Keys to Empowering New/Expectant Moms and Maternal Mental Health

I was talking to someone 2 days ago who mentioned that for millenials, images are the way to go to attract attention to important messages.  In this day and age of limited-word media like Twitter and other social media forums, sound bytes and visuals tend to grab people’s attentions more.  Print media — like magazines and books (like mine) and all the other books I devoured in my quest for knowledge on why postpartum depression (PPD) occurs in certain women — are going more and more by the wayside.  Just today, I stumbled across an email from Karen Kleiman, MSW, LCSW, (founder of The Postpartum Stress Center and author of numerous books on perinatal mood disorders)1 yr and 9 months ago giving me permission to use the below image on my blog.  This image grabbed my attention and I want to help circulate it.   You should too if you care about mothers.  We need images and information like this to reach more expectant mothers.  We need to ensure they are informed before they even give birth so they aren’t blindsided with PPD.

Why do I feel this information is important? My experience with PPD happened back in 2005, and I blogged about the ignorance of my OB/GYN in February 2009, just shy of 10 years ago.  It was one of my first blog posts. Unfortunately, not much has changed between then and now except for the advent of Facebook and other social media to spread the word via organizations such as Postpartum Support International (PSI), PPD survivors/advocates, social workers, therapists and others who treat perinatal mood disorders (PMDs).  I know this from the stories that come across my feed on Facebook.  I know this from talking to others whose job is to care for mothers who struggle with PMDs.  The general population doesn’t know the difference between postpartum blues and PPD because all too many doctors don’t even know the difference.  Karen Kleiman would not have needed to create the above image if she didn’t see the problem still existing with doctors misinforming PPD moms.

The care model for OB/GYNs should be mandated to include:

  1. adequate training in medical schools/residency programs to ensure doctors know how to recognize symptoms of and treat perinatal mood disorders and know the difference between the baby blues versus PPD
  2.  a 15-minute time slot in every hospital baby care/childbirth training session to go over the basics of perinatal mood disorders (PPD, postpartum anxiety, postpartum OCD, and postpartum psychosis), difference between the postpartum blues and PPD, breastfeeding realities, risk factors, importance of lining up practical/social support before baby’s arrival, insomnia as a common first symptom, etc.)
  3. being prepared to offer referrals to organizations like PSI (which has coordinators in every state that can try to help the mother find local help), maternal mental health facilities and mother/baby units (which are starting to pop up more & more around the country), PPD support groups, therapists/social workers who specialize in helping PPD moms, and even websites / blogs / Facebook groups that can provide online support
  4. screening patients for risk of perinatal mood disorders
    • prior to pregnancy – to establish a baseline of hormone levels before pregnancy and determine if the woman has a history of PMDD  or other risk factors for PPD
    • during pregnancy – consultation comprised of questions to try to detect pre-natal depression and review of a standard small booklet with images and bullet points covering the basics of perinatal mood disorders (PPD, postpartum anxiety, postpartum OCD, and postpartum psychosis), difference between the postpartum blues and PPD, breastfeeding realities, risk factors, importance of lining up practical/social support before baby’s arrival, insomnia as a common first symptom, etc.)
    • during 6-week postpartum visit – including blood work to detect iron/thyroid deficiencies and measure hormone/neurotransmitter levels, thyroid panel, Adrenal Stress Index

Click here to see my Onboarding Questionnaire, Pregnancy Questionnaire, and Postpartum Questionnaire.

As you can see, I am continuing to use my PPD experience to come up with ideas to effect change in the reproductive health care arena.  I will continue to find ways to contribute toward public awareness campaigns, as well as resource development and distribution.

New mothers with babies in the NICU are at increased risk of PPD

The motivation for this blog post is a Huffpost article that popped up in my Facebook feed yesterday titled “NICU Moms Are Struggling With Mental Health Problems–And They Aren’t Getting Help” by Catherine Pearson.  It happens to be from 4/13/2018, but I’m only seeing it now for the first time.

I have blogged about the many risk factors for PPD before.  One of the risk factors happens to be premature births.  Last time I blogged about premature births being one of the risk factors for PPD was 9 years ago.  So, I’m way overdue blogging about this topic again!

A new mother who was pregnant one minute–and expecting several more weeks of pregnancy–and suddenly giving birth and seeing your baby hooked up to machines is an overwhelmingly anxiety-provoking experience.  All new mothers are not only hormonal, exhausted and trying to recover from childbirth, but NICU mothers are also anxious about their babies, unwilling to leave their babies’ sides, and find it hard to eat, sleep or even talk to friends and family members who don’t fully understand what it’s like to have a baby in the NICU. Unable to touch, hold and feed her baby and instead seeing her tiny, precious baby hooked up to so many wires, it is natural for a NICU mother to be consumed with feelings of helplessness, distress and fear.  Each day, the NICU mother spends many hours each day at their baby’s side, pumping every few hours, and on high alert with respect to her baby’s breathing and the noises of the machines keeping her baby alive.

In the daily hustle and bustle of the nurses and doctors in the NICU, having them stop and ask the mother (and/or father) how they are holding up and making sure they are taking care of themselves and getting enough rest are not going to be at the forefront of their priorities, though you’d think it should be second nature for them to do so.  In fact, they are seldom trained to know what to ask.  Even if they did ask, there is an inadequate referral system in place to get help for a mother with a postpartum mood disorder.

“…[Studies have suggested that up to 70 percent of women whose babies spend time in the NICU experience some degree of postpartum depression, while up to one-quarter may experience symptoms of post-traumatic stress disorder.”  Simply put, a new mother’s risk of experiencing a postpartum mood disorder is very high.  And that is not surprising in the least.”

What should the screening entail?

I’ve previously blogged about and will repeat here that mothers should be assessed for postpartum depression (PPD) between 4-12 weeks postpartum.   She should be encouraged to have her six-week follow-up visit with her OB/GYN, provided she doesn’t complain about symptoms up to that point.  If she is symptomatic before the six-week visit, she should be screened right then.  If the 6-week screen doesn’t indicate PPD, she should be assessed once more at the 12-week point and also when she weans and when her period returns, since these events can trigger PPD in some women.

The following—in addition to screening tools like the Edinburgh Postnatal Depression Scale or Cheryl Beck’s Postpartum Depression Screening Scale—should be asked at the six-week follow-up visit with the OB/GYN, which can help diagnose PPD:

1. Have you been feeling any of the following for the past 2 weeks:

  • Persistent and mostly inexplicable sadness/tearfulness and feeling empty inside
  • Loss of interest/pleasure in hobbies/activities you once enjoyed; inability to laugh
  • Overall impaired functioning
  • Sleep difficulties (either insomnia or sleeping too much)
  • Weight loss (usually fairly quick) associated with a decrease in appetite
  • Weight gain associated with an increase in appetite
  • Excessive worrying/anxiety/concern about the baby
  • Restlessness/irritability
  • Difficulty thinking, concentrating or making decisions
  • Onset of panic attacks
  • Sense of despair and/or hopelessness leading to thoughts of death/suicide

2. How have you been feeling physically and emotionally?

3.  How is your appetite?

4.  How are you sleeping?  Have you been able to get at least 4, if not 5, hours of sleep a night?

5.  Have you had any recurring thoughts/images that are disturbing?

 

If local resources for PPD are not readily available (though all hospitals around the country should have a list of local psychologists, psychiatrists, social workers, registered nurses, PPD support groups on hand), the least they can do is provide a pamphlet for Postpartum Support International. Its website lists resources in every state.  And many states have already formed, or are in the process of forming, chapters to focus on state-specific efforts at advocacy, training, and other improvements.

If you are a new mom with a baby in the NICU, please, please, please remember that, though your attention is preoccupied with your baby, if you let your own strength and health go by the wayside, it is possible to succumb to a postpartum mood disorder.  Not everyone will succumb, but just remember the increased risk and higher occurrence among NICU moms.  Don’t forget to take care of yourself.  When your baby comes out of the NICU, you need to be strong and healthy to care for your baby.

 

 

Why Screening of Postpartum Moms is Important and Who Can and Should Do the Screening

Today’s post was inspired by a March 19, 2018 NPR article by April Dembosky titled “Lawmakers Weigh Pros and Cons of Mandatory Screening for Postpartum Depression,” as well as a June 2018 Romper article by Karen Fratti titled “Moms Should be Screened for Postpartum Depression in the ER, New Study Suggests, & It Makes Perfect Sense,” a June 30, 2018 News Medical article titled “Screening mothers for PPD in emergency setting,” and a June 29, 2018 Austin360 article by Nicole Villalpando titled “Who should be screening moms for postpartum depression? More doctors now can.

Screening moms for postpartum depression (PPD) serves multiple purposes.  Screening will help ensure moms get the help they need and avoid suffering unnecessarily.  In case you weren’t aware, screening educates women on what PPD is, why it happens and just how common it is (1 in 7 new moms experience it), and helps them avoid what I and so many other mothers have gone through (PPD makes you feel alone, like you’re losing your mind and will never return to your previous self).  It will ensure fewer moms will ultimately fall through the cracks.  It will ensure fewer tragedies involving mothers and their babies.  And I’ve said this many times before, but a mother who is not well cannot care for her baby the way a healthy mother can.  This is pure logic.  Unfortunately, logic takes a back seat because our capitalist society places more priority on what benefits the pocket over what benefits the people’s well-being.

