Yesterday the US Preventative Services Task Force made a recommendation regarding screening for depression in adults and specifically addressed postpartum depression (PPD). This is in alignment with the American Congress of OBGYN (ACOG) recommendation to screen women at least once during the pregnancy or postpartum period. The official recommendation is below.
“The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.”
Seems pretty obvious, right? Women have babies and we should screen them for a disease that is twice as common in women as it is in men and can have devastating consequences for families. But it’s more complicated than that. One: we don’t talk about postpartum depression. Two: we don’t allow women to admit when they need help. Three: we don’t have good systems in place to give women with PPD the comprehensive care they needs. And by “we” I mean us, as in you and me, Oklahoma, America. All of us.
Postpartum is a really bizzare time. You spend approximately 40 weeks, if you’re lucky, carrying another human being inside you. You devote a large portion of your blood supply, nutrients and other resources keeping this person alive and growing them into someone that can survive in this world. Then you give birth to them. Which is a huge deal no matter how you do it. Walk in and drop out a baby in 30 minutes, labor for 4 days, have a c-section…it’s all a big deal. If you don’t get that, let me know. I’ve got stories for you. And then you get to experience the strange period of time called postpartum. For those of you who’ve been there, you know what I’m talking about. You sleep for anywhere from 30 minutes to 2 hours at a time, someone is always crying or needing to be fed, you are leaking fluid from literally everywhere, and you’re body is trying to figure out where that person who used to live inside you went. Weird, huh? But baby’s here so we instantly forget that the mother existed and focus on the cute bundle of joy who’s drooling all over your shirt. We don’t begin to consider that the mom might be overwhelmed, and for most it wouldn’t cross our minds that she would be depressed. We can do better.
Our culture doesn’t do well with mental health conditions. We see depressed or anxious people as “weak” and “crazy” and those that seek psychotherapy as someone who “can’t keep it together.” If you have high blood pressure or diabetes you don’t get this flack. We treat you with lifestyle modifications or medication or physical therapy for your conditions…your mental health should have the same priority as your physical health. It should be treated with the same respect and compassion. We don’t roll our eyes at people with cancer; we come alongside them in prayers of healing and hope and support then in every way we can. Why can’t we do the same with PPD and other mental health issues? Let’s start the conversation. The USPSTF and ACOG has recommended we screen because we as physicians can make a difference by asking women about PPD. The community at large can make a difference by accepting that women with PPD are no different than moms who aren’t affected: both of them care deeply for their families and want to be the best possible mothers. We can do better.
I used a validated screening tool (EPDS) in my clinic for postpartum depression. I haven’t always done it. But then I had patients come back one or two or three years after having their baby and tell me about how they suspect they were suffering from PPD and didn’t know who to talk to. So now I try to screen everyone I can. But we have to work to create access to resources for these moms. Yes I can counsel someone about the risks and benefits of taking medication for PPD. But many moms just need a therapist, or a support group, or even just a community of faith or a community of friends to share the burden with. I hope the USPSTF recommendations will encourage my partners in healthcare to increase our efforts to screen and treat women during pregnancy and postpartum. And I hope that those of you outside of healthcare will lend a hand, share a story or take a turn holding a baby for that new mom. I hope that all of us have the courage to ask postpartum women how they are coping and be accepting of any answer they give us with a willingness to listen and help. We can do better.
The picture above is me and some of my residency classmates (sorry guys) literally hours before I had my first baby. I was a 3rd year resident training to be an OBGYN. I thought I knew what I was getting myself into. Now I look at that picture and see someone who had spent the previous 3 years working 80 hours a week and cramming her brain full of all the information it would hold…but had no idea how things were about to change. I was a (postpartum) hot mess. I struggled to care for my baby and certainly didn’t care for myself. Fortunately I had friends and family who made sure I ate, slept and was wearing clean clothes (thanks mom). That baby reminded me of what a vulnerable human being I was. Of how much grace I needed. She is now doing multiplication and her sister is giving me sass about anything and everything. I love them dearly and am grateful for the opportunity to experience the bizarre part of life we call postpartum with each. But we can do better…let’s try.