One in every 19 maternal deaths in Ontario is attributable to suicide.
That's the troubling finding of a study published in the Canadian Medical Association Journal earlier this week that shines a light on a topic often seen as taboo: suicide among new mothers and mothers to be.
"Despite high-profile media attention and calls to increase knowledge, with the goal of encouraging policy change, little is known about the true extent of the problem in Canada or the steps that can be taken to prevent it," write the authors of the study, published August 28.
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Their conclusion zooms out on the phenomenon of post-partum depression to show that women can be vulnerable to suicide throughout what's called the perinatal period — not only during the first four weeks of the baby's life but months later, as well. And it ends with a caution to health-care providers to be "collectively vigiliant" when it comes to determining a woman's risk.
'It became really isolating'
The research examined coroner records of women aged 18-45 who took their lives over a 15-year period from 1994-2008, and found that suicide accounted for 51 of 966 deaths among pregnant women and those in the first year following birth across the province — that's approximately five per cent. And it makes suicide the fourth leading cause of death for perinatal women.
'The most powerful two words in the English language are: Me too.' - Claire Zlobin, founder of Life With A Baby
It's a conclusion made even more heartbreaking when you consider that perinatal women were found to turn to much more lethal means, including hanging or jumping, than other women who took their lives. And that fewer than half had contact with a mental-health provider in the 30 days before their deaths.
That reality was one of the reasons that drove Toronto mother Claire Zlobin to take matters into her own hands and start Life With A Baby, a network for new parents born from her own feelings of loneliness as a new mother in a new part of the city.
It was 2007 when Zlobin had her daughter, moving from the downtown core to Thornhill to start a family.
But when her husband went back to work, the feelings of isolation crept in around Zlobin.
"It was just me and her in our house. It became really isolating and I had a lot of anxiety, being a first-time mom and not really knowing what I was doing," she said.
A resource born from pain
Before long, her project took on a life of its own and now has chapters across the province to help fill what she says are some of the gaps in mental health services for new parents.
"I think we're lucky in the GTA," she said, citing services offered by Mount Sinai Hospital and the Sunnybrook Health Sciences Centre.
'But a lot of places, there's not a lot of community resources, so you're really driving like 15-20 minutes to get to an early- years centre," she said.
The study, published this week, raises questions about exactly that.
Ontario's rate of suicide among pregnant women falls somewhere between that of the United States and the United Kingdom.
But of all the regions covered in the research, the study authors found women in the northwestern part of Ontario died more often by suicide than in any other region. The North West Local Integrated Health Network (LHIN) spans the area from the Manitoba border to just west of White River, running from Hudson Bay all the way to the United States border. And while it's the largest of Ontario's 14 LHINs, it's also the least populated.
That women in the region may be more likely to die by suicide than anywhere else in Ontario "perhaps speaks to the isolation or lack of access to care, hypotheses that would need to be tested directly," the study says. It also points out that 21 per cent of the population in the region is of Indigenous ancestry.
Thinking beyond post-partum
One of the most serious findings in the study is that women who took their lives did so mainly around the seventh or eight month after birth. That, notes Dr. Brian Goldman, "is far beyond the first four weeks of the baby's life."
In a post for CBC Radio's White Coat, Black Art this week, Goldman points out that the latest definition of postpartum depression pegs it at as starting during pregnancy or during the first four weeks after birth.
The study authors note the finding is important — it could suggest women who experience depression later on might not be diagnosed or receive the necessary care.
But if there is a silver lining to the report, Goldman suggests, it's that it may be possible to identify women at risk before it's too late. That's because the women who died by suicide were found to be more likely to have seen a primary care provider to address a mental health concern within the year before their deaths.
For Goldman, that presents an opportunity. "People like me need to ask about a history of mental health problems as part of routine care," he said.
For Zlobin, being able to connect with other mothers and hear about their shared anxieties was way out the darkness she found herself in all those years ago.
"When you think you are the only one, it makes things a lot harder. You don't want to ask for help so the stigma of all of that prevents you from getting help," she said.
The reality, she hopes new moms will find, is that they aren't alone in their fears.
"The most powerful two words in the English language are: Me too."