So…..question is WHO should screen new moms for PPD?

Her OB/GYN?  This should be a given, period, hands down, no questions asked!  In May 2018 the American College of Obstetricians and Gynecologists recommended that, in addition to the standard 6-week postpartum visit, OB/GYNs perform a follow-up visit within the first three weeks postpartum.  This new recommendation is due to the fact that symptoms of PPD often begin before the 6-week appointment.   See second half of my blog post on the issues many OB/GYNs are faced with in terms of screening.

Her baby’s pediatrician (but here the patient is the baby, not the mother)?  The American Academy of Pediatrics (click here and here) recommends doctors screen mothers for PPD when they bring their newborns in for wellness visits, since they occur numerous times in the baby’s first year; whereas, the mother only gets the one wellness check at postpartum week six.  Pediatricians who realize that the baby’s development can be negatively impacted when the mother is ill with PPD will try to screen the mom for PPD.  Problem is, most pediatricians as far as I’m aware are not prepared to screen and refer mothers since the mother is not a patient.

An ER physician?  While you will no doubt raise your eyebrows, doctors like Dr. Lenore Jarvis, an emergency medicine specialist with the Children’s National Emergency Department at United Medical Center in Washington, DC, have been seeing moms bring their babies to the ER, and it turns out the baby is fine but it’s the mother who is highly anxious and feeling overwhelmed.  In these cases, it’s logical to try to determine if it’s the mother who needs help.  In fact, Dr. Jarvis and several colleagues conducted a research study with several colleagues on screening moms for PPD in an ER setting.  A Eureka Alert release dated June 29, 2018 explains the results of the research study. Moms who participated were screened using the Edinburgh Postnatal Depression Scale supplemented by other questions.  The great thing about the research study is that, when moms scored positive for PPD, they received information about PPD and were offered–or if they had a strong positive score from screening, they were required to have–a consultation with a social worker.  Additionally, the researchers followed up with mothers who screened positive one month later to see how they were doing.  This is akin to case management programs we have in place when patients check out of hospitals (I explain all this in my post below). Now THIS is the way it SHOULD be!

Dr. Jarvis refers to the ER as a “safety net  for people who are not routinely accessing regular checkups for themselves and their children. If a mother is having an acute crisis in the middle of the night and feeling anxious and depressed, they often come to the emergency department for help.”  Because American policymakers have been so resistant to instituting policies that would require insurance companies to work with doctors to ensure PPD is caught early through screening and subsequent referrals–researchers/subject matter experts on PPD are left to make recommendations for what Dr. Jarvis referred to as a “safety net” approach of having emergency rooms screen for PPD when moms come in either for their babies (for colic, fevers, etc.) or even for themselves (symptoms of a postpartum mood disorder).

While I agree we need to cover all bases and try to screen a new mother wherever and whenever possible, why do we even need to resort to waiting until a mom comes into the ER to screen them?  Why do we have to have such a safety-net, fall-back, beats-nothing-at-all, better-late-than-never approach in the first place?  Answer:  our society continues to place too much priority on conception and childbirth but once the baby is born, everyone forgets the mother.  Once the baby is born, the mother’s health falls by the wayside.  I’ve blogged about this before, but the attention from that point on will be on the baby from visitors who coo at the baby and treat the mother as invisible.  Same thing with doctor visits; the mother only gets one postpartum wellness check at 6 weeks.  That’s it.  It’s like the mother ceases to exist.  Whereas, other cultures have customs to honor and mother the mother (click here and here for past posts).  The birth of the baby is synonymous in these cultures with the birth of the new mother and they are honored for bringing new life into the world.  This, my friends, is why maternal mental health advocacy is so important.  Until American policymakers institute policies to demonstrate the importance of mothers and their health, we advocates must continue to act as “squeaky wheels to get the grease.”

The following section is an excerpt from my book.

New mothers, especially the ones at high risk for PPD, should be screened during their six-week postpartum visit, provided she doesn’t complain about symptoms up to that point. If she is symptomatic before the six-week visit, she should be screened right then. If the six-week screen doesn’t indicate PPD, she should be assessed once more at the twelve-week point—or when she weans or when her period returns, whichever comes first, since these events can trigger PPD in some women.

The following—in addition to screening tools like the Edinburgh Postnatal Depression Scale or Cheryl Beck’s Postpartum Depression Screening Scale—should be asked at the six-week follow-up visit with the OB/GYN, which can help diagnose PPD:

  1. Have you been feeling any of the following for the past two weeks?
  • Persistent and mostly inexplicable sadness/tearfulness and feeling empty inside
  • Loss of interest/pleasure in hobbies/activities you once enjoyed; inability to laugh
  • Overall impaired functioning
  • Sleep difficulties (either insomnia or sleeping too much)
  • Weight loss (usually fairly quick) associated with a decrease in appetite
  • Weight gain associated with an increase in appetite
  • Excessive anxiety about the baby
  • Restlessness/irritability
  • Detachment from and inability to bond with the baby
  • Difficulty thinking, concentrating or making decisions
  • Feelings of guilt, inadequacy, failure and/or worthlessness
  • Urge to run away
  • Onset of panic attacks
  • Sense of despair and/or hopelessness leading to thoughts of death/suicide
  1. How have you been feeling physically and emotionally?
  2. Are you feeling particularly stressed, and, if so, is it due to a major change you are experiencing, such as marital problems, death of a loved one, financial problems, a recent move, or a job change?
  3. How do you feel about the baby? Are your feelings in line with your expectations of how you’d feel about the baby?
  4. Do you feel you have adequate emotional and practical support from your partner? Do you have any relatives or any other help, like a doula, to help you with the baby during the day?
  5. Are you breast-feeding and, if so, how is it going?
  6. How do you feel the labor and delivery went? Do you feel you experienced any sort of trauma during the delivery?
  7. Do you feel your childbirth and motherhood experience are meeting your expectations?
  8. Do you feel particularly anxious about your baby’s health (colic, SIDS)?
  9. How is your appetite?
  10. How are you sleeping? Have you been able to get at least four, if not five, hours of sleep a night?
  11. Have you had any recurring thoughts/images that are disturbing?
  12. How have you been adapting to motherhood, in general?
  13. Have you returned, or will you return, to work?

I believe these types of questions should be incorporated by all OB/GYNs throughout the country. This all theoretically sounds good and fine, but in most cases, OB/GYNs are not prepared to implement. Why not? At the very least, it would require training on perinatal mood disorders (recognition of symptoms and treatment), as well as ability to provide the right referrals as needed.

This last paragraph from my book excerpt remains true to this day.  Sad because I published my book in 2011.  Seven years later, things have not really changed.

California’s screening bill, AB 2193, has yet to pass the Senate and get signed into law.  Once passed, it would be an exciting development for mothers, as it doesn’t just require screening for PPD.  It requires health insurance companies to set up case management programs (same way my mother was assigned a case manager each time she had to stay overnight at a hospital to ensure she had a plan in place to address the issues that landed her in the hospital–i.e., physical therapy in a rehab center, visiting nurse to change her bandaging, etc.) to help connect moms who screen positive for PPD with a mental health practitioner.

Case management is set up to ensure there is a treatment/referral plan in place.  I sincerely hope that this means health insurance companies are prepared and able to carry out the new requirements.   And I sincerely hope that California will lead the way for other states to follow suit in setting up similar screening bills that will actually require health insurance companies to set up case management programs.

It goes without saying that screening moms for PPD serves no purpose if you can’t help those who test positive for PPD.  So far, as the first state that put mandatory screening in place, New Jersey has not had any reason to be excited ever since its initial groundbreaking “first-state-to-mandate-screening” announcement.  New Jersey, as well as 3 other states— Illinois, Massachusetts, and West Virginia — have tried mandated screening, and it did not result in more women getting treatment, according to a study published in Psychiatric Services in 2015.

A whopping 78% of those who screen positive don’t end up getting mental health treatment per a 2015 research review published in the journal Obstetrics & Gynecology.  Why have women in these states with mandatory screening not been getting treatment?  Well, for starters:

  1. Some obstetricians and pediatricians are afraid to screen for PPD because they are not equipped to refer.  But why is that?   Why is it hard for them to all rely on the resources available via Postpartum Support International?  Its website lists resources in every state.  And many states have already formed, or are in the process of forming, chapters to focus on state-specific efforts at advocacy, training, and other improvements.
  2. The resources to whom doctors (obstetricians, pediatricians, general practitioners, etc.) can refer mothers are limited, especially in more rural areas.  And in more rural areas, it’s harder to find mental health practitioners trained in prescribing meds to pregnant/breastfeeding women, let alone trained in treating moms with PPD.
  3. All too many mental health practitioners don’t take the woman’s insurance or there are significant limitations from an insurance coverage perspective.
  4. There’s a very long wait (several months) to see most mental health practitioners, especially for the first time….a woman in the throes of PPD can’t afford to–both literally (from a cost perspective) and figuratively (from a life & death perspective).
  5. There’s little incentive financially, thanks to insurance companies’ lack of adequate coverage for doctors who do such screening…..in my opinion, screening should be done at the standard 6-week postpartum checkup and therefore covered as part of that checkup.

