Silent Crisis, Unrescued Mothers

Ariana Sutton gave birth to healthy twins on May 22, 2023, at Newton-Wellesley Hospital, just outside Boston. It was her second pregnancy. Nine days later, she committed suicide, leaving behind her newborns, her 4-year-old daughter, Melody, and her husband, Tyler.

In a note she left, Ariana described herself as “a burden to [her] family.”

There had been no warning signs in her medical chart. Her first pregnancy had gone smoothly, as had this one. Her obstetricians at Newton-Wellesley Hospital, just outside Boston, reassured her throughout that everything looked normal. Ariana had trusted them, and had been excited to bring her twins home.

What her doctors failed to fully recognize was that Ariana had never fully recovered from postpartum depression after Melody’s birth. Her mental health challenges had never fully resolved, but were largely overlooked in the course of her ongoing care. Her second pregnancy just intensified her postpartum struggles after delivery.

She was discharged from the hospital on May 23. Eight days later, Tyler found her dead in their bedroom.

A Growing Toll

The United States has the highest maternal mortality rate among the world's wealthiest nations. The recent data from the World Bank shows that approximately 650 women died of maternal causes in 2023, marking a decline from the pandemic peak but still far above rates in peer high-income countries. During the height of the COVID-19 pandemic, maternal deaths climbed, with over 1200 deaths recorded in 2021, the highest number in recent history.

Mothers in America are significantly more likely to die from pregnancy-related causes than in any other developed country. Recent comparisons show that women in the U.S. are twice as likely to die from childbirth as women in the United Kingdom, nine times more likely than women in Australia, and 17 times more likely than women in Norway, according to the World Bank data.

The burden is not evenly shared. African American women are nearly three times more likely to die from pregnancy-related complications than white women, a disparity that remains regardless of income or education level. Low-income mothers and mothers living in rural areas are also at heightened risk, often due to limited access to quality prenatal and emergency obstetric care.

A review by the Centers for Disease Control and Prevention (CDC) found that four out of every five pregnancy-related deaths in America are preventable. That means hundreds of mothers die each year not from inevitability, but from systemic failure.

In recent years, the federal government has stepped up in its efforts to address maternal mortality. One of the most ambitious steps came in 2022, when the Biden administration introduced The Blueprint for Addressing the Maternal Health Crisis. The plan called for raising hospital safety standards, expanding perinatal workforce as well as the training for healthcare workers, and developing standardized protocols for handling maternal emergencies. It represented one of the clearest acknowledgments yet from Washington that maternal deaths in the United States are a public health emergency.

But for all its promise, most strategies to reduce maternal deaths have historically been focused on the delivery rooms. However, the majority of these maternal deaths happen after the mother and baby have been sent home. According to the data by Maternal Mortality Review Committees, around 65 percent of maternal deaths happen in the postpartum period. They are caused from a wide range of medical complications: hemorrhage, cardiac conditions, infections, preeclampsia, cardiomyopathy, and embolism. One cause in particular, however, has remained persistently under-addressed by hospitals and policymakers alike: maternal mental health complications.

In recent years, mental health conditions, including postpartum depression, substance use disorders, and suicide, have become the leading cause of maternal death in the U.S., accounting for roughly one in four cases, datashow. These losses are especially tragic because, in many cases, they could have been prevented with timely intervention, comprehensive screening, and better access to treatment. Yet mental health remains the blind spot in much of the country’s maternal health policy.

The Postpartum Danger Zone

For many mothers, the most dangerous period begins not in the delivery room, but after they leave it. Once home, they often face overwhelming challenges with limited support, navigating sleepless nights, physical recovery, and the demands of caring for a newborn. “I’d say what is fueling the issue more than anything in our current culture is the lack of connection and support. There’s often no one helping a mother. In other cultures, babies are raised within a community, family, cousins, aunts, uncles, but here, many moms are alone at home with their baby, isolated and without support,” explains Dr. Constance Guille, a professor and director of the Women’s Reproductive Behavioral Health Division at the Medical University of South Carolina. For mothers who are already at risk, this isolation can magnify depression, anxiety, or substance use, sometimes with fatal results.

The postpartum period is also the point when the safety net shrinks. Routine medical appointments decrease within weeks, and when mothers do see a provider, the focus is usually on the baby’s growth and development, not the mother’s well-being.

