Why Aren’t We Screening Every Mom?

Why Aren't We Screening Every Mom for Postpartum Depression?

Yet another study has been published stating that universal depression screening is effective and feasible. This one covered 9000 women and showed that women who were screened in pregnancy were much more likely to get treatment. Once again we see a link between screening and good outcomes for moms. So why aren’t more doctors screening every mom? Were you screened?

I wasn’t. I’m pretty sure that I cried at every single prenatal appointment that I had. At first I blamed it on shock. We’d only been dating about five months when we found out I was pregnant. Then I blamed it on hormones. My OB never gave me the EPDS (the most widely used screening tool) or spoke to me directly about depression. She did ask how I was feeling, and she was very reassuring that the three of us would be okay. Looking back now I can see that she was worried about me: I was the classic definition of a depressed woman. So why didn’t she screen me?

I have a history with depression and anxiety. I was diagnosed in my early 20’s and medicated for almost a year. That information was in my chart. So why didn’t she screen me?

Adam and I went to all of the birth classes offered at our local hospital. I was extremely anxious, almost terrified of the process, of everything that was happening to us and of everything that was to come. No one mentioned postpartum depression or anxiety in any of the classes. They very definitely didn’t mention anxiety or depression during pregnancy. Why did no one tell me the ” title=”Risk Factors for Postpartum Depression and Anxiety” alt=”Risk Factors for Postpartum Depression and Anxiety”>risk factors?

If I had been screened I definitely would have been flagged. I definitely would have gotten help. Inside I was hoping and praying for someone to save me, but I didn’t have the words; I didn’t know what was happening to me. If Adam and I had ever seen a list of risk factors for postpartum mood and anxiety disorders (PMADs) it could have changed everything. Looking at it now I see just a long list of, “Yup, that’s me!”

Studies like this one are so necessary. They back up the lived experience of moms and families all across the country.

“The results of this study suggest that routine depression screening in women, both during pregnancy and postpartum, can lead to high levels of mental healthcare use among women who screen positive.”

For just one moment let me speak to any Obstetricians, Midwives, Doulas, Nurses, and anyone reading this who interacts with pregnant women and new moms: Please screen every pregnant woman and every new mother you come in contact with. Please tell pregnant women and new mothers the risk factors for PMADs. Please explain the prevalence of antenatal depression and anxiety. Early detection and treatment can save lives, it can change lives, it can work miracles. Women do not have to suffer in silence. You can save us.

To all the moms out there who weren’t screened: I’m sorry. I want you to know that I am one of you. I want you to know that I have promised my daughter that if she is ever pregnant, this will NOT happen to her. I, and so many other mamas, am working at the community level to ensure that every mom is screened. Postpartum Progress is helping to lobby for legislation that will move us towards universal screening. There is so much that you can do to help!

Call your doctor and ask why you weren’t screened. Ask if they are planning to implement a screening program for pregnant women. Share studies like the one discussed here that show how effective screening is.

Call your hospital and ask if the risk factors for PMADs are discussed during birth classes.

Call your midwife or birth center and ask if they screen every mom.

Call your doula and ask if she discusses risk factors with moms and screens moms.

Contact your Senator or Representative and ask if they are voting for the Bringing Postpartum Depression Out of the Shadows Act.

Help me keep the promise I made to my daughter. Let’s get screening for #EveryMomEveryTime.

6 Things Moms Need to Know About Labor & Delivery

6 Things Moms Need to Know About Labor & Delivery -postpartumprogress.com

Pregnancy is a miracle, they said. You will love your journey, they said. Be grateful, they said.

Well I say however magical it can be at times, pregnancy is gross, my friends. That’s right. I’m calling it. There are too many bodily changes to keep up with and too many hormones to help us cope with those changes. Creating human life is so not fun for a lot of us, and I for one am glad some are choosing to speak up about it. Recently, model Chrissy Teigen came out of pregnancy with a beautiful bundle of joy and a tweet that said her baby wasn’t the only one wearing diapers. She shouted, “No one told me about this!” and it got me and a whole lot of other women responding “right?!” It opened the floodgates of chatter.

Back when I was pregnant over three years ago, I was inundated with so many pieces of advice because of my New Mom status, but no one really told me the gross aspects of bringing forth human life via vagina. Everything I was told was either positive or teasingly negative, but almost none of it was authentic. In the spirit of being honest, I think it’s time we let other moms—and partners—in on what really goes on.

I don’t want to share just my experiences, so I took to a local mom group that I’m part of and asked the legion of experienced ladies: what do you wish people had told you when you were pregnant and giving birth as a new mom? Here’s what they had to say.

