I am pleased to welcome Dr. Tobi Amosun as a guest today on Postpartum Progress. I met her recently when I went to the Type A Mom conference. If you're on Twitter, you might recognize her as @drbabymamadrama, which is also the name of her website. Dr. Amosun is a pediatrician, so she knows of what she speaks.
Sometimes the diagnosis of postpartum depression (PPD) is obvious.
A few months ago I walked into a patient room and I knew there was something off. There was a palpable air of desperation and heaviness in the room and I knew when I looked into mom’s flat eyes that things were not good. It was as if the invisible cord of emotional connection between a mother and child had been severed. Usually when I am seeing a newborn for the first post-hospital visit, I expect the mother to be one of three options:
A) The mom makes it look like she has a new baby every week and everything is under control. Baby is perfectly dressed in a cute outfit, Mom is in her skinny jeans.
B) Mom is appropriately exhausted (read: dark under eye circles) and a little overwhelmed but seems to be keeping it together as best she can. Baby still dressed in a cute outfit. (FYI, this was me after my daughter was born.)
C) Mom is depressed.
This mom was definitely letter C. She had been on various medications before, during and after pregnancy. I was worried enough about her that I called them several times later that week to see how things were going. She thankfully was getting medication and counseling through her OB and psychiatrist.
Unfortunately, though, the majority of moms suffering from PPD are not that obvious. Some — strike that, MOST — moms have a great ability to mask what is really going on. You put on a happy face so that people see what they expect they should see. How are you doing? "Fine! Things are great… baby’s great! We’re all just great …" Whereas the truth is you would do anything up to and including selling your child to a band of juggling pink ponies to get a decent amount of sleep. Or a shower. And to feel better.
I admit that I love to see a happy smiling mom, cooing at her newborn. Who doesn’t? But as a pediatrician, I am usually the first medical professional to see a mom once she is out of the hospital. I often will see a mom at the 1-2 week follow-up, as well as the 1 month visit. For better or for worse, I am also often the first person to point the mom towards seeking help. Although my priority is the child, in pediatrics I often am treating the family as well. For me a “happy mother makes a happy baby” is true. I can’t expect a mother to want to get up and feed her own child when she is having thoughts of suicide or depressive symptoms.
Here is how a pediatrician should screen for PPD, in my opinion:
1) Go with the gut. If I suspect that a mother is depressed, I will talk to her about it. So much of medicine is about following your instinct and using the art that that exists in science.
2) Screen. This is where the science comes in. Most pediatricians use the Edinburgh screening questionnaire provided by the AAP. http://www.aap.org/en-us/professional-resources/practice-support/quality-improvement/Quality-Improvement-Innovation-Networks/pages/Practicing-Safety-A-Child-Abuse-and-Neglect-Prevention-Improvement-Project.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token). When scored, a score > 9 or any suicidal ideation means that the mom needs immediate referral for evaluation. I have the moms call their OB or primary practitioner to get them started on medication and/or counseling as indicated. It is considered standard of care to do these screens at the 2- week, 1-month and 2-month check-ups.
3) Get others involved. I have no hesitation asking whoever is in the room with mom when the diagnosis is suspected to step up and take some responsibility. Most of my patient population has family members or friends who can help with the baby. When that fails, I will often suggest resources like churches and home nursing or doulas to get the mother and baby through the roughest first few months.
To the mamas: The diagnosis of PPD is not a failure. At all. It is no more a failure to have a diagnosis of PPD than it is a failure to have a diagnosis of strep throat. This is something that is generally quite treatable, and treatment will improve the quality of interaction with your baby and other loved ones.
Hopefully most pediatricians understand the importance of screening for PPD. If yours doesn’t, ask why not. Pediatricians should know that some sort of postpartum mood change happens in up to 80% of women, PPD occurring 10-20% of the time. As the first line of medical defense we need to be vigilant in screening so as to provide a happy, nurturing environment as early as possible.