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.