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.

Having Another Baby, Meds During Pregnancy, & How to Be Selfish

During week’s Facebook Live chat with Katherine, we talked about everything from the decision to have another baby to medication during pregnancy to what a mom should do to find care if she doesn’t have insurance.

Watch for yourself.

Here are all of the links we shared during the broadcast:

We started off on the topic of having another baby as that’s where we got cut off last week when our hour ran out. We acknowledge that not all moms who have experienced PPD need or have to have other children. Those moms’ voices and experiences are valid and we encourage the sharing of those stories because there are other moms who don’t want more children and need to feel less alone. Katherine shared her story of having another child while others shared their experiences in the comments.

The discussion morphed into the topic of taking medication while pregnant, which a few in the chat didn’t even know was a possibility. It IS. If your doctor tells you no, get another opinion. There are safe medications and safe ways to take medication during pregnancy, but you do need to speak with doctors who know what they’re doing. Additionally, you can do other things, like attend therapy, while pregnant to either help medication or to avoid it.

At one point we were discussing advocating for yourself and the care that you need. Katherine said to “be selfish.”

Be Selfish -postpartumprogress.com

What we mean by that is that it’s not selfish to ask for help, to seek help, to take some time out of every single day for you. It’s necessary. It just feels selfish because for too long we’ve been taught we need to be good, quiet, not create a ruckus. Nope. Be selfish. Do what you need for you to get better. You deserve to feel better, to be better.

We talked about Climb Out of the Darkness for a little bit. It’s the largest event in the world promoting awareness about postpartum mood and anxiety disorders. There’s still time to register OR form your own team. Find a team today! We also discussed that nervous/anxious feeling some (many!) get about attending their first (or fifth) Climb. It’s normal. It’s okay. Just show up and be you. The connection you’ll feel with other Warrior Moms is amazing!

We then opened it up to questions. We received a personal message question about what to do if you don’t have insurance. Katherine listed off a number of things you can do, including asking the doctor if they have a sliding scale, while others listed a bunch of other resources in the comments. Warrior Moms looking out for Warrior Moms.

We’ll be back Live on Facebook next Wednesday at noon. If you have questions, please let us know!

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?

National Adoption Month: Addressing Depression During Pregnancy

National Adoption Month: Addressing Depression During Pregnancy

To say I felt depressed during my first pregnancy is an understatement. To say that my depression went untreated is also an understatement. However, considering I presented a number of risk factors for depression during pregnancy, the fact that my depression was basically ignored by those around me feels a bit like a failure of services.

As for risk factors, I could have been a poster child for Depression During Pregnancy.

  • A personal history of depression or another mental illness – Check!
  • A family history of depression or another mental illness – Check!
  • A lack of support from family and friends – Check!
  • Anxiety or negative feelings about the pregnancy – Check!
  • Problems with a previous pregnancy or birth – This was my first pregnancy, so no check!
  • Marriage or money problems – No marriage, no money: double check!
  • Stressful life events – Check!
  • Young age – Check!
  • Substance abuse – No check!

Six out of eight, and add in a side of extreme pregnancy complications due to my own health, and well, it’s easy to see that I was at least at risk for antenatal depression. Yet, not one doctor or nurse ever asked me, “Are you feeling okay? Do you need to talk to someone?” The woman parading as a counselor for the adoption facilitator I began talking to never once asked, “Would you like to talk to some other mothers who also had these same fears during their pregnancies?” No one in my family sat me down and said, “Listen, Jenna. I think you’re depressed and I think it’s affecting your decision making skills regarding this pregnancy.”

Because it did.

After surgery to place a stent in my kidney at 18 weeks, my doctor placed me on Level III bed rest. I had to quit my job as I could only get out of bed to shower. I began to panic not only about my financial situation but about my perceived inabilities as a mother.

I chastised myself all day long in my bed or on the couch watching movies on VHS tapes sent by an online friend as I couldn’t afford cable. “What kind of mother cries when she finds out she’s pregnant? A bad one, that’s the kind. You can’t do this. Look at you: You can’t even do pregnancy right. You’re biologically horrible at pregnancy, so why wouldn’t you be biologically horrible at motherhood? You’re going to fail this baby. You’re going to be a failure as a mother.” The voices in my head taunted me all day long.

So I listened.

I contacted the first adoption facilitator I found in the back of a magazine. I filled out their medical history forms to the best of my knowledge, including that I had previously been on antidepressants. Still, not one person I had contact with at their office ever asked, “Have you considered that your beliefs about your lack of ability to be a mother are signs of depression?” Instead, they preyed on my anxiety, my depressed state, my lack of support, my financial problems, and my age to help me paint a negative self-portrait—one who couldn’t be a mother.

Years later, when I found myself in therapy for postpartum depression after the birth of my second child, a son, I felt anger. I felt angry not only for the young mother who slipped through the cracks, but at myself for not being able to see; not being able to see through the anxiety or depression, not being able to see through the lies and half-truths, not being able to see my child as my own. I held on to that personal anger, the anger directed at myself, for years, much longer than I held on to the anger directed at the adoption facilitator. After all, as so many willing to dismiss birth mothers and their grief say, I “signed those papers, so it’s my decision, my fault.”

It wasn’t until sometime in the past year that I’ve been able to see that young mother with a sense of compassion. I didn’t know what I didn’t know. If you ask any person who suffered from depression, they will tell you that a period of time existed during which they simply didn’t know they were depressed. I simply thought I couldn’t be a good mother, that these thoughts were proof that I lacked maternal instinct, that maybe I’d never be the motherly type.

I’ve cried many tears for the young mother that I was in the process of healing, and yes, forgiving myself. I’m still working on the forgiving part, but I now fully understand how and why I ended up on the path of adoption and eventually relinquishing my child. I firmly believe if we offered mothers considering adoption access to legitimate mental health care resources, we’d see an improvement in the numbers of mothers who both choose to parent and, should they choose to place, feel as though it was an informed decision, not coerced by people seeking to gain from their loss.

However, while we’ve made great strides in acknowledging and providing resources for mothers and families fighting postpartum depression, ethical reform in adoption remains a slow-moving process. If we admit that mothers who are single, who maybe don’t feel worthy of being a mother are worthy of being mothers, then for-profit newborn adoption begins to make less sense. And there’s the rub.

For now, I take comfort in knowing I’m not alone, in offering hope and support to other scared mothers, and in continuing the work of forgiving myself. Maybe someday I’ll get there.