She wanted to be the perfect mom, then landed in a psychiatric unit

Lisa Abramson says that even after all she's gone through – the helicopters circling her house, the snipers on the roof and the drive to get to jail – she still wants to have a second child.

Indeed, just after the birth of his daughter in 2014, before all these problems started, everything seemed incredible. Lisa was in love, as she had imagined. She looked into her baby's round, alert eyes and felt the adrenaline invading him. She had so much energy. She was so excited.

"In fact, I thought to myself," I do not understand why other mothers say that they are so tired, or it's so difficult. I understood that, "she says.

Lisa wanted to be the perfect mom. She was ready to be the perfect mom. She and her husband lived in San Francisco and Lisa had worked as a successful entrepreneur and marketing executive for a Silicon Valley technology company. When she was starting her family, she was organized and ready to go. And this first week after the birth of her baby, everything was going as planned. The world was only love.

Then the baby started to lose weight and the pediatrician asked Lisa to feed him every two hours.

Lisa started to feel unable to follow.

"It has weighed me to say," I have failed as a mother. I can not feed my child, "she says." I needed to feed her – that was the most important thing. And my well-being did not matter. "

She was hardly sleeping. Even when she could get a release of what looked like a purgatory of badfeeding, she could not relax. As she was more and more exhausted, she began to get confused.

Lisa thought that participating in a spin clbad could help. It was something that she liked in the usual way. But after 10 minutes, she escaped from the room.

"The noises and the intense volume of the spin clbad really worried me," said Lisa, "I had the impression that the walls were talking to me."

Back home, she noticed police helicopters flying over their apartment. "There were snipers on the roof," she remembers, thinking, "And there were spy cameras in our room and everyone was looking at me, and my cell phone was giving me strange messages."

Lisa waited for the police to burst in and take her away. But the next morning she woke up in her own bed.

The cops had to stop the nanny instead, she decided. That was wrong, Lisa thought. The nanny should not be punished for my criminality.

Lisa told her husband that it was not fair. She was going to jump from the Golden Gate Bridge.

And it was at that moment that her husband told him that he was going to drive her to the police station himself.

"It was like:" Oh, OK, he takes me and I guess I'm going to get arrested ", says Lisa.

Her husband, David Abramson, remembers it as one of the worst days of his life.

"I take my wife to the hospital and then I enroll her in an inpatient unit," explains David, explaining what really happened that day. "It was really, really difficult."

Not a prison, but a psychiatrist

There was no crime after all – and no snipers and no spy cameras. The nanny had not been arrested and Lisa's destination that day was not a prison cell, but rather the general psychiatric ward of the California Pacific Medical Center at Sutter Health in San Francisco.

The other patients were on site for a drug overdose or alcohol withdrawal. People were screaming. One patient thought he was a dog and crawled on all fours barking. For David, this did not seem like the right place for a new mom.

"What was probably the most heartbreaking was to leave her that night with the hospital staff," he says. "You could see in her eyes and body language that she was panicked."

Lisa says that she has not spoken to anyone for the first five days.

"I do not know if I could not speak or if I did not speak," she said, "but I was sufficiently terrified by the environment and I decided not to respond to questions from anyone. "

Lisa does not remember that doctors or nurses told her why she was there or what was going on. But she remembers that about a week after her hospitalization, her husband had brought her an online printed document about postpartum psychosis.

The article indicated that elevated hormones during childbirth – as well as sleep deprivation – could cause confusion and paranoia. Lisa did not believe it – she thought her husband was cheating on her and had spent hours on Photoshop badembling a fake article.

"I was really like:" No. I've heard about postpartum depression, "she says. "No, I have never heard that there is a postpartum crazy. "

New data on mothers who commit suicide

But postpartum psychosis is real. Studies suggest that it affects about one or two women in a thousand who give birth; some doctors now think that even more women than that are affected, but are not diagnosed. Without proper treatment, some of these women eventually die – by suicide.

Californian researchers have just completed their first major study of maternal suicides. The state's public health service has not yet released the results, KQED was able to review some of the data: 99 new mothers in the state died by suicide over a 10-year period.

Investigators determined that of these 99 suicides, 98 were preventable. Perhaps women would be alive today if the California health care system had done better to screen, diagnose and treat women.

"The work we do here is less than 10% of what needs to be done," says Dr. Nirmaljit Dhami, a psychiatrist at El Camino Hospital in Mountain View, California. She helped review the suicides, but did not share the reporting data with the reporters.

Dhami is an expert on postpartum mental illness and often deals with post-partum psychosis that is poorly managed by OB-GYN. According to his clinical experience and his observations, many doctors ignore the first signs of postpartum psychosis. they do not know that the symptoms are increasing and decreasing.

"Often, the patient will present very clearly, then at other times, with confusion and acute disorganization," says Dhami.

That is what happened to Lisa Abramson: having the impression of being sane for a moment, then believing that the walls were talking to her later.

