US maternal morbidity and mortality are now a hot topic. Physicians and nurse leaders across the country are focused. Few are talking about the disparity in care and attention to maternal mental health. I saw an opportunity to make a difference.

A nurse on a mission

When I started this journey to address the mental health of the moms in our community, a well-respected physician with deep roots in community service told me I was asking the right questions but did not have the answers. He said, “you can’t fix a problem until you understand it.” He was right!

The disconnect between obstetric care and behavioral health specialists was rampant. The availability of resources to the uninsured and those on Medicaid was limited and poorly organized. One in seven women suffers from postpartum depression. Almost half go undiagnosed and untreated. We could no longer offer excuses for ignoring this issue.

With a team of nurses and physician supporters, we set out to build a program to identify women at risk for mood and anxiety disorders in the perinatal period. While still a work in progress, we have an excellent basis for families to get the help they need.

We want women to know that they are not alone.

Help is available to get them through the dark.

Postpartum depression can occur anytime

Postpartum depression is a misnomer. Perinatal mood and anxiety disorders can occur anytime from conception to one year after the delivery of a baby. These disorders are quite distinct from the baby blues.

The Baby blues are a common issue occurring in 50–80% of women and peaks between postpartum days 2–14. The baby blues are related to fluctuating hormones and lack of sleep. Although new moms are concerned when they openly sob at a TV commercial, baby blues will resolve without treatment.

Perinatal depression is much darker and debilitating. A mom feels unable to function for an extended period. Women need to know that when certain symptoms are present, it is time to talk to someone.

These include: crying spells, feeling sad, feelings of hopelessness, and feeling guilty. Some may express a lack of happiness or feel the absence of bonding with the baby. Some may have feelings of hurt yourself or your baby. All of these symptoms indicate it is time to seek medical attention.

Help is here. You are not alone.

Moms negative thoughts prevent the help she needs

Shame, guilt, and feelings of inadequacy prevent moms from reaching out for help. Moms fear judgment. They wonder “what is wrong with me” for not feeling blissful over the birth of their child. They fear their family will judge them. Others fear they may lose their baby if they express their true feelings out loud.

Some moms have intrusive thoughts. She becomes afraid of them. She needs to know that negative thoughts do not necessarily equal behavior. Help is available to manage these thoughts.

We want moms to know we want to take care of her. We want to see her with a happy, healthy family. Our goal is to help her succeed. We do not want women to be afraid to speak out and ask for help. We should be as comfortable talking about depression and anxiety disorders as we are about other pregnancy complications such as gestational diabetes or pre-eclampsia.

Moms life is at stake

Suicide is the leading cause of death of new mothers in the first year postpartum. Infants of mothers suffering from perinatal depression are at increased risk for impaired development, poor communication skills, and future mental health problems. Perinatal depression is not a woman’s problem. It is a family problem. Everyone suffers. We must help women feel safe to come forward and get the help they deserve. Every life matters.

Depression is just the tip of the iceberg

Perinatal anxiety is another important aspect of mental health for new moms. Anxiety is something we have historically written off as “normal” for a parent. Most moms worry over their children, their husbands, and their homes.

However, for those with an anxiety disorder, worry becomes consuming and all-encompassing. Panic attacks may be frequent, leaving mom to feel she has no control.

Panic attacks can be terrifying because of the physical symptoms that occur, racing heart, sweating, chills, and chest pain. These symptoms lead to a constant sense of doom or failure.

Post Traumatic Stress Disorder can occur after delivery

A woman can experience Post Traumatic Stress Disorder after having a baby. This concept surprises some.

After all, no one’s been to war or been attacked by a stranger. PTSD is real for these mothers and their families. Childbirth does not always go according to plan. The birth may not live up to the expected birth plan she had imagined. The beautiful delivery experience may have turned tragic or life-threatening?

Emotional and mental turmoil is real for a mom who almost died from postpartum hemorrhage or the dad who almost lost his wife.

There is hope for those suffering

Moms and their families need to know that they will get better with help. The type of help needed may be different for everyone. Many benefit from a no-judgment zone support group where a group of moms can get together and talk. Others may benefit from medications to help control symptoms.

