There’s still work to do, but we’ve come a long way in postpartum depression awareness in the last few decades. Communities now understand the issue and its effects more than ever, and those in a position to help are taking steps to do so.
One such group is the American Academy of Pediatrics, one of the most trusted authorities in children’s health and development and the world’s leading publisher in the field of pediatrics. In 2010 and again in 2019, they recommended that pediatricians screen new moms for postpartum depression (PPD) at several well-child visits. This will help bridge a gap that pediatricians are uniquely positioned to fill.
In this post, we’ll explore the ways that postpartum care is improving and how more safety nets are being put in place to catch PPD before it does a lot of damage. We’ll hear from two Virginia-based pediatricians who have counseled depressed moms in their own practices and seen the effects of PPD on babies up close.
Related reading: My Postpartum Depression Story | PPD Series | Installment 1
Postpartum Care Fundamentally Changing…Slowly
In 2018, the American College of Obstetrics and Gynecology (ACOG) published new guidelines for OB-GYNs regarding postpartum care for moms. They want to do away with the traditional six-week follow-up visit and replace it with ongoing care during the first three months after birth (increasingly called “the fourth trimester”). One important change is that they strongly recommend OB-GYNs start seeing moms within the first three weeks after birth.
For 15-20% of moms, the first month can be a critical time for their well-being as well as that of their babies and families. It’s during this time that lingering and more intense “baby blues” are diagnosed as postpartum depression. Though PPD can present itself at any time in the first year postpartum, it typically appears within the first 4-6 weeks.
Related reading: Recognizing Postpartum Depression | PPD Series | Installment 2
Despite this timing, unless you had a C-section or are managing some other health condition, you probably won’t see your OB-GYN until the standard 6-week checkup. Of course, you can (and should) call your doctor any time before then if you’re experiencing symptoms of PPD, but it can be hard for new moms to recognize what’s happening to them, or to want to report it. Healthcare professionals, on the other hand, are looking out for changes in mood and other indicators of PPD.
That’s why having regular exposure to professionals in the medical field can be so important. The direction ACOG is headed in is encouraging, but initiatives like that take time to implement. Until regular, ongoing postpartum checkups are standard, there remains a gap between the birth and the six-week mark.
The AAP Steps In to Help Fill the Gap
For now, you’ll actually see your pediatrician a lot more during the fourth trimester than your OB-GYN. This is why your pediatrician is uniquely suited to be a resource in recognizing postpartum depression.
According to the AAP, “[Pediatricians] are in a good position to recognize the signs of PPD because they are in frequent contact with parents of infants.” Many pediatricians follow a pattern of well-child checkups at 24 hours after going home, 1 week old, 2 weeks old, 1 month, 2 months, 4 months, and 6 months old and so forth.
Since postpartum depression is most likely to appear in the first 4-6 weeks after birth, but can also appear later on in the first year, your pediatrician is the most likely healthcare professional to catch it. This is part of the reason the AAP recommends screening moms for PPD at 1, 2, 4, and 6 month visits. In addition to screenings, they also keep a lookout for symptoms as they interact with you.
Why Your Pediatrician Is Interested In Your Mental State
Why does your pediatrician have any stake in your mental health, since you aren’t their patient? Isn’t that some kind of privacy violation?
Pediatricians are keenly interested in the big picture of your baby’s life because a lot of factors can affect whether they are healthy and developing as they should. Well-child visits measure the baby’s weight and height, address any issues with nutrition and feeding, and evaluate the baby’s development. But they often assess other aspects of baby’s quality of life, like safe sleep practices, pets, drug and alcohol use, and so much more.
Research is showing that postpartum depression can severely impact a baby’s development and long-term health. According to the AAP, “Infants who grow up with a mother experiencing significant depression are at risk of toxic stress and subsequent problems with social interaction, language, cognition, and social-emotional development.”
Dr. Randy Burton, a pediatrician of thirty years and a fellow of the American Academy of Pediatrics, says PPD can not only affect development, but the baby’s physical health, too:
If the mom gets so depressed that she’s unable to care for the child, that decreases the amount that the child will be fed and decreases the general care and bonding of the child. So it can have detrimental affects nutritionally as well as the way the child and the mother interact.
Dr. Pooja Prasad, a board-certified pediatrician passionate about treating mental illness and developmental delays in children, sees the effects of PPD in her office, too.
Sometimes these moms are just so overwhelmed with their own emotions that there’s not as much attention given to the infant. I’ve seen anything from babies getting underfed to babies actually getting overfed; the mom doesn’t want to hear them cry so they give them a bottle. The other thing is just that bond is really hard to get established—a lot of times moms just don’t feel like they have a connection to this baby. That can have long-lasting effects as well for the infant.