Babies and poop go hand in hand.

My particular experience is what made me think of this and had a lot of moms agreeing. I heard rumors that you would poop on the table when you’re delivering, but no one told me about the uncontrollable diarrhea that my intense contractions would cause. Embarrassing to admit (but kind of funny in hindsight), I leaked all over my hospital bed because contractions turned my insides to liquid. I thought my water broke. Then when my water did break, I thought I pooped again. Oh boy.

Aside from that, many moms like Heather G. report that when you push, either poop or a baby or both will come out- and that it can make for a confusing delivery. She says, “Push like you have to poo! No one ever told me that. It would’ve been much quicker (of a delivery) if I had been visualizing/pushing right.” There is no telling which one you’re going to get until it greets you with cries or gets discreetly tucked away by a compassionate nurse.

Game of Thrones isn’t the only place where blood is in abundance.

Everyone tells moms, “You’re so lucky not to have a period for like, a year.” What they fail to be envious of is postpartum bleeding, where you basically have all the periods you were “so lucky to miss” catch up all at once. This is actually what Chrissy Teigen was referring to when she said her baby isn’t the only one wearing diapers. The pleasant horror show is known as “Lochia” and in addition to blood, this heavy discharge contains mucus and uterine tissue. It can last for up to six weeks postpartum.

Moms like Jennifer D. and Bethany W. warn that it’s not as easy as just letting yourself bleed: Clots can pose a risk, and your doctor should advise you which types to look out for. It’s a stressful six weeks. Mom Ashley M said, “My postpartum periods were physically horrible, much worse than anything I had ever experienced.”

Sex with your spouse is going to take a long time to resume or feel right.

Most doctors recommend holding off on tumbling in the sheets until at least six weeks postpartum, longer if you had a C-section. Aside from the delay in fun times, other things can greatly impact your sex life. Breastfeeding can sometimes make you drier than normal; hormonal changes, perinatal mood disorders, and sleep deprivation can put you out of the mood; and tension can happen in your marriage because of the sheer stress of having a new baby. Amanda B. laments, “Postpartum sex… How excruciating! And that it’s normal (to be)!” It’s hard for your partner to understand sometimes, which can add to the frustration. Your body and mind went through all sorts of trauma, with lasting effects. Intimacy can be hard to achieve for awhile.

You may not feel immediately attached to your new baby.

In fact, you may not feel that strong bond of love and attachment for a while. Postpartum blues can turn into postpartum depression or anxiety, and these feelings sometimes block out any positivity trying to make its way in. Because so many people talk about the bliss of motherhood, and there is still a stigma attached to perinatal mood disorders. You’re expected to love your baby instantly and feel intense guilt when you don’t. This leads to not being honest about your feelings and seeking help because in an environment that shames mothers for these feelings; it’s hard for a mom to feel safe being open.

When mom Jennifer D. brought this up, almost all the moms I spoke with wholeheartedly agreed. Tanya H. said, “I remember lying on the bed with (spouse) crying my eyes out and saying to him that I thought we had made the biggest mistake of our lives… if you’re not head over heels in love with your baby after you have it, that’s totally normal.” You just went through something very traumatizing, and it is okay if exhaustion and suffering are on the forefront of your mind. Just don’t be afraid to reach out if this feeling lasts.

Your birth plan might go out the window and things can go wrong.

C-sections are reality. Things can go wrong, like your baby being breech, their heart rate rising, or even just being induced when you planned a natural birth. Sometimes, doctors and nurses don’t listen to you. Sometimes your doctors are amazing and they guide you through every step, but it can still go wrong.

Mom Nicole H. mentions “the guilt and shame from within if things don’t go ‘naturally.’ Such as gestational diabetes, induction, C-section, inability to breastfeed…” It can be very difficult to navigate your feelings when you hear so many suggestions about what to do and what not to do. She continues with, “any helpful suggestion made me feel like a total failure as a woman. I felt like my body should just do this! Women have been doing this forever!”

Breast-feeding can be painful, unsuccessful, and ultimately not what happens for you and your baby.

This is something I and the other moms struggled with. I was unable to feed my daughter my breast milk. Not only was she allergic to it, but I barely produced and she couldn’t latch properly. We spent three weeks crying, struggling with consultants, eliminating food from my diet, and she still lost weight and ended up in the hospital. The first night I gave her formula was after I screamed at the consultant that I couldn’t do it anymore. And my baby and I both slept for five hours straight after that bottle I was so harshly judged for. It was the best decision I could have made.

