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

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

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

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

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

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

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

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

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

Postpartum depression is where breast cancer was 30 years ago.

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

 

 

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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.