"It's a symptom that clinicians who are not trained in this area can easily miss out," says Dhami, "because they see the patient in their office with the family, they may think that the patient is normal and probably suffers from sleep. deprivation – and send them home. "

That's how women can be dead. In the United States, mental health problems are one of the major contributors to maternal mortality, according to a 2018 report released by a CDC initiative entitled Strengthening the United States' Capacity for HIV Testing and Prevention. maternal deaths. On the list of causes of death among new mothers, mental health problems (including drug overdoses) rank seventh – almost on par with the complications of hypertension. For white women, mental health problems are the fourth leading cause of death.

Even when new mothers receive psychiatric care in the days and weeks following the birth of their child, says Dhami, care is often inadequate or inadequate. Doctors prescribe the wrong drugs. Insurance companies push patients out of psychiatric units before they are ready. And psychiatric unit staff, in general, are not trained in these diseases, says Dhami, and may not be equipped to take care of the most basic physical needs of new moms.

For example, when Lisa Abramson first arrived in the psychiatric ward, her husband told the resident physician who admitted that he thought Lisa was suffering from postpartum psychosis. The resident told him: "Postpartum what? "

Then, several days after the start of Lisa's stay, she complained of chest pains. She had stopped badfeeding the moment she left home and no one thought her bads would be engorged.

Her husband had to negotiate with the staff to bring Lisa's bad pump home.

She remembers that when she wanted to go, she had to use a room with upholstered walls that looked like an isolation room – "what would you imagine of a terrorist film," Lisa explains.

But the worst was not having the right to see his little girl. The hospitalization unit has a strict policy: no infants nor children in the room. The hospital says this is designed as a safety measure for everyone.

Her family lobbied for her.

"They said:" It's a new mom and she needs to see her baby.That keeps this connection, it's important, "Lisa recalls tearing herself apart. "It was the hardest part, it was not being able to see her."

About five days after the start of her stay there, Lisa's family was able to negotiate a permit for one-hour visits with her daughter, but they were monitored by a person who was constantly monitoring her watch .

Lisa's family was so unhappy with her care at the hospital that her husband decided that he had to get her out of there. They found Dhami and asked him to take care of Lisa's treatment.

Dhami has enrolled Lisa in a comprehensive ambulatory care program she's leading at El Camino Hospital, called the Maternal Outreach Mood Services (MOMS) program, where the new mother can take her baby to her appointments .

California Pacific Medical Center declined to comment on Lisa's case in particular, although Lisa allowed the hospital to discuss her medical record. Dr. Stephanie Wilson, the hospital's Medical Director of Psychiatry, said that bad pumps are now available to women who need them, and that health care providers are reviewing the wishes of new mothers to see. their babies on a case by case basis.

"We take fully into account all the circumstances and details of this patient, the baby – and really see what would be the benefits, if any damage, that it could have for the mother," Wilson said. "Once the symptoms of depression and psychosis begin to improve, it is at that point that I would begin to allow more visits."

A different kind of care for moms

Since the 1940s, much research has been conducted on the ideal protocols for hospital treatment of postpartum mental illness. The gold standard is to admit the mother and the baby to the hospital together, in a specialized mother-baby unit, where they are treated to two.

Part of the mother's therapy in these units seeks to know how to read the baby's signals and how to meet his needs – as well as his. At night, the baby sleeps in a supervised nursery so that the mother can sleep without interruption.

In the UK there are 21 of these mother-baby psychiatric units. In France, there are 15. They exist in Belgium and New Zealand. There is even one in India.

But in the United States, there is zero.

The nearest approximation is in North Carolina, 3000 km from Lisa's, at the University of North Carolina Hospital at Chapel Hill.

The perinatal psychiatric unit is exclusively reserved for pregnant women and new mothers.

"They need to see other mothers live what they're going through," says Dr. Mary Kimmel, the psychiatrist who heads the unit. She is wearing a denim jacket and black suede ankle boots. Whenever a patient wants to know if she is also a mother, she responds that yes, she has two children.

According to Kimmel, each room has a hospital-grade bad pump and a badfeeding consultant helps badfeeding women. The unit has a designated refrigerator to allow moms to store pumped milk.

The main feature of the program is the visitor policy.

"Babies can come to the unit and we really encourage it," Kimmel says. "We encourage older children to come to the unit as well."

Most afternoons, toddlers wander in the living room or color, play with toys and play with each other. The women cradle their newborns visiting, rock them, feed them.

Babies are not allowed to stay overnight. Unlike units in Europe, there is no nursery here. The main reasons for this policy are restrictions imposed by US insurance plans.

Kimmel says that no American insurer would ever pay for a healthy baby to be admitted to the hospital.

"This baby does not have a distinct need to be admitted and so it's not possible to bill her arrival at the hospital," she says. And without that, the hospital could not afford to run a manger.

Days on the UNC unit are very structured, with a range of treatments. There is one individual therapy and many group clbades: courses on parenting and time management, for example, where women practice asking their partner for help; relaxation clbades; and spiritual advice.

Alice Sarti said that the mothers unit at the UNC was the first place that gave her hope as a new mother. After giving birth to her son, she was overwhelmed by mania. She had been struggling with depression many times before, but never before.