Mom Brittanie E. chimes in, “The breastfeeding books I read did not prepare me for struggling with low supply.” Another mom, Tiffani R. gave another insight: “Tetting thrush… my nipple pain… the whole peaceful bonding thing that never happened and then me hating myself for not being able to feed.” A LOT of the moms I spoke with voiced their hardships with breastfeeding and said it was the biggest thing they were not prepared to struggle with.

There are so many other things that the moms and I were chatting about, but these instances where what we all agreed about in unison. Some moms brought up a good point about shame in having a good experience, too.

Mom Meghan D said, “I want to add feeling guilty for having a relatively great breathing experience. Sometimes it’s difficult to share the positive things that happen when you were worried that you might make others feel worse about their experience.”

It can be hard to share your beautiful experience when you know of so many women who had the opposite, but it’s important to celebrate your birth, as it is to be honest and raw about how it went down the drain for you.

Mom Caitlyn A. puts it beautifully, “Labor often does not go exactly as we have imagined, but it does teach us that in life things don’t always go the way we had planned. It’s okay to not be okay. This one moment in time will not define your being so if you don’t have that beautiful, natural delivery you dreamed of, it is okay. Reach for help if you need to discuss what happened to you.”

In the end, everybody has their own unique experience. We encourage you to speak up about yours. I had a great time talking with over thirty moms about our struggles, and it was a great relief for us to hear how so very not alone we are. We all agreed: We can be a little less scared as moms when we have each other to lean on and share with.

I Was Wrong

[Editor’s Note: Today’s guest post comes from Emma Rinker. She bravely speaks of a pregnancy, a loss, and a subsequent baby that left her with pregnancy anxiety, followed by postpartum depression. We’re thankful for her words today. -Jenna]

I Was Wrong -postpartumprogress.com

I found out I was pregnant on Christmas Eve.

I found out we lost our baby on Presidents Day, barely two months later. I had a D&C that same evening.

I did my best to act like I was okay after that, when all I wanted was to crawl into bed and live there. Months went by.

I thought I would be better when I got pregnant again.

I was wrong.

I was terrified of losing another baby. I had anxiety attacks leading up to doctor appointments. My husband, who could clearly see I wasn’t myself, asked our OB twice if my level of anxiety was normal.

At each of those appointments our OB simply stated it was perfectly normal to be anxious after a loss. Our OB was the expert, right?

I felt anything but normal. Nothing could be the same as that rainy day in February when we were told there was no heartbeat. I refused to wear certain clothes. I considered rescheduling appointments if the forecast called for rain. I didn’t feel joy in being pregnant.

I had pregnancy anxiety and didn’t know it. I didn’t know it was a real illness. I didn’t know I could have—should have—been treated for it.

I thought I would be okay when I gave birth and could hold my baby.

I was wrong.

I became dehydrated during labor and developed a fever. When I gave birth to my son, I only remember patting his head and telling my husband to hold him first.

I thought I was too tired to make the effort.

I was wrong.

I had zero interest in trying to bond with our son at first. When I finally felt an urge to hold him, admire him, bond with him 15 hours later, he was promptly taken away for routine tests due to my fever. We didn’t see him for several hours.

We were told our baby was septic and needed to be moved to the NICU for antibiotics. He was placed under the bilirubin lights because he was jaundiced as well.

Hooked up to monitors and IVs and needing the lights meant we could only hold our son to feed him for the next five days. I cried. A lot.

When we finally came home as a family I cried all the time. I had thoughts of my baby getting hurt. I wanted to run away. I was exhausted. I was obsessed over the baby’s weight and whether he was getting enough milk from me. I felt a lot of anger and resentment towards my husband for being able to being able to sleep through every little noise our baby made at night. I looked at my son and only felt the instinct to protect him—the love I expected to feel for him immediately upon seeing him hadn’t happened.

I thought I was having a hard time adjusting to motherhood.

I was wrong.

People could tell I wasn’t myself, but no one said anything until I broke down at our son’s one-month appointment and was encouraged by the nurse practitioner to ask my OB about postpartum depression.

I was diagnosed with it two weeks later at my six-week visit with the midwife, who also handed me a prescription for an antidepressant.

I began seeing a therapist several months later. She was a saving grace as she helped me work through my anger and anxiety.

I didn’t think I would ever enjoy my son. I thought I would need to take a pill for the rest of my life in order to be a mother that was just “good enough.”

I was wrong.