Attention, American policymakers….our mothers are worth it.  I mean, we make such a big stink about fetuses and unborn babies in this country, let’s start thinking bigger picture, shall we?  Without mothers, there would be no babies to conceive and bring into this world.  Let’s start treating mothers less like second-class citizens and more like human beings who deserve to be able to give birth to and care for their babies without getting sick with PPD and possibly dying in the process!

 

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!

 

 

Maternal Mental Health Awareness Month – 2017

Just like this time last year, I’ve come across so many things on my Facebook feed in the past few days–all in anticipation of Maternal Mental Health Awareness Month– that I’m just going to highlight all the exciting work, developments, other mothers’ experiences, and upcoming events all in one post.  It’s just a shame that these exciting developments, including articles to boost awareness, don’t happen all year round!  Think about how much more progress there would be if that were to happen!

As I stumble across more articles this month, I will add them to this blog post.

 

House Bill 1764 in Illinois

I saw an exciting announcement today on my Facebook feed from my friend Dr. Susan Benjamin Feingold, a nationally renowned expert on perinatal (pregnancy and postpartum) disorders and the author of Happy Endings, New Beginnings: Navigating Postpartum Disorders.  She testified yesterday in the Illinois Senate Criminal Committee.  HB 1764 just passed the Senate Committee and must next pass the full Senate.  Once the Governor signs off on it, it becomes Illinois law, making Illinois the first state to pass such a law!  Such a law has existed in the UK since 1922 when the Infanticide Act was put in place to ensure mothers receive psychiatric treatment and rehabilitation, rather than a death sentence or life in prison. Canada and several other European countries have also adopted similar laws.  It’s about time the US did too!

It’s due in large part to the following individuals that HB 1764 has made it thus far:  Dr. Feingold and Lita Simanis, LCSW who provided critical testimony, Bill Ryan (retired Assistant Deputy Director at the Illinois Department of Family and Child Services who regularly visited the Lincoln Correctional Center in Logan County, IL and heard the stories of numerous women serving long or lifetime prison sentences for crimes committed while sick with a postpartum disorder) who proposed the law and brought it to State Representative Linda Chapa LaVia (83rd District) who sponsored it, and Barry Lewis (Chicago Criminal Defense Attorney) who provided a written brief and expert testimony as to why this law is constitutional (in response to opposition from the State Attorney).

Click here for more information about postpartum psychosis and why this news is of such significance and a major stepping stone to what will hopefully be the passing of similar legislation throughout the U.S.   Cases of postpartum psychosis are rare and cases of ones leading to infanticide are even rarer.  But as the article states, all cases of postpartum psychosis are neurochemically caused.  Usually, women who are sick with postpartum psychosis don’t even know that’s what was wrong with them and their conditions go untreated, undiagnosed or diagnosed but not properly treated.  During trial, these women are not allowed to talk about their conditions or have them considered as mitigating factors in sentencing.  Although the idea of infanticide is truly tragic and unfathomable, try donning your empathy hat and imagine what it would be like if it were you (be sure to read up on what postpartum psychosis is and what it does to a person first) that was being controlled by  neurochemistry gone completely out of whack until tragedy strikes with an act you commit–one that you could not prevent or control due to your illness–that you will pay for dearly for the rest of your life enduring painful, unrelenting regret, many years or life in jail (or even face the death sentence), and with your illness never addressed or treated.

 

PPD Screening in NYC and Texas:
On May 18th, First Lady of NYC, Chirlane McCray, announced that NYC Health + Hospitals will screen EVERY new mother for maternal depression.  NYC Health & Hospitals provides healthcare services to more than 1.4 million New Yorkers in more than 70 patient care locations and in their homes throughout New York City.  Click here for the link to her Facebook page announcement.  Click here for more about NYC Health & Hospitals.

On my Facebook feed on May 23rd, I saw a link to an article that made my eyes pop wide open!  How exciting was it for me to read that, over in Texas, House Bill 2466 was passed for new mothers participating in federally-backed health care programs (for low-income families) like Medicaid to be screened for PPD when they bring their babies to see their pediatricians.  Yes, mothers who bring their babies in for their checkups can get screened for PPD by their babies’ pediatricians, and the screening would be covered under their children’s plan, like the Children’s Health Insurance Program. Research has shown that PPD is less likely to be identified and treated among low-income mothers, and this bill seeks to detect PPD through newborn checkups.  The rationale is–which I’ve blogged about previously and even wrote about it in my book–since mothers are not required to see their OB/GYN after childbirth unless there’s a medical issue that needs treatment, there is the opportunity at their babies’ 1-month checkup for the pediatrician to screen the mother.

 

Alexis Joy D’Achille Center for Women’s Behavioral Health:
In my Facebook feed today, I spotted an article about a new center like The Perinatal Mood and Anxiety Disorder Center at Monmouth Medical Center, which celebrated its grand opening on May 5th.  Click here for my blog post about this first of a kind center in New Jersey.  Due to open this fall, the the Alexis Joy D’Achille Center for Women’s Behavioral Health will offer comprehensive maternal mental health care at West Penn Hospital in Bloomfield, PA, in partnership between Allegheny Health Network and the Alexis Joy D’Achille Foundation.  This new facility will offer a wide range of treatment, including weekly therapy, an intensive outpatient program and partial hospitalization for women with more severe forms of PPD.  The Alexis Joy D’Achille Foundation was founded by Steven D’Achille in memory of his late wife who at the age of 30 lost her battle against the severe PPD that hit her after she had her daughter in August 2013.  The article about this new center talks about the work it has done to benefit new mothers since 2015, and the work it plans to do once the facility is completed.

 

Personal Success Story: If You Only Ask – by Jordan Reid
Being your own advocate by being informed about postpartum mood disorders, knowing your risk, and being prepared for the possibility – unfortunately, you have to for self-preservation purposes because there aren’t enough resources to catch the moms who fall through the cracks of doctors failing to diagnose, treat or even refer maternal mood disorders. The post reflects the main steps I suggest in chapter 5 of my book, which delves into risk factors and coming up with a prevention plan.  I also touch on being prepared in a previous blog post by having a therapist lined up, just in case, if you think you are at high risk for postpartum depression (PPD).  I’ve also blogged about risk factors for PPD.

 

Postpartum Support International (PSI):
The annual PSI conference is coming up in Philadelphia!  Register by May 8th to take advantage of early bird rates for its PMD certificate course from 7/12-13, as well as for the regular 2-day conference from 7/14-15).

Additionally, PSI has just announced its partnership with the University of North Carolina-Chapel Hill (UNC-Chapel Hill) School of Medicine to expand the PPD ACT.  The PPD ACT is an iPhone app previously released in the U.S. and Australia to study PPD, which is now expanding its reach to iPhones in Canada and to Android phones in the U.S. and Australia.  The app was designed to help understand why some women suffer from PPD and others don’t, in the hope of improving the ability to minimize risk and find more effective treatments.  Women with the app can participate in surveys and DNA testing to study the genes of those suffering from PPD.  This study is the first of its kind.  Last year, approximately 14,000 women enrolled in the study.  Many women who participated were successfully treated for PPD. Ultimately, the hope is to be able to expand the study across the globe.  To download the app or learn more about the study or PPD, click here. For more information about the PPD ACT, click here to access the UNC-Chapel Hill announcemen, here for a HuffPost Canada post announcement, and here for a Mom.me post titled “Find Out If You Have Postpartum Depression Without Leaving Home” by Claudiya Martinez on May 15, 2017.

 

National Coalition of Maternal Mental Health (NCMMH):
And last and most definitely not least, please have a look at how you can participate in Maternal Mental Health Awareness Week (May 1-7) led by the National Coalition of Maternal Mental Health (NCMMH).  Click here to see how you can partner along with other organizations, blogs, authors, mental healthcare providers, etc. in the awareness initiative by becoming a social media partner (like me) to NCMMH.  Help spread the word about the #1 complication of childbirth on Facebook and Twitter by changing your profile pictures and cover pictures, as well as re-tweeeting/re-posting digital messages from the NCMMH’s Twitter and Facebook accounts from May 1-7.

 

History in the Making for Maternal Mental Health Advocates

I’ve been super busy at work these days, sometimes having to work at night, which is why I haven’t blogged much lately. But I couldn’t let today go by without mentioning the announcement today about a major step in the right direction….finally!  First thing this morning, I received a text from a friend to check out an article in the NY Times about postpartum depression (PPD), followed immediately by an email from my husband with a link to the same article.

