Continuing from previous post titled “Recent News on Screening Expectant and Postpartum Moms,” the following scenarios are the current dilemmas/barriers to progress when it comes to detection, diagnosis and treatment of postpartum depression (PPD).
One of the contributing factors to the numbers of undiagnosed and untreated cases of PPD is that the responsibility for detection, diagnosis and treatment falls between two specialties—obstetrics and psychiatry—that are currently not set up to cooperate with each other in the treatment of PPD. Unfortunately, the “norm” in the United States—which has created a disjointed system that leaves perinatal families at a tremendous disadvantage—consists of:
- Lack of training on perinatal mood disorders (recognition of symptoms and treatment)
- Lack of cooperation between the segments of professional care
The problem with the healthcare industry when it comes to treating women postnatally is that, once a woman has given birth—with the exception of the standard, six-week follow-up visit—it’s almost like the OB/GYN is washing his hands of her. Aside from the doula who fills this gap in care for the new mother, there is no medical professional who fulfills such a need. This is why the role of the doula has evolved and become more commonplace in this country. She is there to provide the family with support for as long as she is needed. It is not uncommon that she stays with a family for six weeks or longer. She can work any schedule that you require. She could work a typical 9 to 5 day, or she can do mornings, afternoons or overnight.
One thing I’ve personally witnessed through the years at my company is the unfortunate tendency for groups to work in silos, which is seldom associated with achieving good results. Similarly, health professionals ranging from OB/GYNs to pediatricians, general practitioners, psychiatrists to social workers work in silos too. They do not work as a team. Not enough doctors out there care enough to cross their areas of expertise and perform the extra step to show that they truly care for their patients–e.g., following up even when not asked to, making sure the mom gets treatment, etc. Ideally, there would be a collaboration between medical healthcare providers (GP, OB/GYN, pediatricians), mental healthcare providers (psychiatrists, psychologists), and others who come in contact with the new mother (lactation consultants, midwives) to proactively coordinate care of the new mother and communicate with each other about her status, treatment and progress. In most cases, the woman cannot muster energy and/or willpower to do this herself.
It’s time for women to stop falling through the cracks once and for all! OB/GYNs, pediatricians, lactation consultants and primary care providers–basically, everyone who would come into contact with a new mother after she has a baby–should know the basics about PPD and be sensitive enough to at least inquire about the well-being of the mom in the first 3 postpartum months. In fact, hospital nursing staff should proactively call each and every mother 1-2 weeks postpartum to see how they are doing. As the new mother checks out of the hospital, the OB/GYN (or hospital staff) should talk to her about the mood changes (i.e, baby blues) that are considered normal and experienced by most new mothers, and why this happens. They should provide a pamphlet about PPD that says right up front (like the Postpartum Support International poster) that the #1 complication of childbirth is PPD, with an occurrence rate of about one out of eight new mothers. That would be more likely to catch attention, as most new moms are likely to wave it off, thinking they would never let themselves fall victim to such a thing as PPD (like me). The OB/GYN should also explain how PPD is different from the blues and offer the patient to call whenever they need to, particularly if their mood changes last longer than 2-3 weeks and seem to be getting worse. Knowing that a professional is just a phone call away can make a big difference.
Significant changes would need to be made at the legislative level first—which is why I believe the passing of the long overdue Melanie Blocker Stokes MOTHERS Act is so important—to drive the changes needed to ensure healthcare professionals are trained in screening and treating PPD, to require healthcare professionals to screen and treat PPD, and to ensure medical insurance covers screening and treatment. More realistically, and in the nearer-term, the ideal approach to treating PPD would be via an extensive referral network or multidisciplinary team of professionals consisting of:
- Obstetricians, pediatricians, family physicians/general practitioners
- Nurses, physicians assistants
- Midwives, doulas, social workers, lactation consultants
- Psychologists, psychiatrists
Why pediatricians, you wonder? Well, pediatricians are the ones who typically see the mother first, and it’s their office that would get the phone calls from the mother with concerns about the baby. It’s the pediatrician’s office that would come into contact with the mother the most, not the OB/GYN’s office. High anxiety can result in an increase in frequency in phone calls—with many even being mundane in nature—to the doctor, nurses or other staff members, particularly if reassurance from anyone on the staff doesn’t do anything to help the mother’s concerns. It’s a shame pediatricians don’t work together with the OB/GYN. If they did, pediatricians can give the woman’s OB/GYN a heads up about the possibility that she could have PPD. Rather than the pediatrician telling the mom that she should be assessed for PPD, which can be taken the wrong way by the mother who thinks it’s the baby that’s their business, not her. Fear of bringing up the topic would merely open up a can of worms, resulting in spending a lot of time—which they lack in the first place—talking about something that is not their specialty.
The pediatrician would normally see both infant and mother right after childbirth and regularly for a period thereafter. However, they do not have en established relationship with the mother. To complicate matters, the mother may feel too embarrassed to admit what she’s going through to a doctor because the focus is the well-being of the baby. It’s only natural for the mother to avoid wanting to be perceived by the doctor as being a failure at properly caring for her own baby. People must realize that the well-being of the baby is dependent on the well-being of the mother. The pediatrician (whose patient is the baby) and even the lactation consultant (whose goal is to ensure the baby can successfully access his/her mother’s breast milk) should be concerned about the postpartum mom because it’s her mental health that has a huge impact on the baby’s development. The least they can do is provide a pamphlet to all new moms, regardless of their current state. In the ideal situation, the pediatrician’s standard protocol should be to ask the new mother during each visit how she is doing, especially if she is a first-time mother and/or a mother who had complications during childbirth.
Actually, I will give my daughter’s first pediatrician credit. Knowing the complications I experienced during childbirth and our extended hospital stay, the first question she always asked me—while looking straight into my eyes—whenever I brought my daughter in during the first few months was “How’s mom doing?” Realizing it was “out of her jurisdiction” to help me, I never went into any details of how I was really feeling.