Whatever help looks like, the first step is reaching out and communicating your feelings. Available resources include mom groups on social media and in-person counselors, psychiatrists, and community resources for help with job searches, food, and clothing.

You are a priority for us

We are raising the bar and setting high expectations for moms. We hope other hospitals and medical groups will also follow this path.

Implement universal screening programs for perinatal depression and anxiety. Provide education programs to nurses and community physicians.

Provide education during routine prenatal care. Build community support groups through social media. Remove the fear. Help these women come out of the shadows.

Let women suffering from perinatal mood disorders know it is safe to seek the help they deserve.

The post Never Feel Ashamed or Afraid to Speak up About Postpartum Depression appeared first on Medika Life.

She was a nurse. I worked with her daily. She was my friend and also my patient. Happily married. Perfect pregnancy. Easy delivery.

How did I not recognize she was suffering from postpartum depression?

She could not get out of bed. Although madly in love with her baby, dark and dangerous thoughts filled her head. Each day she forced herself out of bed. She cried daily. The stress of hiding her depression from her husband was tearing her marriage apart.

One year later, she confessed. During her annual exam, she revealed all that she had been through. Struggling in silence. Sharing with no one. She was miserable.

I am the doctor she trusted. Once I knew of her illness, she got better. Why did I not catch it sooner?

I didn’t ask. She didn’t say.

I’m sorry.

A teen mother

She was a 17 years old child. She and her newborn lived with her mother and mom’s four other children. She grew up without a father. The father of the baby was long gone. Her house was full of family, but she was living all alone.

Four years later, she is pregnant again. She shares with me her fear of having postpartum depression again. She cried as she explained the terrifying thoughts of hurting her baby that flooded her mind after her delivery. She loved her baby. She asked what was wrong with her for thinking this way.

All the risk factors for postpartum depression were right there in front of me four years ago. How did I miss it?

I didn’t ask. She didn’t say.

I’m sorry.

A high-level executive

She was a senior vice president of a large tech company. After years of infertility treatment, she and her husband got pregnant. Always the overachiever, she was not pregnant with one baby. She had twins. During her six-week postpartum visit, she told me she was getting divorced. I was surprised. On the surface, they seemed like the perfect couple. Was postpartum depression a factor?

I didn’t ask. She didn’t say.

I’m sorry.

Depression has many faces

One patient’s husband had an affair. Another struggled with her teenager’s rebellion. One lost her job for not showing up for work. Another couldn’t pay her bills. Another repeatedly came to the office for various vague abdominal pains.

I didn’t ask. They didn’t say.

I’m sorry.

Postpartum depression is real

One in seven women suffers from postpartum depression. I had been treating it throughout my career. I caught the easy cases. I helped them, and they got better.

The world of women’s health has started paying more attention to the 4th trimester. I realized I was missing the harder to spot cases. I had overlooked the subtle clues that were there along. I had underestimated the efforts patients would take to hide their mood disorder. Shame, fear of being judged, and embarrassment forced those suffering from postpartum depression to hide alone in the dark.

We implemented universal screening

We added universal screening for postpartum depression to our office protocol. The Edinburgh Postnatal Depression Scale (EPDS).

Ten questions. Five min.

This simple tool made it safe to step into the light. Each patient fills out a simple questionnaire. The score is not diagnostic, but the questions open a window and an opportunity for dialogue. The tool triggers me to ask the right questions. Five min can change someone’s life.

My eyes are now open to the prevalence of postpartum depression and the subtle ways people hide it. It also revealed to me that these cases were there all along.

They wanted to talk, and I wanted to listen.

I just didn’t ask, and they didn’t say.

A new approach

Universal screening opened a window and shed light on postpartum depression. I have changed my approach. I am asking the right questions. Now we are talking. Patients are speaking up.

I asked. You answered.

I’m so thankful.

You are not alone.

Never be afraid to talk about postpartum depression.

The post Better Care is Needed for Postpartum Depression appeared first on Medika Life.