Mental health advocates are excited not just about the news that splashed the headlines of today’s New York Times and NPR about the importance of screening adults for depression.  It’s the acknowledgment–finally–that new and pregnant moms need screening because catching and treating PPD early is crucial to the wellbeing of both the mother and the baby, and to the family unit as a whole.  I’ve blogged in the past about how screening and seeing someone experienced in treating PPD could have prevented my painful experience.  Having the screening recommendation come from the U.S. Preventive Services Task Force is particularly meaningful, as its recommendations have far-reaching impact on things like healthcare (i.e., American College of Obstetricians and Gynecologists, American Academy of Pediatrics, American Academy of Family Physicians) and health insurance in this country.  In fact, its recommendations appear in the current issue of JAMA (Journal of the American Medical Association).

This is a major milestone for maternal mental health advocates in this country.  And it’s about freaking time!  I attribute this milestone to the persistence, hard work, dedication and passion of many, many amazing people either independently acting or as part of organizations formed–too many to list here but foremost on the list is Postpartum Support International (of which I’ve been a member since 2006)–to spread awareness about an all too common condition suffered by mothers that even today people are not aware occurs in 1 out of 7 moms.  Seeing my friends’ names in these articles–Heidi Koss, a survivor/advocate/counselor and Wendy Davis, Executive Director of Postpartum Support International–mentioned makes them all the more meaningful to me.  They are passionate about what they do because they don’t want mothers and their families suffering unnecessarily.

You would think something like screening, which I’ve blogged about numerously in the past, would be mandated by all healthcare professionals who come in contact with expectant/new moms.  In one of my very first blog posts from back in June 2009, I included my suggestions for what screening would entail. Unfortunately, screening has not been embraced because, after all, where there is a positive, there is always a negative.  In this case, there are several negatives, with the biggest being none other than STIGMA, one of the 2 biggest barriers to progress for the battle against PPD.

Stigma–and the ignorance associated with it– comes from resistance to change and attitudes about what screening would mean (“Oh, once a mom is screened positively for PPD, then she will automatically be medicated”).  That, by the way, is totally false.  No one is deliberately trying to medicate every mother and give more business to the pharmaceutical companies.  Again, I have blogged plenty about this in the past, but medication is just one way to treat a perinatal mood disorder and in many cases critical to helping restore the neurochemical imbalance that childbirth has brought about.  Without medication, I might not have survived my PPD.  In most cases, it’s a combination of medication and therapy (like CBT) that is most effective.  In some, less serious cases of PPD, therapy or peer-to-peer support (with a PPD support group led by a survivor) and/or an alternative treatment like meditation or acupuncture is sufficient.

Speaking of which, there is another major barrier, which is what happens once an expectant or new mom screens positively for a perinatal mood disorder….can we find them immediate help?  Although there are more resources now than there were back when I suffered from PPD, we still have a very long way to go.  There is definitely a need for more help among the healthcare, mental healthcare, and peer-to-peer support communities who are experienced in treating perinatal mood disorders.  You’ll all too often hear that there is a long wait to see a psychiatrist (an MD who has the ability to prescribe meds), once you’ve found one that is near you that has experience treating perinatal mood disorders.  Unfortunately, there just aren’t enough mental healthcare practitioners who are experienced in treating perinatal mood disorders.  There aren’t enough mental healthcare practitioners, period.  And among general practitioners, not enough are experienced enough or even have adequate bedside manner to know how to treat/behave toward a mother struggling with a perinatal mood disorder.  I know, because I had seen one of those doctors, and it was a horrible, horrible experience for me.

These are the problems that we need to overcome if we want to truly be able to prevent any more mothers from falling through the cracks.  There are many steps to get where we need to be, but we have attained an important step in the right direction with the recommendation from the U.S. Preventive Services Task Force!

Things Your OB/GYN Won’t Tell You But Should

Lately, I’ve been having a hard time picking what topic to blog about in the little time that I have to blog.  Nowadays, something I read in my Facebook feed has to really spark my interest in a big way.  Today, I stumbled across this HuffPo article “6 Things Your Ob-Gyn Won’t Tell You But Should.”  The article is meant to provide guidance to women who are thinking about becoming ,or are already, pregnant and need to find an OB/GYN that is right for them.

Here’s the comment I left:

I can tell you what my OB/GYN didn’t tell me about….postpartum depression…or treat me in an understanding/sympathetic fashion….or know who to refer me to for help. It’s pitiful and inexcusable that they are supposed to be charged for the care of women’s reproductive health matters, and yet perinatal mood disorders are still so far off their radars! They must get up to speed and be prepared to inform, detect (this includes screening pregnant and new moms with basic questions), and treat and/or refer to a specialist for treatment!

Here’s my advice for you that is coming from someone who has been down the road of having to find an OB/GYN (because I had just moved to the area) and was merely relying on the fact that so many women in town have the same one, without really feeling the doctor out ahead of time by asking questions and really determining if he was the right fit for me.  I didn’t allow any chance for my gut instinct–usually very fine-tuned–to really kick in.  How was I supposed to know he was going to have such poor bedside manner at the first hint of things not going as planned, and then drop kick me when he realized I had PPD?

In addition to the questions the Huffpo article lists, be sure to ask the following:

  1. How much about PPD and other perinatal mood disorders do you know, and can you tell me about them?
  2. Do you screen all your patients during, at minimum, the postpartum period for any postpartum mood disorder (PMD)–both via basic questions asked (see sample questions here) and via bloodwork?
  3. Do you treat PMDs, and if not, do you have referrals to healthcare providers who specialize in treating PMDs?

Please note that I am not limiting this advice to those with a history of depression.  I never had depression prior to my pregnancy and yet managed to get hit from left field with PPD and was thus left feeling sad, scared, alone, helpless and hopeless.

Please do not follow in my footsteps.

Be in the know and choose your OB/GYN wisely.

Sign this Petition! Don’t Let Any More Mothers Fall Through the Cracks Any More

REVISED AS OF WEDNESDAY, MARCH 12, 2014, 9:30 PM EST

By now, you’ve probably already heard about the woman who drove her minivan into the ocean at Daytona Beach, Florida.  Her three children–ages 3, 9 and 10–were in the minivan.  And the woman was pregnant with her fourth child.   When I first started reading the article, I was bracing myself to read about the tragic loss of four lives–actually, five lives if you count the unborn child–but thankfully, they did not perish in the ocean.  From the little I could gather from the article, it seemed that the woman was suffering from psychosis, which is how bipolar disorder can manifest in a pregnant or postpartum woman.  The 911 recording of her sister indicated that she was “talking about Jesus and that there’s demons in my house and that I’m trying to control her…..She’s, like, having psychosis or something.”

My friends and I cringed as soon as we heard about this story, just like we cringe when there is ANY news of mothers who attempt to kill their baby/children and themselves.  We cringe because we know that the general population–the majority of people out there who are ignorant about postpartum mood disorders–seem ever so swift to condemn the mother’s actions.

I am sick and tired of the stigma.  Sick and tired of the ignorance about maternal mental health. Sick and tired of women being failed by their doctors and by a medical system laden with holes that let all too many mothers fall through the cracks.

Are you sick and tired too?  Well, join me now in signing a petition to implement universal mental health screening for every pregnant and postpartum woman.  Let’s put an end to the stigma and ignorance, and get mothers the treatment they need before a perinatal mood disorder (PND)–a mood disorder during/after pregnancy which can affect up to 1 out of 7 new mothers–leads to tragic circumstances!

I have participated in/encountered several meaningful discussions on Facebook about screening over the past week.  I know from the past 5 years of blogging and advocacy that, for every bunch of PMD survivors and advocates that voice their support for the implementation of universal mental health screening of pregnant and postpartum mothers, there is at least one individual voicing concern, and even opposing  it.  Why would anyone be opposed to the simple asking of a set of standardized questions to try to see if a mom might be experiencing symptoms of a PND, you ask?  Well, these individuals are concerned that legislating such a screening would cause an already over-medicated society to fall deeper into the arms of Big Pharma and doctors even more reason to simply dole out medication prescriptions.  These individuals fear that, in addition to  inadequate experience with PNDs and an inadequate referral system to therapists who do have experience treating PNDs–both of which are entirely valid points, unfortunately–one too many moms will simply be prescribed medications (and sometimes the wrong ones, to boot) when what many moms do need is therapy as well.  To make it more complicated, many moms will fear taking medications for fear of passing the medications on to their babies through their breast milk.

Whether we get the 100,000 signatures or not, the very least that we hope would come of this petition is to raise greater public awareness of PNDs and reduce stigma. If we were to reach 100,000 signatures, then there would have to be a federal law to INVESTIGATE the subject.  If universal screening were to come about, it would be offered to all mothers, but mothers can opt out.  There would NOT be a mandatory prescription doled out if a mother tested positive.  The desperately sought outcome of the petition would, first and foremost be, EDUCATION of doctors to screen in a non-intrusive fashion, take thyroid levels into consideration, how to provide compassionate and nonjudgmental care, etc., as well as EDUCATION of mothers about PMDs and treatment options available if she were to experience a PND.  It would be up to the mother how/if she would seek treatment.

