Co-Director Kathryn Emerick, MD
photo: Jamie Manser
Annually on March 1 is Self-Harm Awareness Day; while it can be a difficult topic to discuss, it is crucial to understand for the pregnant and perinatal population. Self-harm can precede maternal suicide and has impacts on both mom and baby.
Defining the Problem
Perinatal self-harm is an increasing public health crisis. Population data indicates that self-harm in the year preceding or following birth doubled in the U.S. between 2012 and 2017. This tracks with maternal suicide being a leading cause of maternal death in high-income countries such as the US. Impact on the mom and baby include preterm labor, increased need for blood transfusions, respiratory distress of newborn, low birthweight and more difficulty with parent-infant bonding. While it is difficult to separate this data out from risks associated with untreated perinatal mood and anxiety disorders (PMADs), the information we have certainly suggests that perinatal self-harm is associated with worse health outcomes for mom and baby.
Who is at Risk for Perinatal Self-harm
The highest risk populations include those with history of psychiatric illness, age less than 24, history of self-harm, history of substance use and social determinants of health including less than high school diploma and unmarried status. For the post-partum population specifically, multiparity and preterm birth seem to be associated with risk of self-harm.
Assessing for Perinatal Self-harm
Directly assessing for perinatal self-harm is important because it is not likely to be reported due to the perceived stigma surrounding maternal mental health struggles and the societal expectation of what motherhood should look like and feel like. There can be tremendous pressure for a birthing person to present themselves as not struggling because they believe that they are to blame for struggling or that it is a moral failing to experience PMADs. It can be very helpful when discussing this topic to remind the person that experiencing PMADs is not related to something that they did or didn’t do and is not something they could have prevented.
Recognizing the Signs
Identifying the signs of self-harm during the perinatal period is crucial for timely intervention. Common indicators include unexplained injuries, frequent isolation, changes in mood or behavior, and avoiding discussing how they feel. Our entire community — not just providers but loved ones, family members and friends who see an individual most often — should be vigilant to these changes.
Resources for Someone Struggling with Perinatal Self-harm
- National Suicide Crisis Line: 988
- National Maternal Mental Health Hotline: 1-833-TLC-MAMA (1-833-852-6262)
- Find a provider or join a free, online support group at postpartum.net