Perinatal Mood Disorders: Who Should Screen?
By Jodi K. Hitchcock, MSW
I am often asked whose responsibility it is to screen a pregnant or postpartum woman for a mood disorder (or a PMD). This seemingly simple question has a complex answer. I can reply with whom should be screening, or with whom is actually screening, or there is even whom I think needs to be doing it. Unfortunately, these three are rarely one and the same and that leaves many women at risk for never receiving a proper diagnosis or treatment.
Lets begin with whom should be screening. In an ideal world, all obstetricians and midwives would include a standard PMD assessment during all perinatal visits. Unfortunately, this rarely happens and when it is addressed, a clinical diagnostic tool is often not used. The doctors and midwives that I have discussed this with have explained a variety of reasons why they do not routinely screen their patients. The most common reason that has been given is that they do not know what to do with a patient whose scores indicate a high probability for a PMD. In the area that I live, there are very few resources readily available for doctors and midwives to refer patients should they be experiencing a PMD. Women who are on Medicaid have the most difficulty finding specialized treatment, which leaves these women particularly vulnerable to more significant problems.
Through my experience researching and working with the perinatal population, I have discovered that there is an “underground society” of professionals providing these services, but they are not well known and are rarely publicized. I have many theories behind why I believe this is the case, but I will save those for a future post! The bottom line is that physicians are often times at a loss for what the next treatment step should be so they skip the clinical diagnostic assessment entirely. I am not placing blame on obstetricians or midwives, this is a much broader concern where changes need to be made at every level.
Although most hospitals now include some form of PMD education or screening as part of the discharge process, this is only a minor first step in accurate diagnosis and treatment. The majority of women will experience some form of postpartum blues in the first 2 weeks postpartum. If the symptoms become worse or are not getting any better at 3 weeks postpartum, it is likely that she may be experiencing a PMD and this could not be determined at discharge from the hospital. Although a 6-week postpartum visit with a doctor is generally a standard practice, for women going through depression, anxiety, panic, etc., this can feel like a very long time to wait. This is one of the main reasons that I feel the optimum place for a new mother to be screened is at the pediatrician office. New babies are often seen a couple of times in the first month after birth to do weight checks (especially if they are breastfed). A standard diagnostic test (such as the Edinburgh Postnatal Depression Scale) could be administered to the mother at each of these visits and referrals made to see a specialist or even see their own doctor (sooner than the usual 6-week visit). In addition to diagnosis occurring sooner, having multiple assessments done in one location allows the medical professional the ability to monitor the symptoms to see if the woman is improving with time or getting worse. The sooner a mom receives treatment for a PMD, the least amount will be needed for a shorter amount of time. Therefore, early detection is beneficial to mom, baby and the family unit and pediatricians play a key role in this success!
About the Author:
Jodi K. Hitchcock, MSW is a mother of 4 amazing children (ages 10, 9, 6 and 21 months) and the stepmother to a wonderful 14 year old. She currently works 24 hours a day as a stay-at-home mom to those lovely children. In addition, Jodi works as an independent consultant providing perinatal support, education and outreach to mothers, couples and families experiencing PMD’s. In addition, she conducts training seminars and provides outreach education to other perinatal professionals. After experiencing a variety of PMD’s during and after her pregnancies, Jodi is able to provide a unique combination of personal and professional knowledge to the people she works with. Jodi especially loves to work with pregnant women who are experiencing or are at risk to experience a PMD so that she may empower them through education and prevention techniques so that they may have the best possible birth experience! To read more about Jodi and her personal experiences, visit her website @ www.mypostpartumlife.com