Yesterday I drafted an open letter to Dr. Gerald F. Joseph, president of the American College of Obstetricians and Gynecologists, to ask him what he planned to do to support his stated platform of postpartum depression. Here’s just a bit of it.

I know obstetricians aren’t psychiatric professionals. I knowyou already have enough responsbilities, what with delivering babies. I know you already have tough jobs, what with all the liabilities you have. I know you already don’t have enough time with your patients.

It’s just that many women never get to a psychiatrist. The only healthcare providersthey seeare you –the OB –and their pediatrician. You may be the only chance they ever get to be identified, treated and recover effectively from a perinatal mood or anxiety disorder like postpartum depression.

A lot of OBs out there are doing amazing work, but there are still too many who either don’t help or make things worse. I hate to say it but I hear from more than a few women with postpartum depression who tell me they didn’t receive good treatment from their OB/GYNs. Some have been made to feel like damaged goods, like their OBs couldn’t get away from them fast enough. Some have been made to feel like nothing was wrong, or were simply ignored. Just today, I received the following in an email from a reader:

“My OB/GYNs were, honestly, terrible. They were phenomenal when I was pregnant, and with delivering my baby, but with the postpartum stuff they treated me like a piranha and did a bad job of diagnosing what was going on (which, I believe, has made my recovery longer and allowed the disease to get more intense than it had to).”

The overall gist of my “open letter”post was that I felt I hadn’t seen much coming down the pike yet from Dr. Joseph and ACOG on postpartum depression, and I was beginning to get a little curious. But then guess what happened??


Yes, that’s right. ACOG is now encouraging OB/GYN’s to screen patients for depression both during pregnancy and after.

“Screening for depression during pregnancy and afterward benefits women, infants, and families, according to a new Committee Opinion issued today by The American College of Obstetricians and Gynecologists (the College) and published in the February issue of Obstetrics & Gynecology. Because pregnancy and the postpartum period are pivotal times to identify women suffering from depression, the College encourages ob-gyns to strongly consider screening for it.” (my emphasis)

This is a good start from ACOG. As reported on MedPage Today (which did the best story on this), however, they left a lot of wiggle room.

“What screening tools to use, who should do the screening, and how often were also left up to the physician’s discretion in the ACOG committee’s opinion, published in the February Obstetrics & Gynecology.”

In the MedPage Today story, Dr. Joseph explained:

“Unfortunately, although I personally and many, many of our fellows feel that screening in the pregnant patient during and certainly after is extremely important,” he told MedPage Today, “there’s not a big girth of information that would allow us to publish evidence-based guidelines that say it absolutely should be done.”

I wonder how OB/GYNs will react to that. Will they say, “If they can’t even tell us for sure when and how to do it then why should we screen for postpartum depression?” Will they assume the pediatrician is going to do it? Or will they say “I was thinking of doing this anyway so I’m going to take the initiative and start now.” I also wonder what kind of additional data ACOG is looking for to make the postpartum depression screening guidelines a little more helpful, and if they plan to undertake getting that kind of information for use in the future.

I’m not disagreeing that more data may be needed. I just wonder when we’re gonna get it.