Do you remember your first OB/GYN visit six weeks after giving birth? I can, and what I remember most was how tired I was and how heavy the car seat felt as I balanced my baby inside it on one arm.
Most women also remember their doctor talking to them about birth control even though it was most likely the farthest thing from their mind at six weeks postpartum.
What is missing from this picture? What else could help at this early juncture of motherhood? Obstetricians and pediatricians should be talking to and screening new moms for postpartum depression (PPD).
PPD is the most common complication associated with pregnancy and childbirth. PPD can occur after any birth, beginning any time after a woman delivers, but usually two to three weeks after giving birth. On average, 20 percent of new mothers experience perinatal mood and anxiety disorders. This means about 1.3 million women are affected annually.
The Edinburgh Postnatal Depression Scale (EPDS) is a simple screening tool that anyone can use and takes less than five minutes to administer. This 10-question survey helps determine whether or not treatment is needed. I give it to every new mom I meet, and it is easily accessible online.
I do this because new moms and the people who care about them often don’t know whether their symptoms add up to PPD, which can take many forms and have many gradations. The EPDS is valuable because it gives us information so we can make a plan to connect a new mom to necessary resources.
The pediatrician’s office is another place where new moms are seen regularly during the first year of a baby’s life. However, despite the fact that the American Academy of Pediatrics now recommends screening new moms at well child visits, only a small percentage of pediatricians are currently screening for PPD in their practices.
One study showed that, “although 90% of pediatricians assume responsibility for identifying maternal depression, a large percentage (71%) rarely or never assess for maternal depression or (93%) rarely or never provide a mental health referral.”
According to Katherine Stone, mother, advocate, writer and founder of Postpartum Progress, “There is still so little awareness about postpartum depression and its various symptoms and manifestations that many moms don’t recognize what’s wrong with them. They don’t know to ask about PPD or how to recognize it in themselves. At the same time, research shows that obstetricians and pediatricians miss at least half of moms with postpartum depression when they look for it based on professional observation alone. So both moms and docs benefit from the use of a validated screening tool like the EPDS to find moms who are struggling and get them the help they need.”
Stone says that what gets in the way of doctors using the EPDS is, “what to do when it indicates a mom might have postpartum depression. To which psychiatric professional should they refer the mom? What is their responsibility in following up on the mother to see how she’s doing, or to see whether she followed through on the referral?”
Lynne McIntyre, D.C. support coordinator for Postpartum Support International, who runs a free PPD support group in Northwest Washington, says, “There really is no reason not to use the EPDS. The instrument itself is free. It’s quick to use and very easy to score. Doctors can be reimbursed by insurance to administer it — even pediatricians. And lastly, and most importantly, everyone who administers the EPDS to a pregnant or new mom has someone to refer her to. All they need to do is give her contact information to her local PSI coordinator and we will take care of the rest.” PSI has support coordinators in every state including Maryland and Virginia.
The EPDS is a tool that doctors can and should use to help them assess how a new mother is faring. This is because often a new mom presents her best self at an office visit or doesn’t speak up and an important opportunity to intervene is missed.
Stone says, “People still don’t know how common PPD is and how significantly it can affect the long-term health of mom and baby when it goes untreated. This is a serious issue.”
It’s too serious to ignore or not act on because of fear or uncertainty about where to send a new mom if the EPDS shows she might have PPD. There are many resources available to help new moms. Below are some resources for new moms and the people who care for and about them:
“This Isn’t What I Expected: Overcoming Postpartum Depression” by Karen Kleiman
Jennifer Kogan is a clinical social worker in Northwest Washington who works with parents