My son was nine months old when I felt my heart swell with love for him. He was 15 months old when I realized I was enjoying being his mom—medication free.

One day you will find yourself smiling at your child as you watch them play. One day you will laugh with them and realize you’re truly enjoying them. One day you will look at them and feel all the love in the world for them.

You will.

Until then, keep fighting Warrior Mom Emma Rinker is Wife to her high school sweet heart and Mom of two boys. She loves chocolate cake, beer, and pole dancing (for fitness!). Emma has dreams of writing the next Great American Novel, but for now she can be found writing on her blog, Muddy Boots and Diamonds.

Bed Rest and Depression

Bed Rest and Depression -postpartumprogress.com

Last month the American Congress of Obstetricians and Gynecologists (ACOG) released a list of “Five More Things Physicians and Patients Should Question” when it comes to OBGYN procedures. It’s an addition to their Choose Wisely campaign which started with “Five Things Physicians and Patients Should Question.” In all, there are now ten recommendations ACOG makes for physicians and patients to question.

Four of the ten recommendations specifically address pregnant women, and one of them caught my eye for a number of reasons. Julia West at Mothering addressed it as such:

This research shows many side-effects of bed rest during pregnancy including: “muscle atrophy, bone loss, maternal weight loss and decreased infant birthweight in singleton gestations, and psychosocial problems including depression, anxiety, stress, family disruption and financial burden.” ACOG states plainly that “information to date does not show an improvement in birth outcome with the use of bed rest or activity restriction.”

I just wish you could have seen the look on my face as I read that paragraph the first time. And the second. And the third. And then when I clicked over to read the research. Jaw-dropping doesn’t begin to describe it.

I’m not your typical pregnant patient. I have chronic unilateral hydronephrosis; the ureter out of my right kidney isn’t big enough and a growing uterus pinches it off, causing a host of problems. I experienced two surgeries during my first pregnancy as they tried to insert a stent which they eventually removed because it only made things worse.

They placed me on Level III bed rest at 18 weeks gestation. Financial burden? Anxiety? Stress? Depression? Oh yeah. I ended up placing my baby for adoption because I couldn’t see past the crisis mode that I was in at the time. You can also tick off “maternal weight loss,” too. I gained a total of 19 pounds. I wasn’t proud of it; I looked sick because I was sick.

I was also alone for almost all of that time. I spent hours in my apartment, staring at the ceiling of my bedroom, or when I dared, the ceiling in the living room. The isolation only exacerbated the depression and anxiety. It was a dark, scary, and very lonely time.

I expected, with better health care and a planned pregnancy, my subsequent pregnancies wouldn’t be quite so isolating and debilitating. I was wrong, of course. Level III bed rest came later on than it did during my first pregnancy—28 and 32 weeks—but I still found myself stuck on the couch or in bed. Living in a new state with no real friends yet, I didn’t really have any visitors other than my beloved mother-in-law. My husband worked 24 hour shifts, leaving me alone with our toddler during my third pregnancy. Parenting from the couch isn’t easy, let me tell you.

Was I depressed during these episodes of bed rest? You betcha, though I worked hard at hiding it. These were pregnancies I was supposed to be happy about; these were the babies the adoption agency told me I would someday have, when I was “ready” for “my own” children. I plastered a smile on my face and made jokes about how losing 11 pounds during pregnancy meant that my figure would bounce back so much more quickly. (Of note, it did not.)

I also stressed about the financial burden my bed rest placed on our growing family. While my husband’s job as a firefighter provided well for us, I felt an overwhelming need to provide something since I couldn’t during my first pregnancy.

My anxiety continued to sky-rocket. While I was actively seeing a therapist when I got pregnant with our second son, I couldn’t visit her once placed on bed rest, and from that point on, things were kind of touch and go when it came to intrusive thoughts, fear, depression, and panic attacks.

Part of me understands that I was a special case, that bed rest kept the constant contractions from turning into progressive contractions and pre-term labor. I was lucky and carried all three babies to 38 weeks. But this new news out of ACOG makes me wonder if they would have done something differently with my case(s) over a decade ago. If I had been allowed to keep working with my daughter, would I have parented? If I had been able to continue attending therapy during the final trimester of my pregnancy with our youngest, would my relapse of postpartum depression and anxiety have been caught sooner?

I don’t know. But I do hope these new recommendations will help expectant moms avoid unnecessary stays in bed and that it helps them avoid antenatal and, perhaps, postpartum depression and anxiety. Placing moms in isolating situations doesn’t seem conducive to positive mental health.

Were you on bed rest? How did it affect your mental health?