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Lisa Abramson says she even goes through the door – the helicopters circling her house, the snipers on the roof, and the car ride to jail – she silent wants to have a second child.
That's because the daughter was born in 2014 – before all that trouble began – everything felt amazing. Lisa was smitten, just like she'd imagined she would be. She'd look into her baby's round, alert eyes and feel the adrenaline rush through her. She had so much energy. She was so excited.
"I really like thinking like," I do not get why other moms say they're so tired, or this is so hard. I got this, '"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 worked as a successful entrepreneur and as a marketing executive for a Silicon Valley tech company. When it came to starting her family, she was organized and ready to go. And that first week after her baby was born, everything was going according to plan.
Lisa to feed her every two hours.
"It weighed on me as, I've failed as a mom. And what about the most important thing. And my well-being did not matter. "
She was barely sleeping. Even if she could get a release from what felt like breastfeeding purgatory, she could not relax. As she got more and more exhausted, she started to get confused.
This was something she loved. But after 1
"The noises and intense volume of the spin class are really alarming to me," Lisa says, "It felt like the walls were talking to me."
Then, back at home, they noticed police helicopters circling over their apartment. "We were snipers on the roof," she remembers thinking "And there were spy cams in our bedroom and everyone watching me."
Lisa waited for the police to burst in and take away. But the next morning, she woke up in her own bed.
The cops must have arrested the nanny instead, she decided. That was wrong, Lisa thought to herself. The crime.
Lisa told her husband it was not fair. She's going to jump off the Golden Gate Bridge.
"It was like," Oh, OK, he's taking me in and I guess I'm getting arrested, '"Lisa says.
Her husband, David Abramson, remembers it as one of the worst days of his life.
" I'm bringing my wife to the hospital and then. " checking in into an inpatient unit, says David, explaining what really happened that day. "It was really, really challenging."
Not jail, but a psych ward
There was no crime after all – and no snipers and no spy cams , The nanny had not been arrested, and Lisa's destination was a jail cell, but rather the general psychiatric ward at Sutter Health's California Pacific Medical Center in San Francisco.
The other patients were there for drug overdoses or alcohol withdrawal. People were screaming. One patient thought he was a dog and crawling around on all fours, barking. To David, it did not seem like the right place for a new mom.
"Which is probably the most heart-wrenching thing, what having to leave her that night with the hospital staff," he says.
For the first five days, Lisa says they did not speak to anyone.
"I do not know if I couldn" I speak I was not going to answer anyone's questions. "
Lisa does not remember any doctors or nurses telling her why she was there or what was going on.
The article said elevated hormones from childbirth-plus sleep deprivation-can trigger confusion and paranoia. Lisa did not believe it – she thought her husband was tricking, and spent hours on Photoshop, piecing together a fake article.
"I really have just like," No. I've heard of postpartum depression, " she says. Crazy . "
New data on moms who by suicide
But postpartum psychosis is real. Studies suggest it affects about one or two women out of every thousand that give birth; some doctors now think even more women than that are affected, but go undiagnosed.
California researchers just finished their first big study on maternal suicides. The state's public health department has not yet published its findings: 99 new moms in the state by suicide over a 10-year period.
The investigators determined that of those 99 suicides , 98 were preventable. The women might be alive today if the health care system in California had done a better job screening women, diagnosing them, and treating them.
"The work here is less than 10 percent of what needs to be done, "says Dr. Nirmaljit Dhami, a psychiatrist at El Camino Hospital at Mountain View, Calif.
Dhami is an expert on postpartum mental illness, and often has cases of postpartum psychosis that mishandled OB-GYNs. Based on her clinical experience and observations, she says a lot of doctors do not know the early signs of postpartum psychosis;
"A lot of times the patient wants to see very clearly, then at other times, wants to present with acute confusion and disorganization," Dhami says.