“Most people have one visit with their OB-GYN around six weeks postpartum, but then that's it,” said Dr. Emily Dossett, a reproductive psychiatrist who founded the Reproductive Mental Health Program at LAC+USC Medical Center. “Most of the suicides occur from week seven or eight after delivery until the end of that first year, when the woman doesn't have any contact with her own doctor. And even if she has a nurse, the attention is mostly on the baby, not the mother,” she added.

For Abby Webb, a 40-year-old mother of two in Delaware, things got worse very quickly. Her history of depression offered little preparation for the intensity of postpartum depression, which began soon after she delivered her son this May. “I felt crazy – flat out, use the word, I was crazy,” she says. What set postpartum depression apart, she explains, was a constant fear: “It’s this sense that something bad is going to happen, and it’s going to end up costing my baby’s life.”

The American College of Obstetricians and Gynecologists (ACOG) reports that perinatal depression, major or minor depressive episodes during pregnancy or within a year after childbirth, is among the most common complications of pregnancy.

One in five mothers experiences mental health challenges during or after pregnancy, according to the ACOG reports. Yet many never seek help. For Abby Webb, the warning signs appeared right after the delivery. Her thoughts felt off, and her emotions were intense. “It wasn’t just postpartum depression. I had postpartum rage and postpartum anger. And I was terrified that if I asked for help, someone would take my kids away,” she says.

The fear is far from uncommon. “Some women worry that if they admit to a mental health problem, or especially a substance use problem, their baby will be removed from their care,” explains Dr. Dossett.

Gaps in Care

The Biden Administration's Blueprint for Addressing the Maternal Health Crisis included a seemingly simple policy to deal with preventable maternal deaths: extend postpartum Medicaid coverage from two months to a full year. Proposed in 2021 by then-Vice President Kamala Harris, the measure won broad adoption, 46 states have approved it .

The expansion was meant to be a turning point. Instead, where a woman lives often determines whether she can get care after giving birth. In the case of the U.S., it is not that accessible in many parts of the country. Analysis shows that about 35 percent of U.S. counties are “maternity care deserts”, a term the March of Dimes, a nonprofit focused on improving the health of mothers and babies, used to describe areas with no hospitals or birth centers offering obstetric care and no obstetric providers. More than 2.3 million women of reproductive age live in such places, most of them in rural communities.

The situation is getting worse. Between 2010 and 2022, 530 hospitals shuttered their obstetrics units, removing access even in communities that once had it. In rural America, these closures often mean a pregnant woman or a new mother faces hours of travel for prenatal visits or delivery, a burden that can delay treatment when complications come up.

When Abby was diagnosed, doctors asked her to come to the hospital every day to do group therapy in the closest mental health facility she could go, a requirement that proved challenging for many reasons, but one the most inconvenient ones was that the trip took her 45 minutes drive each way. “I had no money to pay for gas to go back and forth. It was awful,” she recalls.

Access to mental health care is even less common than maternity services in many parts of the country. Most U.S. counties lack obstetric units altogether, and far fewer have mental health providers. Analysis of the Health Resources and Services Administration shows that on average there are fewer than 10 mental health providers per 100,000 people across the states.

Another critical factor in accessing care, including mental health services, is having reliable health insurance. The number of uninsured women in the U.S. is significant and this lack of coverage creates a major barrier to treatment. Without insurance, women may face big costs for therapy, medication, or psychiatric consultations, forcing many to go without care, rely on overloaded public clinics, or end up having big medical debts. According to the analysis of the data provided by the ERASE-MM Community Vital Signs Project, in half of America’s states, more than 10 percent of women are uninsured. In Texas, the situation is even more severe: one in four women live without any health insurance, leaving them particularly vulnerable during and after pregnancy. This coverage gap deepens the existing disparities even worse, making it far more difficult for low-income mothers and mothers in rural or underserved areas to access essential mental health support when they need it most.

Individual Tragedies vs. Systemic Failures

Ariana’s postpartum depression began to surface after the birth of her first child. At first, her concerns seemed like the normal worries of a new mother. But those concerns quickly intensified into overwhelming anxiety. She became consumed with fear. Her worries included everyday things, that the tap water might be unsafe for the baby, or that she had somehow hurt her daughter just by giving her a pacifier.

