You have to break through the uncomfortable…Why? Because mothers are dying from postpartum mood disorders

You have to break through the uncomfortable…..We are losing a silent battle that no one wants to talk about.

Amen!  These are the words Brian Gaydos utters when people ask what happened to his beloved wife, Shelane, and his answer “She died from a disease called postpartum depression” makes them uncomfortable.  Discomfort from stigma is what keeps suffering mothers quiet and getting the treatment they need and deserve.

When I read the August 4, 2017 article by Michael Alison Chandler in the Washington Post titled “Maternal depression is getting more attention – but still not enough” and I saw Brian’s words at the end of  the article, I decided I needed to blog about these words and about the tragic death of his wife.  Shelane Gaydos, a 35-year-old mother with 3 daughters, lost a baby in utero at 12 weeks and within 3 weeks died by suicide.  Family members did not realize until a while after her death that she had suffered from postpartum psychosis.  The article mentions, and as statistics have always indicated, women are more likely to attempt suicide during the first year after childbirth than during any other time in their lives.  It is important to note that a woman doesn’t need to give birth to experience any one of the various postpartum mood disorders, including postpartum depression (PPD), postpartum OCD and postpartum psychosis.  She can suffer from these disorders after having a miscarriage as well.

The article mentions certain things I’ve mentioned all along in my blog and in my book:

  • 1 in 7 new mothers experience a perinatal (during pregnancy and after birth) mood disorder, and yet these disorders continue to be under-diagnosed and under-treated
  • A relatively small percentage seek professional help either because they don’t know what they are experiencing deserves and needs  professional help and/or they don’t know where to go to get help and/or they are ashamed to seek help
  • More obstetricians and pediatricians lack than possess the training needed to diagnose and treat perinatal mood disorders
  • Certain risk factors are the reason why certain mothers develop PPD and others don’t: genetic predisposition to biological factors (some mothers are affected by hormonal fluctuations during/after childbirth and after weaning more than others) versus environmental factors (poverty, poor/abusive relationships, premature birth or miscarriage, inadequate support, inadequate paid leave from work)
  • It’s thanks to advocates with platforms with a broad reach to members of the government and media that there has been progress in recent years.  Brooke Shields is one of the first of the advocates to start the trend of sharing their own experiences, spreading awareness, and trying to effect change.
  • There are still stubborn societal myths (thank you to the patriarchal and quite misogynistic forces and views still in place here in the 21st century) that only serve to put unnecessary, additional stress on women, encouraging the false notion that all mothers can not only care for their babies without any sleep or support, but also be able to breastfeed without any issues and return to their pre-baby bodies and weight quickly.  Unbeknownst to many of us stateside, societies around the world (and in olden days here in the good ol’ USA) have customs in place that provide new mothers with the support they need to recover from childbirth and care for their newborn baby.  Instead, because we are a strictly capitalistic society, more and more mothers now work and have anywhere between 0-13 weeks of paid leave and are expected to recover and jump right back to their jobs before having babies, as if they’d never given birth in the first place!  If only men who think “Women have been giving birth for centuries should just up and go back to the way they were” can experience childbirth firsthand sometime!

Certain states, like Massachusetts, New Jersey, and Illinois have passed laws that mandate screening for PPD, and thanks to recommendations by the American Congress of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP), healthcare providers are screening for PPD more routinely.  What I would like to know is whether these screenings are even happening (I am dubious):

  • In 2015, ACOG recommended that OB/GYNs screen women for PPD at least once during pregnancy and once after childbirth.
  • In 2010, the AAP recommended that pediatricians screen mothers for PPD at well-baby visits during the first 6 months.

Says Adrienne Griffen, founder and executive director of Postpartum Support Virginia, whom I have the honor of knowing through my affiliation with Postpartum Support International:

Postpartum depression is where breast cancer was 30 years ago.

I truly and sincerely hope and pray that it’s NOT going to be ANOTHER 30 years for us to see a significant change in the way we view PPD as a society and reduce the numbers of women suffering–and even dying–from perinatal mood disorders!

