Opinion: We don’t talk enough about the single most common complication of pregnancy

Editor’s Note: Aimee Danielson, Ph.D., is the Founder and Director of the Women’s Mental Health Program at MedStar Georgetown University Hospital and Co-Chair of the DC Perinatal Mental Health Task Force. The views expressed in this commentary are her own. View more opinion on CNN.

Motherhood is often painted in a bright palette: pink tulips, blueberry pancakes and sunny smiles.

But there is a shadowy side of motherhood, too, that frightened women describe to me in private. It’s a darkness often felt in the middle of the night as they rock their babies, exhausted and spread thin.

Their bodies have undergone rapid, often traumatic change. Their brains have experienced a steep spike and drop in hormones. The courses of their lives have shifted. Add sleep deprivation and isolation, and the early months of motherhood can bring on feelings of despair, of hopelessness — even terror.

As a clinical psychologist with decades of experience in maternal mental health, I know that mental illness is the single most common complication of pregnancy. According to the World Health Organization, nearly 1 in 5 women develops a psychiatric disorder before or after birth. Among women of color, more than 1 in 3 suffer from postpartum depression. That means many of us will be affected by perinatal mental illness — or mental health conditions that arise or occur in the weeks before or after birth — whether personally or indirectly, at some point in our lives. Yet, in my experience, these statistics are rarely discussed, and I’ve learned from many obstetricians that they’re shocked to hear this data.

Mothers and their families deserve better. And, finally, that silence is beginning to break, led by survivors who know the difference treatment can make, and the relatives and friends of mothers who never got the chance to be treated.

Thanks to their advocacy, the US opened its first national hotline for maternal mental health last year. In less than a year, they answered nearly 12,000 calls and texts. The Maternal Mental Health Leadership Alliance also helped secure $50 million in federal funding for the hotline and for state programs that increase access to treatment for maternal mental illness. And here in Washington, the DC Council passed a bill that established a perinatal mental health task force, which will provide critical guidance and recommendations for improving perinatal mental health services in the District later this year.

Now is the time to build on this momentum: expanding screening, broadening access and tailoring care.

I know firsthand that a simple depression screening can be a vital step toward hope and healing. I’ve seen countless women cry with relief when they realize the pain they’ve been keeping private has both a diagnosis and a remedy.

But screening must be accompanied by access to treatment, and the gap remains profound. Three in four women with a perinatal mental illness don’t get the treatment they need — which is both tragic and unacceptable, because even for the most serious disorders, we know how to help: More than 95% of women who receive immediate, urgent treatment for postpartum psychosis recover within three months.

The problem is that there aren’t enough clinicians equipped to deliver care, and fewer still whom patients can afford to see. In Washington, D.C., there are over 8,000 births each year, yet far too few with specialty training in reproductive psychiatry who accept commercial insurance and Medicaid. Nationwide, there is one intensive perinatal mental health treatment program for every 21,000 women with a disorder. To visualize what that means, imagine Capital One Arena filled to capacity with sick mothers, all waiting for access to one treatment program — with hundreds more lined up outside.

As a result, too often, mothers are shunted into care settings that don’t meet their needs. In a crisis, they’ll be admitted for an inpatient stay on a psychiatric unit — which can be traumatic in itself — as these programs take them away from their infants and family, often disrupting the bonding process.

Intensive perinatal mental health programs address these gaps in services and confer a range of benefits, to both mother and baby, over traditional inpatient or outpatient care. Mothers spend the day alongside other mothers, engaged in group therapy, practicing mindfulness and developing healthy attachment with their infant — and at night, they can go home and integrate the skills they’ve learned into their family life. The program’s focused intensity — typically offering three hours of daily treatment over a four to six week stay — means that patients receive concentrated care, allowing them to gain essential skills and support that would otherwise take months to develop and that are essential to their recovery.

Connecting every mother to the care she deserves requires everyone to act: philanthropists to provide seed funding, policymakers to create frameworks for scale — and, most of all, the public to demand change. We need your help, your attention and your voice. Our children, families and communities will only flourish when mothers do, too.

As perinatal mental health clinical teams across the US work to open doors to new programs with models of care that center and protect the mother-baby bond, we hope they will be worthy of the mothers, families, clinicians and advocates who made them possible. Most of all, we hope this brings more women into the light.

And to the moms and moms-to-be, who may be struggling in the silence of the night: Support is out there. Help is out there. You are not alone.

For support and resources related to pregnancy and parenthood, call or text the National Maternal Mental Health hotline at 1-833-852-6262. If you or someone you know needs help, call the Suicide and Crisis Lifeline at 988 or visit 988lifeline.org.

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