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April 28, 2024, 9:30 am
The number of women who die during pregnancy, childbirth or during the postpartum period in the Netherlands is very low, with an average of eleven cases per year*. This applies to all of Western Europe, where maternal mortality is rare. In other parts of the world, such as Africa (excluding North Africa), this is very different.
Good news, you might say. Yet it is precisely that low figure that ensures a harsh outcome of the recent study by the Maternal Mortality and Morbidity Audit Committee of the Dutch Association for Obstetrics and Gynecology (NVOG) and 113 Suicide Prevention. In contrast to other measurements, this study looked at maternal mortality up to one year after delivery.
What turned out is that while the number of deaths due to, for example, bleeding or heart problems has been declining for years, the number of young mothers who end their lives remains the same. With four to five deaths by suicide per year, suicide is now the most common cause of maternal death in the Netherlands.
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The outcome is in line with previous international studies into the subject in, for example, England and Sweden, where the figures are comparable. Researcher Kinke Lommerse, psychiatrist at the Haaglanden Medical Center and who works for the National Agenda for Suicide Prevention: “These are small numbers, but they have a huge impact. More attention to mental health and suicidality during pregnancy and postpartum is therefore very important.”
Even more, because Lommerse also sees that there is indeed attention for mental problems during and after pregnancy. “Midwives, gynecologists and maternity assistants are keenly aware of this and there is more and more specialist care for mothers who struggle with feelings of depression.”
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But no matter how happy the psychiatrist is with these developments, she believes things can and should be improved. “Only if healthcare staff work together better and there is more knowledge about suicidal thoughts, can we contribute to preventing young mothers who no longer see a way out from taking their lives.”
“Do you ever think about death?” is an important question to ask, says Merith Cohen de Lara, a mental health psychologist with a specialty in psychological complaints before, during and after pregnancy. She agrees with what Lommerse says. “Mental well-being is high on the agenda of healthcare providers. Feelings of depression can be discussed and that is good, but the question ‘do you ever think about death?’ is asked too little.” And that’s a shame, she thinks, because that question can often make the difference.
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“Women who don’t have those kinds of thoughts are often shocked by it. Yes, they feel sad or down, sometimes even very bad. But death? No, they don’t think about that. For women who do have suicidal thoughts, such a question can provide relief, because they can finally talk about it and realize that it is not bad or strange that those thoughts are there.”
The psychologist understands that asking such a question is exciting. “People are sometimes afraid of giving someone an idea, but asking such a question doesn’t do that. In fact, asking for it actually reduces the chances.”
Also read: Postnatal depression: what can you do?
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Cohen de Lara believes it is up to health care providers to be attentive to a mother’s mental state, especially in the two weeks after childbirth, because that period is a common time for the development of depression.
Another time when depression lurks is around the thirteenth week after birth. “Some women only then dare to admit how bad things are actually going,” says Cohen de Lara. And it is precisely with these women that things go wrong more often, Lommerse saw in her research.
“Suicide often takes place weeks or months after birth in a period when there is little (professional) attention for a mother’s mental well-being.” During that period, healthcare providers are often no longer nearby, so problems may be less likely to be discussed or noticed.
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Highly educated women who suffer from depressive feelings at a later stage after giving birth often know how to find help. She regularly sees Cohen de Lara in her practice. Lommerse’s research shows that this may be different for less educated women.
They sometimes struggle with other social problems such as a small social safety net, housing or money problems, which in turn cause stress and feelings of depression. They also do not always manage to receive the right care, because they do not know the route to assistance (well).
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Thoughts of death in the first period of motherhood are nothing new, according to the figures from Lommerse’s research. A big difference between ‘the past’ and now is that depressive feelings can be discussed. The psychiatrist hopes that we will go one step further in the coming years.
“All pregnant women should know that they can experience psychological problems, that they can feel depressed or even have suicidal thoughts. And if they get it, they need to know that it can pass. Especially if they get the right help.”
You can go here for help
Women with depressive and/or suicidal complaints can report to their GP or midwife, who will refer them to specialized professionals such as Cohen de Lara or the crisis service.
Are you thinking about suicide? Contact 113 Suicide Prevention 24/7 free and anonymously via 0800-0113 or chat on 113.nl.
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*Published figures on maternal mortality often differ, because multiple definitions are used and figures are measured in different ways. In this case we assume mortality before, during or shortly after delivery (source: Kallianidis et al, ACTA, 2022). Lommerse’s research looks at maternal mortality up to one year after childbirth, which makes the figure (16) higher.
