I woke up Monday morning to the news about Hayden Panettiere, and I got a pit in my stomach. Another woman, another tragedy, and postpartum depression somewhere near the root of it.
I sat with that pit for a while, and I realized I had two options: I could feel sick about it and move on with my day, or I could use the one thing this community actually has - each other - to do something about it.
So I’m doing something. Next week I'm launching a campaign, a coalition of brands and voices you know, aimed squarely at this epidemic and the women it's quietly taking from us. I'll tell you everything soon.
But I couldn’t wait a week to say something. So for now, I want to leave you with some initial thoughts.
Hayden was 36. I’m not here to speculate about the cause of death. But what I can tell you is that she told all of us, publicly, over the past several years that she struggled with postpartum depression, that she struggled with addiction, and that the hardest part was how long she carried it alone before she said a word. She eventually confided in the entire world.
That is what an epidemic looks like when it hides in plain sight. She deserved rooms that made it safe to confide sooner.
Last year, at a table in Los Angeles, we filmed a series called In Confidence. Thirty women, one dinner, one rule: say the thing you have not said anywhere else. I remember watching those confessions land and realizing that almost every woman at the table had assumed she was the only one.
That assumption is the most expensive lie in our community. This week made the cost impossible to ignore, and it sent me back to the research on maternal mental health. I want to walk you through the numbers, because most people have never seen them, and because they are about our community more than we want to admit.
Mental health conditions are the leading cause of pregnancy-related death in the United States, ahead of hemorrhage and ahead of cardiac complications. Mental health, including suicide and overdose, accounts for nearly one in four maternal deaths, according to CDC data reviewed by state maternal mortality committees. Suicide and overdose are the leading causes of death for mothers in the first year after birth.
One in five mothers experiences a maternal mental health condition. Postpartum depression and anxiety are the most common complications of pregnancy and childbirth, more common than gestational diabetes or preeclampsia.
Seventy-five percent of them never receive treatment. Fewer than 20 percent of prenatal and postpartum patients are screened for depression at all. Of the women who screen positive, only about half receive follow-up care. Untreated, symptoms can last up to three years.
One hundred percent of these deaths are considered preventable. When state review committees examined pregnancy-related deaths caused by mental health conditions, they classified every single one as preventable. Every one of those stories had a version where she got help in time.
The cost of doing nothing is 14 billion dollars a year. That’s the Maternal Mental Health Leadership Alliance’s estimate for untreated maternal mental health conditions in the US, about 32,000 dollars per mother and baby. I include it only because systems tend to listen to money before they listen to mothers.
I know the women in this community - I sit across from you at dinners all over the country. You run companies, hospital systems, portfolios, households. You are the emergency contact for everyone you love. You are the one people call when things fall apart, because you are the one who does not fall apart.
The research on help-seeking has a hard truth for exactly this woman: help-seeking drops as responsibility rises. The more people who depend on you, the harder it becomes to say you are struggling, because your steadiness is the thing everyone else is standing on. Studies point to the same barriers again and again, and none of them is ignorance. High-achieving women delay care because of stigma, because of time, and because of the fear that admitting struggle will cost them the credibility they spent decades building. The screening gap makes it worse. A woman who is never asked and has trained herself never to volunteer falls straight through.
Your “I’m fine“ is a load-bearing wall. You have all probably said it this week - I have too.
A few weeks ago I broke down in the kitchen in front of my husband, told him I felt like a shell of myself, for a number of reasons. And he looked at me and said: “but you always seem so put together”. And that’s when I realized the hard-shelled casing on the exterior of my body is a facade. I’m pretending to ‘have it all together’ when, in reality, it’s impossible for the ones who love me to see through that opaque shield.
We tell ourselves we will deal with it after the raise closes, after the school year ends, after the baby sleeps, after the board meeting. We are exceptional at holding weight. We are terrible at putting it down. Somewhere along the way, we decided that being the strong one meant being the silent one, and nobody ever audited the compounding effects of that silence.
So let me audit it.
Confiding is not the opposite of strength. It is the same skill you use in a boardroom when you say the risk nobody wants to discuss, out loud. It is considered a leadership act. Every woman at that dinner in LA who said the unsaid thing walked out more powerful, and she made every other woman at the table more powerful too, because secrets isolate and honesty organizes. When one woman says it out loud, five more realize they are allowed to.
The courage to confide becomes the confidence to lead. Next week, I’ll be putting out a PSA alongside many incredible brands and influencers titled: The Courage to Confide, because after this week it reads less like a title and more like an call for hope.
If you are struggling, tell one person. A friend, your partner, a therapist, a helpline at 2 AM. You do not have to tell everyone. You have to tell someone. Start the sentence with “I’m actually not fine“ and let it be ugly and half-formed. The women in that room in LA taught me that the sentence never comes out polished when it’s the truth.
If you are thinking of someone else, ask her how she is doing, then ask again. The first answer is almost never the real one. She has spent years perfecting it.
If you lead people, ask about the mothers on your team. Most women return to work inside the exact window when postpartum depression peaks. A manager who asks a real question and normalizes a real answer is doing prevention work, whether she knows it or not.
More on what we’re building is coming next week. If you’re interested in getting involved, please send me a note and I will add you to the distribution.
These are real, free, and staffed by people trained for exactly this. Save them. Share them. You never know whose feed they need to land in.
National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA (1-833-852-6262), free and confidential, 24/7
Postpartum Support International HelpLine: 1-800-944-4773
Crisis Text Line: text HOME to 741741
988 Suicide and Crisis Lifeline: call or text 988, available 24/7
As always, thanks for being here,
Alexis
We go deep on all of it, the emotional complexity of building a life worth living, in The Breadwinners community.
Learn more: www.thebreadwinners.co
Follow: Alexis | The Breadwinners
CDC Maternal Mortality Review Committee data (2017-2019, with consistent findings in the 2021 data released August 2025)
Maternal Mental Health Leadership Alliance, “Maternal Mental Health Facts and Sources” (mmhla.org/mmh-facts-sources).
US. Maternal Mental Health Leadership Alliance (mmhla.org/mmh-facts-sources).
Maternal Mental Health Leadership Alliance (mmhla.org/mmh-facts-sources).
Policy Center for Maternal Mental Health, “Fact Sheet: Maternal Mental Health” (policycentermmh.org/maternal-mental-health-fact-sheet).
Trost, S. et al., “Preventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008-17,” Health Affairs (2021)
Luca, D.L. et al. / Mathematica (2020), “Financial Toll of Untreated Perinatal Mood and Anxiety Disorders”
Comments
Nothing yet. Say the first thing.
Sign in to join the conversation.