 

 

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American Academy of Pediatrics on the Importance of Screening New Moms for PPD

According to the latest American Academy of Pediatrics report published on November 1st in the journal, Pediatrics, with the over 400,000 infants born to moms with depression each year, perinatal (both antenatal and postpartum) depression is “the most underdiagnosed obstetric complication in America [which untreated and improperly treated] leads to increased costs of medical care,….child abuse and neglect,….family dysfunction and [adverse] affects [on] early brain development.” [1]

As I have said in prior posts, depression in new moms impacts the entire family.  Not only do fathers have an increased risk for developing depression themselves, but babies are at increased risk for insecure attachment, which can lead to developmental (cognitive) delays and behavioral (social, emotional) problems as they grow older.  Children exposed to maternal and/or paternal depression are at much greater risk of developing mood disorders, such as depression.  Hence, to ensure the health and wellbeing of the baby, it is important to ensure the health and wellbeing of the baby’s mother, which is why pediatricians are in a good position to screen new moms for postpartum depression (PPD), as well as help provide referrals for treatment and community resources/support services.

Between the American College of Obstetricians and Gynecologists recommending similar screening earlier this year and now the AAP, I truly hope that this will mean more new moms with perinatal depression being properly diagnosed and treated!  According to this report, although most pediatricians agree that screening for perinatal depression is something that should be included in well-child visits during baby’s first year, they also felt that they didn’t have adequate training to diagnose and treat PPD.  The report also states that the “perceived barriers to implementation [include] lack of time, incomplete training to diagnose/counsel, lack of adequate mental health referral sources, fear that screening means ownership of the problem, and lack of reimbursement.”[2]

There are indications, based on the report, that there have been efforts to move toward inclusion of women’s perinatal health in pediatric practices as demonstrated by programs like the one set up between Dartmouth Medical School and 6 pediatric practices in New Hampshire and Vermont, which show that pediatricians have the ability to effectively screen for PPD.  There is also the ABCD (Assuring Better Child Health and Development) Project, which is comprised of 28 states and their AAP chapters.  It’s wonderful that in Illinois, one of the ABCD states and one of the only states with a postpartum depression law, pediatricians who use the Edinburgh Postpartum Depression Scale to screen new moms for PMDs are actually paid (yes, paid!) by Medicaid for doing so.   Once again, Illinois is setting a positive example for the rest of the country when it comes to looking after new mothers and babies.  For more information on the initiatives going on in the various ABCD states, visit www.abcdresources.org and www.nashp.org.

What we need to do is mandate pediatrician (and OB/GYN) training to recognize PPD symptoms and provide proper referrals to medical/mental health practitioners trained in treating PPD.  The ideal goal would be the establishment of a multi-disciplinary approach (like I mentioned in my last post) wherein doctors–be it OB/GYNs whose patients are the new mom or pediatricians whose patients are the babies of the new mom suffering with PPD—would collaborate with each other and mental health providers in their communities to ensure new moms suffering from a PMD does not fall through the cracks.

I’d like to end this post by pointing out the difference between the AAP’s view of PPD timeframes of occurrence and peak prevalence versus the proposed guidelines I wrote about in my last post with respect to the DSM-5.   The AAP indicates that the peak for a PMD is 6 weeks postpartum, with another peak occurring 6 months postpartum.  It goes on to state in the report:  “Given the peak times for postpartum depression specifically, the Edinburgh scale would be appropriately integrated at the 1-, 2-, 4-, and 6-month visits.” [3]  Hey, American Psychiatric Association, the AAP gets it more than you do!  Please get with the program!

In Conclusion:

From the mere fact that it’s the primary care pediatrician that sees the new mother and her interactions with her baby within the first six weeks (before the postnatal follow-up visit with her OB/GYN at 6 weeks), the pediatrician is in the best position to detect maternal depression early and help prevent adverse outcomes for the baby and the family. “In addition, it is the [pediatrician] who has continuity with the infant and family, and by the nature of this relationship, the [pediatrician] practices with a family perspective [since a healthy functioning family means the healthy development of the child].”[4]  Screening can [and should be] be integrated into the well-child care schedule, as it “has proven successful in practice in several initiatives and locations and is a best practice for [pediatricians] caring for infants and their families.”[5]  The report further clarifies that, since the infant is the pediatrician’s patient, just because the pediatrician screens for PPD does not mean that the pediatrician must treat the mother. It just means that if a PMD is detected during the screening process, the pediatrician would provide information for family support and referrals for therapy and/or medical treatment, as needed.


[1] Earls, Marian F. and The Committee on Psychosocial Aspects of Child and Family. Incorporating Recognition and Management of Perinatal and Postpartum. Pediatrics 2010;126;1032-1039; p. 1032.

[2] Ibid., p. 1034.

[3] Ibid., p. 1035.

[4] Ibid., p. 1035.

[5] Ibid., p. 1037.