"Every minute, I had to do a job: look for daycare, redo and redo my budget," she recalls. "I'm not going to line up three bottles – I'm going to line up 17 bottles."

She liked her productivity. She is a business badyst and likes to get things done. But then everything started spiraling.

"There was a definitive break," she says. "I started screaming about things that did not make sense – they made sense to me."

For his family, it was only an incoherent rage. They called the police and took Alice to the nearest hospital where there was a bed available – not the mother's unit at UNC, but rather a general psychiatry room located in several cities. the.

"You saw people who could not speak, who could barely walk," she said. "People have been released in this state."

Alice refused to take medication, which made her unpopular with the staff.

"A social worker told me that I was going to lose my child if I did not do it," she says.

During her three-week stay, she saw her son once, for 20 minutes.

"I could not touch him at any level, he was in his car seat and I caught him and shouted at him," she says.

It's hard for her to admit what it was like to come back to him after her release.

"It was like a burden," Alice says. "I had the impression" How will I be able to do that? "I held it in my arms, I washed it and I 'd felt it. did everything, but the link was not there.I lost time with my son and I will never get it back. "

Alice was cared for in two different hospitals, never feeling better before ending up at her mother's psychiatric unit at UNC Chapel Hill.

Finally, everyone seemed to understand what she was going through, she said – the pressure she felt and the guilt. She saw her son regularly and the staff helped her to reconnect with him.

"It was this incredibly stimulating environment," she says. "It changed the trajectory of my life and that of my son."

Yet, even in this seemingly perfect place, things can go wrong. By the time Alice was released, her mania had dissipated. But then she slipped into the deepest, darkest depression she'd ever known. She returned to UNC, fearing to kill herself.

With Alice and the other patients, the doctors are so eager to get the mothers back home quickly that they sometimes take too much medicine, explains Kimmel. Part of this pressure comes from the mothers themselves, who want to be with their children, but also from insurance companies.

The mother unit of the UNC pays bills like other hospitals – they take out commercial insurance and Medicaid to cover the costs of care.

But the longer a patient stays, the more the insurer has to pay, which is not good for his or her results. Kimmel and other doctors say that as soon as a patient leaves suicide watch, insurers start calling to ask when she can return home.

"The average length of our stay varies from about a week to two weeks," says Kimmel.

And in Europe? "The average length of stay is about 40 to 50 days," she says.

This means that some American doctors can administer new drugs to their patients, but they do not have time to see if they work well. Or, they should immediately give women the most intense medications – drugs that force them to stop badfeeding – instead of slower-acting therapies that could give a mother more time to feed her. baby in the bad.

It also means that patients like Alice can be hospitalized four times before they receive the right treatment they need to truly recover.

Insurers insist that the decision to fire does not only concern costs, but also what is best for patients.

Hospitals are not necessarily the ideal environment for stabilizing drugs, says Kate Berry, Senior Vice President of Clinical Innovation at America & # 39; s Health Insurance Plans, a group of professionals for insurers.

"There are other contexts in which care can continue," she says, "such as a partial hospital or an intensive ambulatory care facility that might be more supportive of the presence of the mother and the caregiver. baby."

Alice Sarti says that psychiatric hospitals in the United States only store people. Only the unity of the mother was a place of healing.

"It's a different kind of place," she says. "It's the type of mental health care that everyone should have access to – not just the mothers – it's what mental health care should look like in this country. do not approach it. "

At present, the UNC is the only hospital in the country to have a psychiatric unit reserved for pregnant women and new mothers. A hospital in New York has a women's unit. And the El Camino Hospital, where Dhami is practicing in California, will soon begin construction of a women's psychiatric unit, geared to the needs of new moms. The opening is scheduled for 2019.

Ready to try again

Lisa Abramson plays wrestling with her daughter Lucy.

"Ready? Ready? Come on!" Lucy screams and Lisa gives her a small rubber ball.

Lisa feels like she's back to normal. But she thought a lot about her experience of postpartum psychosis.

Despite everything, she decided to have another baby.

"It was the most courageous moment of my life," she says. "Without knowing anything [about] how that will really work, let's try again. "

She was terrified, however, that the psychosis would come back.

"They say there's about 50% chance," she says. "I can try to set up a more optimal situation, but you do not know either – and it's out of your control, which is difficult."

The first thing she wanted to avoid was to go back to the hospital.

"The hospitalization was probably the most traumatic [aspect] from all the experience, "says Lisa.

These days, she likes to be a mom, she says. Lucy is 5 years old now. His second daughter, Vivian, is 18 months old.

The psychosis did not return after Vivian's birth, partly because of all the precautions taken by Lisa. She made sure to get enough sleep. She gave herself permission to give up badfeeding, if it was too much.

"We have so many self-help messages," Lisa said. "Do anything for your kids." "Leaving everything. That's what it means to be a good mother. "And for me, that's not what makes me a good mother, that's what made me fall apart.

"I try to put myself first – without guilt – and I know that this makes me a better mom. "

This story is part of the partnership between NPR and KQED, the California Report and Kaiser Health News.