Did you know that screening is routinely offered by many OB/GYNs already?   I have not heard any negative experiences when it comes to screening that is offered to mothers today.  A big Thank You to Karen Kleiman, MSW, LCSW, founder of The Postpartum Stress Center and author of numerous books on perinatal mood disorders for giving me permission to use this image, which I saw pop up on my Facebook feed a few days ago.

screening_Kleiman

I would like to quote fellow Mama’s Comfort Camp member, Anna Tarkov (thank you, Anna, for letting me quote you!), in response to another member’s comments about preferring a cultural overhaul comprised of a national campaign to educate and support for new mothers over the implementation of universal screening…which don’t get me wrong, I absolutely agree with as well (we need all three: SCREENING, PUBLIC AWARENESS/EDUCATION, AND SUPPORT):

We can and should push the culture change [campaign to educate and support but with no screening] that needs to happen, but I just don’t know if it’s enough…..I share your concern for medication as a sole solution, but I feel we already have this situation with our medical system. Many conditions don’t require medication and could be treated in another way. Each patient is responsible for making up their own mind and each clinician should present all the options. I thought carefully about whether I should take medication as part of my treatment and I think I made the right call for myself. If someone else chooses another path, that is fine, but if even one life of a mother or child or innocent bystander can be saved if we were to have effective screening during pregnancy and after, I would consider that a victory…….My hope would be that with better screening, clinicians can also be required to provide a lot more beyond a diagnosis. I am cautious about any new proposed policy and often what we end up with is far from perfect. But my feeling is that doing nothing isn’t an option and any step in the right direction is a good idea.

You summed it up so nicely, Anna!

Oh, and do read and encourage others you know to read the facts, and nothing but the facts about bipolar disorder during pregnancy and postpartum.  Here is just one of many places you can read up on it.

Please, please, please…..sign the petition and SHARE WIDELY.  Let’s get as many signatures as possible!  Tweet about it.  Blog about it.  Share about it on Facebook.  Let’s be the change that we so desperately need for our mothers!  Let’s make sure that no more mothers fall through the cracks.  Thank you!

Developing Systemic Solutions to Postpartum Depression

One of two real quickie posts from me today, and I never post 2 at the same time!   Thanks to Twitter, I am in better shape news-wise than before, that’ s for sure! 

Back in August 2010, a bill referred to as “An Act Relative to Postpartum Depression” was passed and went into effect in Massachusetts. Click here for my previous post on this.  Today, there was a Boston Globe article titled “All mothers need to be screened for postpartum depression” posted by Marjorie Pritchard that provides an update on the state’s progress.  Although funding for the heart of the bill–universal screening and public awareness initiatives–has been practically non-existent, progress is being made that includes the state Department of Public Health issuing regulations on best practices and data collection for screening. 

Additionally, the mission of a 34-person Commission chaired by Emily Story (Democratic state representative from Amherst), and made up of health care providers, insurance representatives, survivors, legislators and state agency representatives–among many others–is to come up with best practices in screening/referrals/treatment, public awareness, and education of healthcare professionals.  Basically, the development of systemic solutions to postpartum depression so desperately needed to help women and their families get the help they need when it comes to an illness that strikes so many new mothers.

It’s certainly encouraging to see such progress–albeit slow and steeped with challenges (in the form of funding and the state of the economy and health insurance)–in Massachusetts.  Before the end of this decade, I’d like to see all 50 states working to achieve the same goals with respect to maternal (and family) well-being !

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.

24th Annual Postpartum Support International Conference

Last week, I spent 3 days (October 27-30) at the annual Postpartum Support International conference.  This year, it was held in conjunction with the biennial (every 2 year) Marce Society conference, which is traditionally held in the city of the current President of the Marce Society.  With the current President of the Marce Society being Katherine Wisner of the Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, this year’s conference took place in Pittsburgh.

Past PSI conferences I attended were in Jersey City, NJ and Kansas City, KS.    With this year’s conference being held in conjunction with the Marce Society, there were over 400 people in attendance, including leading researchers and experts in postpartum depression (PPD).  I was honored to be in the presence of so many individuals who have made such a huge difference on behalf of so many women who have suffered perinatal mood disorders.

Individuals like (note that there are too many to list here, but here are the ones that are most notable to me because I have read their research in the years I have been doing tons of reading on PPD):

  • John Cox, DM, FRCPsych, FRCP, who, along with colleagues J.M. Holden and R. Sagovsky, developed the Edinburgh Postnatal Depression Scale (EPDS) in the 1980s.  Dr. Cox was awarded the Louis Victor Marce Medal in 1986 for his pioneer research and clinical work in perinatal Psychiatry carried out in Uganda, Scotland and Staffordshire.  In 2002 he was elected Secretary General of the World Psychiatric Association.
  • Lee Cohen, MD, director of the Perinatal and Reproductive Psychiatry Clinical Research Program within the Clinical Psychopharmacology Unit of the Massachusetts General Hospital, as well as an associate professor of Psychiatry at Harvard Medical School.  Dr. Cohen is a national and international leader in the field of women’s mental health, and is widely published with over 200 original research articles and book chapters in the area of perinatal and reproductive psychiatry.
  • David Rubinow, MD, Chair of Psychiatry and Professor of Medicine at UNC Chapel Hill.  Dr. Rubinow is currently President of the American Neuroendocrine Society and the Society of Biological Psychiatry, has won numerous awards for his research, his clinical supervision and training, and his scientific administration, and serves on the editorial boards of six journals and has authored more than 300 scientific publications.
  • Cheryl Tatano Beck, DNSc, CNM, FAAN, is a Distinguished Professor at the University of Connecticut School of Nursing.  Dr. Beck serves on the editorial boards of 4 journals and has published over 125 scientific articles as well as 4 books.

I was one of the minority there who was not a mental, medical or public health professional, or social worker.  There were 3 other young ladies there who, like me, are simply moms who want to learn more about perinatal mood disorders and find ways to help spread awareness, as well as to advocate on behalf of and provide support to other mothers.   These young ladies were Katherine Stone, Lauren Hale and Amber Koter-Puline.  This was my 2nd time meeting Katherine and 1st time meeting both Lauren and Amber.  This was the first time all 4 of us PPD bloggers were together in one place.

Here we are:

Amber Koter-Puline, Katherine Stone, Lauren Hale, and me

Another highlight of the conference was the appearance of Former First Lady Mr. Rosalynn Carter as the keynote speaker and book signing of the book “WITHIN OUR REACH: Ending the Mental Health Crisis,”  which she co-authored along with Susan K. Golant and Kathryn E. Cade.

There was so much information provided at the conference, but I was able to take away these 2 really important points that I would like to share with you:

  1. It is critical that we integrate behavioral health with medical care that is provided by those charged with the reproductive health of women.  I learned there is a multi-disciplinary approach to treating women with perinatal depression comprised of a psychiatrist, obstetrician, obstetrical nurse practitioner, and psychiatric social worker at Kaiser Permanente Medical Center in San Francisco.  We REALLY need more of these throughout the country!  In certain other countries, it’s the midwives and early childhood nurses–in addition to GPs–that are the front line of screeners.
  2. There was a presentation about the proposed changes being made regarding the treatment and screening of PPD for the DSM-5 due to be published in May 2013.  During this presentation, the ballroom grew noticeably hotter as one by one members of the audience took to the microphone to state their questions and concerns.  Most of them centered around the announcement that 4 weeks is the cut-off date for onset.  I mean, have you heard of a more ridiculous thing than that?!   That means that any screening that may occur (as not all OB/GYNs or other health professionals screen today) would only occur in the first 4 weeks postpartum, since a postpartum mood disorder (PPMD) would’ve had to rear its ugly head by then.   Why, then, you ask would they propose such an outlandish thing?  Well, it’s because all these years the DSM-IV and all its predecessors are based purely on statistics obtained directly from research.  Not doctor’s offices or hospitals or clinics.  Not from data obtained from the EPDS given to the thousands of moms that give birth each year.   Sounds like typical political, ahem, B.S. if you ask me….

Okay, so what does this all mean?  This means that moms will not only continue to have their OB/GYNs dismiss their PPMD symptoms, but now in addition, there will be a specific cutoff of 4 weeks.  Anything after 4 weeks will risk being shrugged off, as doctors will be referring to the handy dandy DSM-5 as the Bible and complacently inform these moms that they couldn’t have a PPMD because they were more than 4 weeks postpartum.

There is still opportunity to improve on the DSM-5 as it is being proposed.  You can help make a positive difference.  How?  Well, starting in May 2011 and ending midnight of June 30, 2011, the public will be able to submit comments on the draft of the DSM-5 on the American Psychiatric Association’s DSM Development website.   I will be signing up to do so, and I hope you will too.   The more women who do, the better chance we have of convincing the powers that be that they need to extend the onset period to 1 year (or even 3 months would be far better than 4 weeks)!  Voice your concern.  Tell them why.  Share your story.  I know numerous women whose symptoms of PPD didn’t begin until after the 6th week.  Like me, for one.   Other countries who have had ancient social support customs in place for centuries have had 6-8 weeks as the period in which the new mom must be cared for.  There is a reason behind that….just as there is a reason behind the Swedish model of the primary care physician (or general practitioner) performing postnatal screening between 8 and 21 weeks postpartum, with 13 weeks as peak prevalence.

