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  • Getting Beyond Baby Blues: The Importance of Post-Partum Depression Screening
Getting Beyond Baby Blues: The Importance of Post-Partum Depression Screening
Contributor
Written by
Elayne Clift
November 2019
Contributor
Written by
Elayne Clift
November 2019

When Michelle Obama revealed her experience of loss as a result of a miscarriage and infertility issues in her memoir Becoming, she helped other women with similar experiences address their pain. More recently, Meghan Markle, Duchess of Sussex, revealed her challenges as a new mother.  She, too, shed light on a topic not usually addressed.

 

While neither Ms. Obama nor the Duchess seem to have suffered full-blown postpartum depression, they have helped focus on the need for postpartum depression screening, highlighted by recent recommendations from the U.S. Preventive Services Task Force, an independent panel of physicians and epidemiologists that develops recommendations for clinical preventive services. 

 

As a women’s health advocate and educator, I worry that screening could contribute to further pathologizing women’s experiences, especially when they are connected to their reproductive lives. I fear that Big Pharma will cash in, and that fetal effects from antidepressant medication will be minimized. I am concerned about medication transmission via breastfeeding.

 

At the same time, I know from personal experience as well as my work in women’s health that postpartum depression (PPD) is real, and serious, for many women. It differs from the so-called “baby blues” that may occur after birth when a mother’s hormones are adjusting and she feels especially tired, emotional and overwhelmed. But when these feelings linger and exacerbate, often as a result of isolation, fatigue, loss of social and professional identity, and an unfulfilled need for emotional as well as physical support, full-blown post-partum depression can occur.

 

That’s when providers, including pediatricians, need to recognize the possibility of PPD, which if left unattended can last for long periods and make functioning difficult. PPD, which can begin during pregnancy, shortly after giving birth, or as long as six months after a baby is born, manifests as prolonged depression, irritability, debilitating fatigue, withdrawal and difficulty bonding with the baby. Women may eat too much or too little and sleep too much or not enough. Guilt feelings, anger or low self-esteem may dominate.

 

It’s important that women who experience PPD have their feelings validated vs. being immediately labeled as pathology. After all, who wouldn’t feel inadequate or irritable without sufficient sleep, or feel lonely being stuck at home with a demanding infant when a short time ago, you were enjoying the intellectual stimulation that comes with having satisfying work. But when PPD can’t be relieved by a supportive partner, a loving friend, or a home helper, more than emotional support may be needed.

 

Postpartum Progress, a nonprofit organization “created by moms for moms with maternal mental illness,” says pregnancy-related depression “is like trying to run a marathon with a broken leg.” Many women relate to that analogy while others say it doesn’t come close to describing the struggle to overcome PPD.

 

That’s why the Task Force report calls for screening women for depression during pregnancy and for a year after giving birth. But screening can be problematic. There is little consistency when it comes to identifying and treating mothers with PPD and “women fall through the cracks all over the place,” as one mom blogged. Many OB-GYNs or general practitioners are reluctant to do screening for fear of making things worse or having nowhere to refer women. Others think their patients are “just stressed out” and with time, routine and a little Benadryl to help them sleep new moms will soon feel better.  Even women with a history of depression get brushed off.

 

Here’s where feminist analysis and sensitivities make a difference and add to the effectiveness of screening.  As Ayesha Chatterjee, a women’s health advocate formerly with Our Bodies, Ourselves points out, “Integrating screening into maternal services and care for perinatal emotional complications is long overdue. It must extend beyond [what is usually thought of as] postpartum depression and catch mothers along a spectrum that includes other less talked about [possibly precipitating] issues like anxiety, obsessive-compulsive disorder, and PTSD during pregnancy and the postpartum period.” Chatterjee notes that “different mothers need different kinds, levels and combinations of support to heal and make a smooth transition to parenthood.” Emotional support may come from mothers’ groups, a doula, social worker or health care provider, although many women can’t access professional support because of lack of resources. That’s why the new screening recommendations included coverage of services by The Affordable Care Act.

 

Some women benefit from antidepressant medication as well as the validation that comes through sensitive conversation. However, advocates urge that only qualified psycho-pharmacology experts should be writing prescriptions and monitoring for patient reactions regularly.

 

 Vital questions about who should be screening, how, and how often still need to be addressed and resources will be necessary to train providers for effective screening. Among them should be pediatricians because new moms may not see their obstetrician or primary provider frequently but they are likely to take their babies for routine checks during the first year.

 

Screening must also move beyond informal chit-chats or assumed observational expertise.  And often unreliable self-report questionnaires should not be the only assessment tool. Screening must be timely and its setting empathetic and non-judgmental, as Chatterjee points out. “It must respond to a mother’s unique situation and needs. Without this, we will lose the women we do reach, more will fall through the cracks, their experiences will continue to be marginalized and pathologized, and the health of mothers, babies and families will spiral downward while the U.S. continues to have disturbing maternal health outcomes.”

 

Postpartum depression affects an estimated 15 to 20 percent of new mothers in the U.S. It’s time we took the experience and effects of PPD seriously. With sensitive responses, many women could be spared a lot of pain. We might even save some women’s lives.

 

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Elayne Clift writes about women, health and social issues from Saxtons River, Vt. (www.elayne-clift.com)

 

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