When I saw the recent article titled, “When she asked for help for postpartum depression. The nurse called the cops” on Slate.com, I was appalled and frustrated. Postpartum depression is a clinical condition that affects up to 20% of new mothers. Among women in living in poverty, the percentage is much higher (upwards of 60%). It can also affect fathers too. In fact, science has shown us that the mental health of both fathers and mothers can impact family and infant outcomes. The work around understanding the specific effects of father’s mood is growing.
As a behavioral pediatrician, I see many mothers with postpartum depression (either active or history of). I see the effects of untreated, under-treated or undiagnosed parental mental conditions has on the family and I work to try to educate resident learners, other providers how to “tune in” and ask these sensitive questions. It is never easy to probe about parents’ mood or mental health, but it is very important to consider when thinking about the larger picture and understanding the environment in which children live. Mothers with postpartum depression, or other mood disorders, are trying their best to raise their children and attend to their needs. They are NOT bad parents. There has been work on understanding how postpartum depression is perceived in certain cultures and our society. Unfortunately, while we have come a long way and more pediatricians and front-line providers are screening for postpartum depression, when mothers finally get the courage to talk about it, some are chastised, made to feel insignificant or even guilty. They are NOT criminals who should be treated as such.
Postpartum depression can be treated. However, the first step to treatment is identifying it and helping support the mother (or father) suffering to seek much needed help. Those of us on the front-line (pediatricians, family practitioners, advanced nurse practitioners, home visitors, obstetricians and community mental health providers) play a critical role in being advocates for our families.
RELATED: Follow up of Mothers With Suspected Postpartum Depression From Pediatric Clinics (Frontiers)
We know evidence-based treatments such as home visiting, positive parenting programs, psychotherapy and medication can help. We also know that when mothers with depression get help they need, children are likely to fare better in terms of their overall growth, development and behavior. There are more and more programs to help teach mothers skills that include problem solving, helping to restructure negative thoughts and parenting to ensure mothers gain the confidence they need to care for their child and cope.
RELATED: Home Visiting Programs are Vital for Maternal and Infant Health (AmericanProgress.org)
There are major initiatives to help primary care providers learn the signs, understand the reasons for screening and how to sensitively communicate with the mother what steps are needed to ensure that mother and baby can continue to thrive and get mothers the help they need. In fact, the American Academy of Pediatrics released an online module I blogged about that can help clinics understand how to start screening for maternal depression during visits to the clinic.
For providers out there who are unsure of how to handle a positive screen, check out the resource above and also head over to the American Academy of Pediatrics STAR Center website where you can sign up for the e-newsletter on screening tips, access resources and seek additional assistance on billing and screening logistics through the Technical Assistance Center.
If not knowing where to refer mothers after a positive screen is a concern, make sure you look at Postpartum Support International. This non-profit organization is just one resource that has resources in EVERY STATE and US TERRITORY. They also have an online presence with support groups and “ask the expert” chats, along with resources for both mothers and fathers. Other organizations to look at include the Anxiety and Depression Association of America, Postpartum Health Alliance, and the National Institute of Mental Health.
We know that more pediatricians are screening for postpartum depression since the American Academy of Pediatrics first released guidelines in 2010. In fact a paper published in 2016 by Dr. Bonnie Kerker and colleagues documented an improvement in screening rates, still less than half of all pediatricians are routinely screening for postpartum depression. We have much more work to do. The article in Slate highlights that combating the stigma and raising awareness of ways to sensitively support these families as early as possible is still a fight we must keep pushing forward.
I hope you will join me.