It's what happened to Lisa Abramson –
"This is a symptom that clinicians who are not trained in this field can easily miss," Dhami says, "Because they see the patient in their office with the family, they can think it is normal and they probably suffer from sleep deprivation – and discharge them home."
That's how women can end up dead. In the U.S., mental health problems are one of the main contributors to maternal mortality, according to a 2018 report from a CDC initiative called Building US. Capacity to Review and Prevent Maternal Deaths. Mental health problems (which include drug overdoses) rank seventh – nearly tied to the complications of high blood pressure. For white women, mental health problems are the fourth leading cause of death.
Dhami says the care is often inadequate or inappropriate. Doctors prescribe the wrong medications. Insurance companies push patients out of psychiatric units before they are ready. Dhami says, and may not be equipped to care for even the most basic physical needs of new moms.
For example, when Lisa Abramson first arrived at the psych ward, her husband Lisa had postpartum psychosis. The resident said to him, "Postpartum what ?"
Then, several days into Lisa's stay, she complains of pain in her breasts.
Her husband had a job in Lisa's breast pumping from home.  Lisa says.
But the worst thing of the year is "She remembers what she wanted to do, she had a room with padded walls that looked like a solitary confinement chamber." her baby daughter. The inpatient unit has a strict policy: no infants or children on the ward.
"They said, 'She's a new mom and she needs to see her baby. it's important, "Lisa recalls, tearing up."
Lisa's family was so unhappy with her care at the hospital, that her husband decided to get out of there.
Dhami enrolled Lisa in a Comprehensive outpatient program she runs at El Camino Hospital, called the Maternal Outreach Mood Services (MOMS) program, where the new mother can bring her baby along during appointments.
California's Pacific Medical Center declares it to be Lisa's case specifically, even though Lisa authorized the hospital to discuss her medical records. The hospital's inpatient psychiatric medical director, dr. Stephanie Wilson says the new moms' wishes to see their babies on a case-by-case basis.
"We take into consideration all the circumstances and the details of that patient, of the infant – and really seeing what, if any, benefit or even potential harm, it could have been to the mother, "Wilson says.
A different kind of care for moms
There's plenty of research, dating back to the 1940s, on the ideal protocols for inpatient treatment of postpartum mental illnesses. Part of the mom's therapy in these units is getting guidance on how to read the baby's cues, and how to meet the baby's needs – as well as her own. At night, the baby sleeps in a supervised nursery, so the baby can get uninterrupted sleep.
In the United Kingdom, there are 21 of these mother-baby psychiatric units. In France, there are 15. They exist in Belgium and New Zealand. There are zero.
The closest to North Carolina can be found in North Carolina, 3,000 miles from where Lisa lives at the University of North Carolina at Chapel Hill .
The perinatal psychiatric unit here is exclusively for pregnant women and new moms.
"There is a need for them to see other moms going through what they're going through," says Dr. Mary Kimmel, the psychiatrist who runs the unit. She wears a denim jacket and black suede ankle boots, and whenever she's a mom, she says yes, she has two kids.
Every room has a hospital grade breast pump, Kimmel says, and there's a lactation consultant who helps women with breastfeeding.
"Babies can come to the unit and really encourage that," Kimmel says. "We encourage older kids to come to the unit."
Most afternoons, toddler's scurry around the day room, or color, play with toys and play with each other. Women cradle their newborn visiting, rocking them, feeding them.
The babies are not allowed to stay overnight though. Unlike the units in Europe, there's no nursery here. The main reasons for that are the restrictions of U.S. insurance plans.
Kimmel says no insurer in the U.S.
"That baby does not have a distinct need to be and so it's not possible to bill for the baby at the hospital," she says. And without that, the hospital can not afford to run a nursery.
The days on the UNC unit are very structured, with a range of treatments. There's one-on-one therapy and lots of group classes: parenting and time management lessons, for example, where women practice for their partner for help; relaxation classes; and spiritual counseling.
Alice Sarti says the moms unit at UNC. After she gave birth to her son, she became engulfed by mania.