To think that women who are sick with PPD will continue to be shrugged off and go untreated and allowed to suffer unnecessarily angers me to no end.    We are supposed to make progress, but instead, we are more concerned about statistics obtained during very limited studies.   Folks on the DSM-5 committee, this is a blatant example of not being able to see the forest for the trees. 

Massachusetts Postpartum Depression Legislation Signed into Law Today!

Quick post for the purposes of expressing my elation over the fact that the Massachusetts Postpartum Depression legislation has been signed into law today, Thursday, August 19, 2010!  Yep.  The Massachusetts Governor has signed House Bill 4859, otherwise referred to as Chapter 313, An Act Relative to Postpartum Depression.   Click here for more details.

HURRAY FOR PROGRESS!

Similar to the Mother’s Act passed at the Federal level, HB 4859 stipulates a focus on earlier detection of postpartum mood disorders through screenings, improved collaborative efforts among health professionals for the treatment and referral of patients, the training healthcare providers, and public awareness campaigns.  Click here for an excerpt of the bill. 

It’s exciting to see these changes occurring across the country, isn’t it?!  Click here for details on the latest in legislative developments relating to maternal mental health.

April 13, 2010 is 4th Anniversary of New Jersey’s Postpartum Depression Law

Four years ago today, New Jersey became the first state in the country to pass legislation requiring healthcare professionals to educate and screen all new mothers for postpartum depression (PPD). 

Since then, New Jersey’s Dept of Health and Senior Services’ Speak Up When You’re Down campaign has:

The key to helping mothers and their families minimize the risk (or effects, if it does occur) of PPD is early identification (via screening) and education (via awareness campaigns and ensuring healthcare providers are all aware).   Through knowledge of risk factors, symptoms, and services available locally, mothers and their families will be able to recognize sumptoms of PPD early on, as well as take immediate action to ensure proper diagnosis and treatment.

I’d just like to clarify what screening is.  It sounds like poking and prodding is involved.  No, women are not treated like lab rats or anything like that.  Screening is merely a doctor proactively asking some questions to ascertain whether a new mother entrusted to his care is exhibiting any signs of PPD.   The most widely-used screening tool for PPD is The Edinburgh Postnatal Depression Scale (EPDS), which many hospitals in New Jersey have elected to use.   It’s also important to note that, though doctors are required to screen all new mothers in their care, a mother has the right to refuse to answer some or all of the questions. 

I wish this legislation were in effect back when I had my daughter!  There are many others that feel the same way as I do.  Before this legislation went into effect four years ago, some doctors were already asking all new moms fundamental questions at each visit to ascertain if there are any symptoms of PPD, since after all it does occur in as many as one in eight new mothers!  One of the reasons why this legislation was necessary is because there are still so many doctors out there who don’t go the extra mile where their patients are concerned–and worse fail to diagnose PPD properly.  The screening should currently be taking place as the new mom leaves the hospital after having her baby, plus at her 6-week follow-up with her OB/GYN.   Since so many cases of PPD develop before the six-week follow-up visit, at some point–and I fear this may never happen because it would require a huge change in health insurance and ACOG (and whatever other organization that would have anything to do with this) — a 3- or 4-week follow-up visit becomes a requirement/standard.    What a HUGE difference this would make, wouldn’t it?!   Maybe if enough people push for this, it will happen.  One can only hope…and dream.

PPD Legislative Hearing in Boston on January 27, 2010

Calling all Massachusetts residents who care about the health of mothers and their families…… 

Here is a great opportunity to help make a difference with respect to postpartum legislation.  Attend a hearing on postpartum legislation at 10:00 AM on Wednesday, January 27, 2010, at the State House (Gardner Auditorium) in Boston.  Show your support for this potentially groundbreaking legislation by attending the hearing, as well as a press event taking place there prior to the hearing.

State Rep. Ellen Story of Amherst will be presenting House Bill 3897: An Act Relative to Post-Partum Depression before the Committee on Financial Services.  This bill provides for screening, referrals, education on PPD (not only families but health/mental healthcare practitioners), and even a home-visiting program for at-risk women.  Organizations, such as MotherWoman, support this legislation.

For more information, please contact Liz Friedman at liz@motherwoman.org.

Senator Barbara Mikulski Fights for Women’s Preventive Health Services

Washington, DC – Dec. 1, 2009 – Senator Barbara Mikulski (D-MD), a senior member of the Health, Education, Labor and Pensions Committee, introduced the Women’s Health Amendment today, the goal of which is to improve the Senate’s Health Care Reform Bill by requiring health plans to cover women’s preventive care (e.g., cervical screenings, annual mammograms for women under 50 opting such screening, antepartum and postpartum depression, heart disease, diabetes).  Such screenings would cut treatment costs via early detection and prevention.   

Here are excerpts of the summary of the bill:  Basically, what the amendment does is “require all health plans to cover comprehensive women’s preventive care and screenings, and cover these recommended services at no cost to women.”  The bill points out the current dilemma–i.e., women are increasingly delaying or skipping preventive health care due to costs, putting themselves at risk if a serious health issue is not prevented or detected early on.  Additionally, women’s unique health needs throughout their lifespan must be taken into account in determining coverage of preventive services.   

I was in shock and completely confused upon hearing the news a few weeks ago regarding the recommentation for mammographies and cervical cancer screenings to be performed on women 50 years of age and older.  I thought to myself ”What is going on here?  There hasn’t been a sharp decline in the occurrence (or deaths due to) breast cancer recently, nor have there been any new scientific breakthroughs with respect to early detection.  Same thing applies to cervical cancer.  It appears that women have once again been relegated to second class citizen status.  How can these people turn a blind eye like that toward women’s health?  The health of all its citizens–women included– should be the priority of the government of this country.”    

Fact of the matter is, until there is a better means of preventing and detecting breast cancer (and earlier), women in their 40s–particularly those with family histories of breast cancer–must have access to early mammogram screening.   Seeing how this amendment would also include PPD screening makes me hope all the more for this amendment gets passed.

Thank you, Senator Mikulski, for representing the interests of women by introducing the Women’s Health Amendment!

Time Article Off the Mark….But What Else Is New?

I know I said my next post was going to be about the importance of sleep for postpartum moms, but there are times that I cannot wait to get my thoughts–not to mention anger–out of my system (and onto this blog…after all, that’s what my blog’s for…to vent and share my thoughts with others).  What’s got me riled up this time?  I’ll let you guess (but then again, my title is a give-away, isn’t it?).   As many of my friends (and blog followers know), my #1 anger trigger is when people say things out of ignorance/stupidity/condescension/racism.   What falls under this category of anger triggers is when the media wastes its ability to reach out to mass audiences with the truth, and instead focuses on one thing, which is to generate sales and attract attention while distorting the truth and adding to the misconceptions (or myths) that exist about motherhood and postpartum depression (PPD).  

Check out  the Time article I am ranting about.  It’s about the Melanie Blocker Stokes MOTHERS Act.  And here is my letter that I sent to the editor on Friday in response.  I am sharing this with you because, quite frankly, I doubt anyone at Time would pay any attention to it.  Why would they?  After all, they chose not to include my interview in the article because I don’t say things that shock and disturb.  I’m only telling the truth from a PPD survivor’s perspective, who has taken on blogging and writing a book to join the growing numbers of women who are gaining the courage to share their experiences with others.

– – – – – – –

Frankly, I am shocked and dismayed at this article, which shows a completely one-sided view with respect to the Melanie Blocker Stokes MOTHERS Act.  Catherine Elton only named an opponent but no advocates, despite the fact that she interviewed me and a couple of other PPD survivors who are active on the PPD blogging scene.  By failing to mention advocates, you are giving—whether intended or not—the appearance of a lack of support for this bill, particularly of women who happened to survive a perinatal mood disorder, happen to have their eyes wide open, and can see clearly how this bill would bring us from out of the Dark Ages and into the 21st century in terms of public awareness and once and for all ending the myths that keep women suffering unnecessarily in silence.  

Passage of this legislation would benefit thousands of mothers in this country each year through an increase in public awareness campaigns, education, support services, and research to ensure early detection and treatment of perinatal mood disorders.   Those with a strictly anti-pharma agenda fail to see what this bill is truly about.  They are letting their hatred of medications cloud their ability to see the benefits and, even worse, imagine things that don’t even exist in the language of the bill—i.e., forced screening and drugging of expectant mothers. 

I am shocked that you would consider this fair and accurate reporting. This is but another example of another opportunity to educate the public about PPD completely wasted with attention-getting headlines and a biased focus that serve to prevent progress that’s so desperately needed with respect to public awareness of PPD.  If you think this article is helping mothers out there, you are dreadfully mistaken. 

– – – – – – –

By writing an article about this bill, Time should have done so with all sides equally represented.  There ARE MANY supporters of this bill that are PPD survivors and friends and family members that saw what these women had to suffer through, and totally support this legislation.  Such a one-sided view, as this article was written in, only shows there might be some kind of bias on the part of the editor and/or author.  Makes you kind of think there is a hidden agenda….