The fears escalated in a short amount of time. She insisted Tyler take their baby to the emergency room, not once, but several times. Each time, doctors examined the baby and found nothing wrong. But eventually, they recognized the real emergency wasn’t the baby, it was Ariana.

She was admitted twice to the psychiatric unit at Newton-Wellesley Hospital and prescribed antidepressants. After the second hospitalization, the medication began to take effect. Ariana seemed to stabilize. She returned to work, resumed her routines, and appeared to be herself again.

When Ariana told Tyler that she wanted to have another child, he hesitated. The memory of what had happened after their daughter’s birth was still fresh. He feared that the depression Ariana had experienced during the postpartum period might return, and this time, it could be even more severe.

But Ariana was still in therapy, and her therapist and psychiatrist assured the couple that she would be closely monitored throughout her pregnancy. That promise that someone would be paying attention gave Tyler enough reassurance to move forward with trying for another baby.

Ariana became pregnant with twins, and the pregnancy progressed without any major complications. She was excited and hopeful. She often chatted with the contractor working on their home, who happened to be a father of twins himself, asking him questions about what life with twins might be like. She started preparing the nursery, filling it with decorations and plans.

Her one of the biggest fears was to deliver prematurely. Then at 34 weeks, Ariana’s water broke. While early labor is not uncommon with twins, she immediately grew anxious and blamed herself. She wondered whether a recent stomach bug had triggered the early labor or if she could have done more to prevent it.

Doctors and nurses tried to reassure her. The nurse assigned to her, who was a twin herself, gently explained that delivering at 34 weeks was still within the normal range for twin pregnancies. But the reassurance didn’t land and Ariana’s worry had already taken roots.

According to Tyler, it was hard to get psychiatric treatment for postpartum depression. “Even when we knew what it was, we still had a difficult time finding a therapist specialized in postpartum depression. Because it's not talked about. It's not publicized. It's not even quick to look up on the internet,” he says.

Lack of mental health providers, especially the ones specializing in postpartum depression or addiction create the zones called “mental health vulnerability areas”. The Maternal Vulnerability Index, or MVI, ranks U.S. counties and states on the risks expectant mothers face, assigning each a score from zero to 100. Lower scores indicate the least vulnerability, while higher ones mark places where the odds of poor maternal health outcomes are greatest.

According to the MVI of mental health in the US, women in more than half of the counties in the US have a high risk of facing mental health issues.

Organizations like ACOG recently have started prioritizing mental health treatment for mothers and have been providing recommendations, calling for all pregnant and postpartum patients to be screened for mental health conditions. Too often, anxiety, depression, or even suicidal thoughts go unnoticed. ACOG now urges providers to screen every patient multiple times, at the initial prenatal visit, midway through pregnancy, and again during postpartum.

However, putting those recommendations into practice isn’t as straightforward as it might seem in many parts of the country. According to Dr. Guille, screening remains limited. “OB-GYNs and pediatricians now have to learn how to screen and diagnose mental health concerns,” she says. “Some have embraced that role and do it very well. Others may not see it as part of their practice. They worry about screening someone, identifying a problem, and having nowhere to send them. That’s a very real concern,” she added.

Doctors who worked with Ariana, and knew about her postpartum depression failed to recognize the signs while she was in the hospital and it was too late too soon to help her. When asked about what doctors could do differently, Tyler replied “If I could do something differently, I probably would have discussed it with doctors at Newton-Wellesley if I see any familiar signs, is it okay for her to be checked back into the ward?” He continued: “But again, we didn't have a lot of information on the topic even after those four years. Everything was brand new.” Sadly Ariana happened to fall victim to the healthcare system that overlooks health mental health complications like hers and often treats such cases as individual tragedies while they are deeply connected to structural failures.

Ariana’s death is not just a personal tragedy, it is emblematic of a national failure to recognize and address maternal mental health. Her struggles, and those of countless other mothers, expose gaps in postpartum monitoring, access to mental health care, and insurance coverage that leave many women unprotected in the weeks and months after giving birth. As the U.S. struggles with rising maternal mortality, policymakers and healthcare systems face an urgent question: how many more lives will be lost before maternal mental health is treated with the same urgency as physical complications? Until structural reforms extend care, support, and monitoring beyond the delivery room, mothers like Ariana will remain unrescued.