All those adverse affects of PPD mean that your pediatrician should actually care a lot about your mental health—for the sake of your baby’s well being. The AAP so strongly recommends screening for postpartum depression because “the well-being of the infant is inextricably linked to the mother-infant [relationship].” In other words, your health is intimately tied to the health and development of your baby. You are a critical component of your baby’s life, and that means your pediatrician is interested in how you’re doing.
As for privacy concerns, your pediatrician knows you aren’t their patient and they don’t intend to treat you for postpartum depression. The screening is only a catalyst meant to reveal potential problems and start a conversation.
So What Happens If A Screen Is Positive? Will the Pediatrician Call CPS and Have Your Baby Taken Away?
Sometimes moms worry that opening up about suffering from PPD will get their baby taken away from them. We hear stories about women whose depression drove them to harm their babies and we think our pediatrician will fear for our child’s life. Dr. Prasad says that situation is exceptionally rare.
CPS is only something that’s done in very, very extreme cases, and that’s not something that we do very easily. It’s generally the furthest thing from our mind.
So what is on your pediatrician’s mind?
AAP guidelines give steps for pediatricians to take if a PPD screen comes back positive: demystification, referrals and resources, and follow up.
Demystification
Demystification is the process of making PPD less scary, overwhelming, and isolating. Dr. Burton elaborates on the process: “You encourage [the mom] that this is a very common response. It’s not just her; it’s something we see very frequently.” Dr. Prasad emphasizes another key component—dismantling the guilt: “A lot of moms have mommy guilt. Moms feel guilty for feeling the way they feel and they don’t understand that this is something that 15% of women go through after pregnancy.”
Your pediatrician won’t make you feel like a bad mom for having postpartum depression. Instead, they’ll encourage you, lift you up, and make sure you know you aren’t alone.
Related reading: Reframing Mom Guilt | It’s Okay to “Fail”
Referrals and Resources
Though your pediatrician won’t beat you up about battling PPD, they also don’t want you to stay where you are emotionally. The AAP weighs in on why it’s so important to get help right away: “If the mother continues to experience depression and there is no intervention for the mother-infant relationship, the child’s developmental issues are likely to persist and be less responsive to intervention over time.”
In other words, the quicker you get treatment that works, the less chance PPD will affect your baby in the long run.
The first thing your pediatrician will do is instruct you to see your own doctor as soon as possible. Your pediatrician can’t treat you, but they can refer you back to your own doctor, who can prescribe medication if you need it and direct you to local counseling offices.
Support doesn’t end there, though. Since the mother-infant relationship is so important, your pediatrician may point you to other resources to support that relationship even as you seek treatment. Postpartum depression can affect breastfeeding, so you might be referred to lactation services. And since PPD can disrupt your bond with your baby, there’s even help available for building a stronger relationship.
Follow Up
The AAP says that a key component of the process is following up with a mom “to be certain that she is receiving treatment and that depressive symptoms are decreased.”
To spur moms into getting help, Dr. Prasad says sometimes all it takes is having the initial conversation. Dr. Burton agrees that most moms just need some encouragement to make an appointment with their doctor.
But since PPD can be so serious on the baby and you, your pediatrician will want to verify that the situation is under control and improving. Dr. Prasad says she counsels moms on what they should start to do, “and then I call back and make sure they’re actually doing it, because the follow up is where they can kind of get lost.”
What Your Pediatrician Wants You to Know
Ultimately, your pediatrician just wants you to be healthy, happy, and able to care well for your baby. They don’t want to rip your child from you or make you feel incompetent. In fact, Dr. Prasad wants moms to know their pediatricians are there for them:
They may feel alone, but they’re not alone. It’s scary, and having a baby is always going to be scary, and having these emotional ups and downs to some extent is completely normal. But if it gets beyond that realm of what you feel like is normal, then we’re there to help. We’re not there to judge. This is about making sure you’re doing okay so that the baby can do okay. At the end of the day, for me anyway, this is a team effort. This is going to be something where you and I are always going to be a team through everything we go through.
What You Can Do
Building a good relationship with your child’s pediatrician is about open, honest communication. Don’t be afraid to talk with your child’s doctor about any troubles you’re experiencing in parenthood, especially any symptoms of postpartum depression you may be having. If a PPD screening comes back positive, listen to your pediatrician and take the steps you need to get help.
If you’re an expectant parent, ask potential pediatricians at meet and greets if they screen for postpartum depression and keep a lookout for symptoms at well-child visits. Though the AAP strongly recommends screening and many pediatricians have jumped on board, not all offices are doing them yet. Even for providers that do screen, you want to make sure they take the results seriously and will follow up with you. Above all, you want a pediatrician who will observe you at checkups to make sure you’re doing well.
Your Pediatrician Is There For You
The medical community is doing more and more to support new moms at risk of PPD. Postpartum healthcare reform is on the horizon, but for now, pediatricians are in one of the best positions to identify postpartum depression before it causes significant problems. Pediatricians increasingly screen for PPD and look out for symptoms because they care deeply about your baby—and that means caring deeply about you, too.
~Kaitlyn
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