It’s a shame that words of hate and anger on the part of the bill opponents–so much louder and attention-getting because they are so much more frightening (not in a good way, mind you)–can easily distort the truth.  In the long run, all this does is work against the very people this bill is trying to help…MOTHERS.

Current Dilemmas, Barriers to Progress When it Comes to Diagnosis and Treatment of PPD

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.

Baby PREP – Parent Readiness Enhancement Program, a prevention program for expectant moms at-risk for postpartum anxiety

Are you pregnant, live not too far from Tallahassee, Florida or Chapel Hill, North Carolina, and a first-time mom interested in prenatal education and tools for dealing with postpartum anxiety and related distress–which along with postpartum depression–are increasingly being recognized as a serious problem with negative consequences for both mom and baby?

Hope your answer is a resounding Yes!  Why?  Prenatal education is something this country, in general, is lacking.  Actually, let me clarify.  Sure, you have magazines and books catering to the expectant moms.  But what I’ve said in several posts, actual hands-on training is sadly lacking.  You may ask “But what about classes hospitals offer?”  They are usually 1- or 2-hour classes with specific topics, like breastfeeding, childbirth and infant care.  Well intended, but hardly adequate.   Better than nothing, but still inadequate when you compare the childbirth preparation and assistance with the transition to motherhood that doulas (and communities in other cultures) provide the expectant mom. 

So, going back to the question of whether you are pregnant and interested in prenatal training, then here’s a wonderful opportunity you shouldn’t pass up!   The Florida State University and University of North Carolina at Chapel Hill are conducting an exciting research study, which investigates a prevention program for postpartum anxiety and related distress.  My hope is that these studies will spur on more of the like throughout the country!

According to the Baby PREP site, which you should visit for more details, this program consists of one initial screening session, 6 FREE prenatal classes, and two follow-up appointments, for which you will be compensated $40.  Participating in this program can help you feel more prepared for the adjustments and care of an infant for the first time.   By feeling more prepared for this major transition, the first-time mother will be less likely to develop postpartum anxiety symptoms or distress.  Not only can your participation help you, it will help researchers better understand how to more effectively prevent anxiety symptoms from developing in the postpartum period for others.

PLEASE CALL 850 / 645-1766 FOR MORE INFORMATION.

Recent News on Screening Expectant and Postpartum Moms for Perinatal Mood Disorders

Screening expectant and postpartum moms for perinatal mood disorders is a topic that is coming up more and more these days, as well it should.  Why?  The more it’s brought up, the more the public will realize the prevalence of postpartum depression (PPD) and need for early detection and social support to help prevent and/or minimize its occurrence.  And perhaps one day in the not-too-distant future the standard for care of expectant and postpartum moms will see an improvement in both areas, not to mention banishing the stigma of perinatal mood disorders once and for all!   

Over at Amber Koter’s blog Beyond Postpartum, two of her recent posts address the importance of screening mothers.  One was on how Australia may pave the way for screening, and the other on how screening can be performed by pediatricians at infant visits (this is because currently the only postpartum follow-up there is today is at 6 weeks…beyond that there would have to be a problem before insurance would cover an additional visit(s) to the OB/GYN).  We’re not the only country considering the implementation of screening for perinatal mood disorders (and it’s a good thing too!).  Australia is considering the screening of pregnant moms for their risk of PPD.  The article mentions that, though the stigma of PPD has decreased, “many women were still falling through the cracks due to a lack of prenatal and postnatal screening…..Long-term untreated [postnatal depression] can cause delayed cognitive and emotional development in the baby. The benefits of picking up [PPD] early are immense.”

Over at Lauren Hale’s blog Unexpected Blessing, a recent post brings attention to a recent article in the Journal of the American Academy of Pediatrics that starts off with this promising statement:Screening for maternal depression is gaining acceptance as a standard component of well-child care.”

And over at Katherine Stone’s Postpartum Progress, her post on June 12th informs us of yet another example of a hospital setting up a program—having moms complete questionnaires to identify risk factors and having high-risk moms see a postpartum support specialist before discharge—to help identify moms with PPD.  Way to go University Community Hospital of Tampa!

Also pulled from Postpartum Progress’ highlights on screening from the Public Briefing on Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention that took place on June 10, 2009:

  • The National Academies endorses screening and believes it’s crucial, but also emphasizes screening is not helpful unless there is effective follow up and treatment tied to it. 
  • Individuals need an informed choice in the treatments they choose.  
  • The group suggests that governors of each state convene a task force to develop and implement the strategies they recommend.   

Additional highlights on screening pulled from the full report of the same title:

  •  Pg 5-3: “[Although] screening alone will increase recognition [of depression], the best outcomes [of studies occur] when primary care settings [implement] quality improvement programs that [support] patient education and initiation of therapy.
  • Pg 5-6: “The unique triggers and social issues of [the postpartum] period have led to recommendations for pediatricians, obstetricians, and family physicians to screen postpartum women.  It is particularly during this period of parenting that depression has been widely recognized as impacting the parenting and nurturance of the child.  Publicity about severe cases of postpartum depression has led to increased awareness and promotion of screening and education.”
  • Pg 5-6:  “Some public health programs have initiated comprehensive programs to address maternal depression.  Several state health departments have programs that support screening, provider training, and parental supports.  New Jersey, since 2006, has had a law requiring screening, education, and referral.  Illinois provides additional clinician payment for conducting postpartum screening.  Screening programs can have an educational role that decreases stigma as well as providing supports to individuals in their parenting role.  When screening is implemented the pressure to provide follow-up resources can stimulate treatments resources, such as depression support groups. In Washington, with the advent of depression screening in the state’s Maternal Support ‘First Steps’ Program staff report that the number of postpartum depression groups in the state have more than doubled.  In Australia, over 40,000 women have been screened in a wide range of clinical and public health programs with the EPDS [Edinburgh Postnatal Depression Scale] antepartum [or during pregnancy] or postpartum.”
  • Pg 5-7:  “In a survey of obstetricians, 44 percent reported that they screened for depression [while 31 percent of] family physicians surveyed in one state [indicated] they always screened at postpartum visits and 13 percent always screened mothers at well-child visits.  The use of written screening tools was rare, with 82 percent using an interview (Seehusen et al, 2005).  Pediatricians report that observation or information inquiry is the most common method of detecting maternal depression.”
  • Pg 5-11: “[Several] state programs are conducting screening programs in which home visitors administer and score a standardized depression screen and then refer mothers (or fathers) scoring above a predetermined clinical threshold to community mental health services for further evaluation and treatment as indicated.”

Not only do I feel that postpartum screening is needed, I believe OB/GYN offices should screen their patients initially (as new patients), prenatally (during pregnancy), and postpartum.  OB/GYNs should screen their patients for risk of perinatal mood disorders prior to pregnancy, throughout pregnancy (more frequently if the predisposition exists), and as part of the standard 6-week postpartum check-up (they should even offer a 3-month check-up to determine if there are any PPD symptoms and/or moving the 6-week visit to the 4th week, so there is one at one month and one at two months) to increase the likelihood of successfully detecting PPD.  The standard 6-week postpartum visit with the obstetrician should include blood work to check for deficiencies in iron, thyroid, etc., even if there are no outward signs of anything amiss, like PPD.  The standard protocol should be to, first of all, establish a baseline of hormone levels (progesterone/estrogen) before pregnancy.  Then, at 6 weeks postpartum, tests should include a thyroid panel, Adrenal Stress Index and blood work to measure hormone/neurotransmitter levels. 

ONBOARDING Questionnaire:

  1. Have you experienced PMS, and if so, what are the symptoms?
  2. Have you or an immediate family member experienced mood disorders, major depression, PPD, extreme anxiety, panic attacks, an eating disorder (e.g., anorexia), alcohol or drug addition, bipolar disorder, OCD, and/or psychosis?
  3. Do you experience any negative effects from taking birth control pills?
  4. Do you have or do you have a family history of thyroid disorder?
  5. Have you had a baby before?  If so, have you had any previous negative experiences related to childbirth (stillbirth, miscarriage, adoption, abortion)? 
  6. Have you had PPD before?
  7. Have you had infertility issues and had to have multiple IVF cycles?

OB/GYNs should be proactive instead of reactive and only treat patients that come through their door that already have symptoms of a mood disorder.  Why is that, you ask?  Well, the earlier they treat the patient, the faster the patient will recover, and the quicker she can return to caring for her baby.  For instance, if a woman indicates in the onboarding questionnaire that they have a personal or family history of bipolar disorder, the obstetrician should follow her closely during pregnancy and postpartum.  Even if a woman has never exhibited signs of bipolar disorder, if she has a family history of it, her first episode may occur after childbirth. 

PREGNANCY Questionnaire:

Once a patient becomes pregnant, the doctor should advise her on what PPD is and how the risk indicators correlate with PPD.  The history of the patient (i.e., answers to all the above), in addition to any complications during childbirth, should be recorded and taken into consideration when evaluating the patient for the possibility of PPD.  Regardless of whether a woman is at risk for PPD, there should still be a consultation in which the doctor will briefly go over what it is and who is at risk.  If the woman is at risk, there should be an explanation of the treatment options and an emphasis on having a support network lined up to provide emotional and practical support that goes into effect as soon as they return home from the hospital.  Speaking to the woman’s partner directly would be a plus for emphasis on the importance of their support.  The doctor should explain to patients and their partners how first-time parenthood is not as easy a transition as they are led to believe.

