality. A history of mental illness and being pregnant, versus in the postpartum period, also puts a mother more at risk for suicide.***

Any admission of thoughts of wanting to escape and/or having made a mistake in becoming a mother should be thoroughly investigated. Questions to a mother about her dark thoughts will never put suicidal thoughts in her head, and just may save her life.

*Walker, C. When You’re a Mother Contemplating Suicide. Retrieved from http://www.scarymommy.com/mother-contemplating-suicide/.
** Wenzel, A and K. Kleiman . (2011) Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood. New York, NY: Routledge.
***Orsolini, L. et al, (July 2016) Suicide during Perinatal Period: Epidemiology, Risk Factor and Clinical Correlates. Front Psychiatry.

Terri Buysse is a clinical psychologist with a private psychotherapy practice in Edmonds and Everett, Washington. She specializes in perinatal, parenting, and trauma work. She is one of the facilitators for Little Sprouts, a new mothers’ support group in Mountlake Terrace, and is a member of Perinatal Support Washington.