"Every minute I had to do with a task: researching day cares, doing and re-doing my budget," she remembers. 17 bottles. "
She loved how productive she was. She's a business analyst and loves getting things done. But then, everything started to spiral.
"There's a definite snap," she says. "I started yelling things that did not make sense."
To her family, it was just incoherent rage.
"You saw people that could not speak, that's not the mom's unit at UNC, but rather a general psych ward." could barely walk, "she says.
Alice refused to take any meds, and that unpopular with the staff.
"I did have a social worker tell me I was going to lose my child if I did 't' pull it together, '"she says.
During her three-week stay, she saw her son once, for 20 minutes.
" I was not able to touch him on any level. "
"It felt like a burden. It's hard to come to it, so it's gone."
"It feels like a burden "Alice says. "It felt like, 'How I ever go to do this?' I've got him, I bathed him, and I did all the things – but the connection was not there. "
Alice was treated at two different hospitals [UNITED KINGDOM]
Finally, everyone seems to understand what she is going through, she says – the pressure she's feeling and the guilt. She saw her regularly, and helped her to re-establish her bond with him.
"It's this incredibly nurturing environment," she says.
Yet, even in this seemingly perfect place, things can go wrong. By the time Alice was discharged, her mania had cleared. But then she slipped into the deepest, darkest depression she had ever known. She is back in UNC, she's afraid to kill herself.
With Alice, and with other patients, doctors are talking about how to get over the medication, Kimmel explains.
UNC's mom's unit pays the bills like other hospitals – they take commercial insurance and medicaid to cover the costs of care.
But the longer a patient stays, the more in insurer has to pay, and that's not good for their bottom line. Kimmel and other doctors say, as soon as a patient comes off suicide watch, calling insurers start calling.
"Our average length of stay runs from about one week to two weeks," Kimmel says.  And in Europe? "About 40 to 50 days is the average length of stay there," she says.
doctors may start their patients on new drugs, but not on time if they work well.
It means that that. Or, they have to start breastfed – instead of slower-acting therapies
Insurers insist the decision to discharge is not just about cost.
Hospitals are not necessarily Kate Berry, Senior Vice President of Clinical Innovation for America's Health Insurance Plans, says: "There are other settings where the care can continue," she says. Alice Sarti says "mental as a partial hospital or intensive care patient setting."
Alice Sarti says mental hospitals in the US are just warehousing people. Only the mom's unit felt like a place of healing.
"It's a different kind of place," she says. And that does not come close. "
Right now, UNC is the only one hospital in the country that has a designated psychiatric unit just for pregnant women and new moms. A hospital in New York has a women-only unit. And El Camino Hospital, where Dhami practices in California, wants to start building on a women-only psychiatric unit, with a special focus on the needs of new moms. It is slated to open in 2019.
Ready to try again
Lisa Abramson is playing catch with her daughter Lucy.
"Ready? Set? Go!" Lucy shouts and Lisa rolls her a small rubber soccer ball.
Lisa feels like she's back to her normal self.
"It's the most courageous moment of my life," she says.
They were terrified, though, that the psychosis would come back.
"They say there's about a 50 percent chance "she says. "I can try to set up a better situation, but you just do not know – and it's out of your control, which is hard."
The number one thing she wanted to avoid was going back to the hospital
"The hospitalization is probably the most traumatic [aspect] of the whole experience," Lisa says.
These days, she loves being a mom, she says. Lucy is 5 now. Her second daughter, Vivian, is 18 months old.
The psychosis did not come back after Vivian's birth, in part because of all the precautions Lisa took. She made sure she got enough sleep.
"We've got so many messages of just self-sacrifice," Lisa says. "'Do anything for your kids.' 'Drop everything, that's what it means to be a good mom.' And for me, that's not what made me a good mom.
"I'm trying to put myself first – guilt-free – and know that that makes me a better mom. "
This issue is part of NPR's reporting partnership with KQED, the California Report and Kaiser Health News .