Questions the doctor could ask the patient from the time she first learns she is pregnant and throughout her pregnancy, keeping in mind that preeclampsia and other complications can also cause depression to occur:

  1. How have you been feeling physically and emotionally? 
  2. Have you had any pain, spotting or difficulty sleeping? 
  3. Are you feeling particularly stressed, and if so, is it due to a major change you are experiencing, such as marital problems, death of a loved one, financial problems, a recent move, a job change?
  4. Is this a planned pregnancy?
  5. Do you have any expectations in terms of childbirth, motherhood, childcare and becoming a parent for the first time? 
  6. Have you had any prior experience in caring for a newborn/infant?
  7. Aside from pregnancy books and books on baby care, have you read anything on PPD?  If not, you should read Placksin’s “Mothering the New Mother” and other books listed on the Postpartum Support International website and on Katherine Stone’s Postpartum Progress
  8. Do you feel particularly anxious about this pregnancy?

There are OB/GYNs who do perform such screening today, though it’s not a standard practice (but it should be).   Patients identified as high risk for PPD or have had PPD before, should be referred to a psychiatrist—preferably one who has worked with pregnant women—for a consult.  The OB/GYN should explain to the patient not to be troubled by or panic about being referred to a psychiatrist, particularly if they have never seen one before.  The reason for the referral should be explained carefully, as should the symptoms of the baby blues versus PPD.  Having these patients establish a relationship with a psychiatrist early on is important because it is the psychiatrist who would then serve as the primary contact after the baby is born and up until the six-week visit with the OB/GYN.  Unless there is a medical issue with the mother, the OB/GYN will generally not see her until the six-week follow-up.  Having this other healthcare professional as a contact in case PPD rears its ugly head fills the void that exists in all too many cases, like mine, where mothers have no idea where to go for help if they have PPD. 

POSTPARTUM Questionnaire:

Mothers should be assessed for PPD several times in the first year after delivery, with the most critical timeframe between 4-12 weeks.   The best time to initiate a screen would be at the six-week follow-up visit with the OB/GYN, provided she doesn’t complain about symptoms up to that point.  If she is symptomatic before the six-week visit, she should be screened right then.  If the 6-week screen doesn’t indicate PPD, she should be assessed once more at the 12-week point and also when she weans and when her period returns, since these events can trigger PPD in some women.

The following—in addition to screening tools like the Edinburgh Postnatal Depression Scale or Cheryl Beck’s Postpartum Depression Screening Scale—should be asked at the six-week follow-up visit with the OB/GYN, which can help diagnose PPD:

1. Have you been feeling any of the following for the past 2 weeks:

  • Persistent and mostly inexplicable sadness/tearfulness and feeling empty inside
  • Loss of interest/pleasure in hobbies/activities you once enjoyed; inability to laugh
  • Overall impaired functioning
  • Sleep difficulties (either insomnia or sleeping too much)
  • Weight loss (usually fairly quick) associated with a decrease in appetite
  • Weight gain associated with an increase in appetite
  • Excessive worrying/anxiety/concern about the baby
  • Restlessness/irritability
  • Detachment from/inability to bond with the baby
  • Difficulty thinking, concentrating or making decisions
  • Feelings of guilt/inadequacy/failure/worthlessness/of being a bad mom
  • Urge to run away
  • Onset of panic attacks
  • Sense of despair and/or hopelessness leading to thoughts of death/suicide

2. How have you been feeling physically and emotionally?

3. Are you feeling particularly stressed, and if so, is it due to a major change you are experiencing, such as marital problems, death of a loved one, financial problems, a recent move, a job change?

4. How do you feel about the baby?  Are your feelings in line with your expectations of how you’d feel about the baby?

5. Do you feel you have adequate emotional and practical support from your partner?  Do you have any relatives or any other help, like a doula, to help you with the baby during the day? 

6. Are you breastfeeding and, if so, how is it going?

7. How do you feel the labor and delivery went?  Do you feel you experienced any sort of trauma during the delivery?

8. Do you feel your childbirth and motherhood experience are meeting your expectations?

9. Do you feel particularly anxious/concerned about your baby’s health (colic, SIDS)? 

10.  How is your appetite?

11.  How are you sleeping?  Have you been able to get at least 4, if not 5, hours of sleep a night?

12.  Have you had any recurring thoughts/images that are disturbing?

13.  How have you been adapting to motherhood, in general?

14.  Have you returned, or will you return, to work?

I believe these types of questions should be incorporated by all OB/GYNs throughout the country.  Doing so would mean fewer expectant and new mothers falling through the cracks, increased public awareness/early detection/treatment of perinatal mood disorders and subsequent reduced impact to children, and spurring on an increase in referrals to establishment of support services.   This all theoretically sounds good and fine, but in most cases, OB/GYNs are not prepared to implement.   Why not?   It would require training on perinatal mood disorders (recognition of symptoms and treatment), as well as ability to provide the right referrals as needed.  More on such barriers to progress and current dilemma in my next post.

A Kirstie Alley Fan No More

Once upon a time I was a Kirstie Alley fan…well, what happened, you ask, that would change my mind?  Well, evidently she has decided to go on some kind of anti-MOTHERS Act–or what she refers to as MOTHER F_ _ _ERS Act (real nice) kick–leading all her fans and Twitter followers out there, just as the Pied Piper led all the mice that were blinded by his music….a perfect analogy in my opinion because these people are blinded by ignorance that breeds fear and conspiracy theories.

By the mere mention of the word “screening” these people choose to believe the government is out to get everyone because it couldn’t possibly want to do something to actually help people. They choose to jump to the conclusion that we are moving to a “1984”-like society with Big Brother moving in on us. Wow, that was an amazing leap, cuz nowhere in the bill does it say that screening is mandatory! 

And by the mere mention of the word “treatment” these people jump to the conclusion that we are now going to force all mothers out there to swallow pills. Um, okay then.  Again, the bill does not state such a ridiculous notion.  I read some of the exchanges and stopped because it was all a bit much and was giving me indigestion.  I get it, you’re angry.  You hate the government.  You hate meds.  But DO NOT stand in the way of what can make such a positive difference in the lives of so many women who are currently suffering (or will suffer) from postpartum depression…what many people even today don’t even acknowledge as a real illness.

I see the bill as an opportunity to educate this country on an illness that more women have suffered from than people will ever know. It’s also an opportunity to get increased funding in research to improve medications and discover more alternative treatment options, as well as an increase in postpartum support services.

Kirstie, you can accuse me of being naïve all you want, but hear this. Screening–which again is NOT mandatory– is having a doctor ask the patient a few questions to determine if she is feeling alright. What in the world can be the harm in that?!  Plus, the woman has THE RIGHT to decline if she so desires.   We are in a free country, aren’t we?  Personally, I wouldn’t mind answering a few questions. And by the way, what the heck is the harm in that anyway? Oh, yeah, that’s right….those with conspiracy theories think this is an invasion of privacy…another Big Brother ploy by the government.

Kirstie, did you even bother to consider that, if a woman is suffering from depression during pregnancy and is diagnosed at that point, it will improve her chances of getting some form of treatment and support early on so it doesn’t follow her postpartum?!  Heck, if my OB/GYN and his staff had screened me once it was determined I had insomnia (at 6 weeks postpartum, which should have been so obvious that I had PPD rather than the blues), I could’ve been spared the painful journey that I traveled in the following weeks.

Kirstie, if you think you are doing a noble deed and helping other moms out there with respect to perinatal mood disorders, then think again. Instead of blocking progress, do something that will make progress happen.

Kirstie, let me ask you. Are you and others like you willing to take the charge and educate the public about perinatal mood disorders? Will you champion this cause? Because that’s the key to banishing the stigma and myths, the major hurdles to women seeking help for a perinatal mood disorder.

Kirstie, do you know what the occurrence rate of PPD is in this country? Probably not. All you and others like you choose to focus on is one thing and only one thing. Your conspiracy theories. Just remember that, as long as society remains ignorant about PPD the stigma associated with mental illnesses–particularly around a time that is supposed to be happy (i.e., childbirth)–will continue to keep mothers mouths shut and suffering unnecessarily in silence.

Another hurdle is people not realizing the difference between the blues and PPD. Just in the past week, I spoke to 2 people who didn’t know the difference. Why doesn’t everyone not realize what symptoms to look out for? Because there is a shameful lack of information made available to the public. What we need are: MORE EDUCATION, MORE RESEARCH, MORE SUPPORT SERVICES. This, ladies and gents is what this country needs if we want to stop the silent suffering of mothers!

Without a federal mandate, more women are going to continue suffering unnecessarily, families will be torn apart, and deaths will occur…all because there aren’t enough resources and funding out there to make a difference at the rate we are progressing, which is at a snail’s pace. Simply unacceptable!