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.

Antenatal depression and antenatal anxiety: Jen’s story

antidepressants pregnancyI struggled with undiagnosed antenatal depression and antenatal anxiety.  I felt like such a fraud.  My husband and I had planned for this baby.  I should have been overjoyed and glowing.  Instead I walked around in a fog of self-hatred, irritability, and unrelenting worry.  My internal monologue consisted of, “I should be happy, dammit!” Why couldn’t I enjoy this pregnancy?  It was my final pregnancy, and we were giving our nearly three-year old daughter a sibling.  Where was my pregnancy glow?  Why did I feel like all I did was complain, vent and whine?

Why couldn’t  I relax?  I felt so much pressure to get my oldest potty trained before the new baby arrived.  I felt like all loose ends needed to be tied up.  I had to finish my toddler’s baby book before the new baby arrived.  I had to make sure I was exercising daily.  I had to maintain a tight control on my blood sugar.  I had gestational diabetes with my first pregnancy, so I spent my final pregnancy watching my food intake.  Every time I heard a comment about “eating for two”, I wanted to rage.  I did not have that luxury of eating whatever I wanted.  The meal plan made me miserable.  If my numbers weren’t within the expected range, I immediately panicked.  I was terrified that my daughter would struggle with complications from my gestational diabetes.  Not even the ultrasound showing a healthy twenty week baby girl diminished those fears.  I felt like I had no right to complain or worry.  I knew what to expect.  I needed to just suck it up and deal with it.

Like postpartum depression, antenatal depression looks different for each mama.  My lovely friend Susan describes her antenatal depression like this.  “I just remember feeling a crushing weight and numbness. I wanted to not be pregnant anymore and had thoughts of throwing myself down the stairs. That’s what sent me to a perinatal psychiatrist. All my joy left like I was in a vacuum – and I was suddenly convinced a new baby was the end of everything as I knew it.”

My experience of antenatal depression differed from Susan’s.  My depression manifested itself in extreme irritability, bordering on rage.  I had no patience for anything – traffic, my husband, my daughter, my parents and my sister, my friends, and my co-workers. One of the triggers for my rage was my daughter’s refusal to take naps on the weekends.  I could barely control my reaction.  I would yell and scream at my husband.  I would need to leave the house to give myself an adult timeout.  I still cringe when I remember an epic tantrum that occurred during my seventh month of pregnancy.  I was at a concert at an outdoor venue.  I cut in front of everyone waiting in line for the bathroom and for water, simply because I was pregnant.  I was rude to everyone that day. I took out my rage on anyone in my path.  This irritability and rage manifested itself in full-blown postpartum depression and postpartum anxiety after my youngest was born.  I wish I had recognized these signs sooner.  I could have treated this during my pregnancy when my initial struggle began.

Antenatal depression and antenatal anxiety are not as widely known as the other perinatal mood disorders.  We do moms a disservice when we fail to screen for depression and anxiety during pregnancy.  We need to focus on both the needs of the mother and the needs of the baby.  Mothers are vulnerable during both pregnancy and the postpartum period.  Ask the pregnant mom how she is doing and really listen.  I read this amazing piece that Andrew Solomon wrote regarding depression in pregnancy.  Thank you Andrew for speaking up for both the mothers and the babies.  If you are feeling fragile, do not read Andrew’s piece.

Pregnancy Anxiety and Family History of Miscarriage

Pregnant BellyFirst-time mothers can find many things to be anxious about when they become pregnant. What will pregnancy be like? Will my baby be healthy? Did I start taking my prenatal vitamins early enough? Am I really ready for this? But some women may have an additional fear that seems more relevant than it might to other pregnant women: Will I be able to stay pregnant, knowing that my mom had a history of miscarriage?

This anxiety was something that I had to deal with when I discovered I was pregnant with my son shortly after beginning infertility testing. After a year of trying to conceive, I had been getting rather depressed about failing each month, and the beginning of that year of trying may or may not have started with a miscarriage I was too afraid to see my doctor about. I know now that that was a bad decision, not telling my OB/GYN about the three weeks of heavy bleeding that had forced me to reschedule my initial annual exam where I’d intended to ask for a prenatal vitamin prescription, but I didn’t bring it up because I didn’t want to know for sure. My mom had suffered three miscarriages when I was a kid – the reason why there ended up being eight years between the births of my two younger brothers – and I was trying to shield myself from the emotional aftermath of knowing for sure whether it was a miscarriage or just an exceptionally heavy period. My periods were awful and unpredictable when I went off the Pill. I still have plausible deniability.

So there I was with a positive pregnancy test around Christmastime 2004, overjoyed that I was finally pregnant, but haunted by the shadow of a possible miscarriage. Some of these things are genetic. Some are due to environmental factors. Some don’t seem to have any reason whatsoever. Were those genes passed on to me?

These fears led to a tearful call to my OB/GYN just after New Year’s. I was spotting. They tried to reassure me over the phone as they set up the appointment for me to come in. Spotting can happen in a normal pregnancy. It doesn’t mean anything is wrong. But predisposed as I was to anxiety, this was no consolation. I saw the CNM I liked at my OB/GYN’s office for a pelvic exam and a urine test. The blood was brown, though, old blood, and my pregnancy test was positive. My cervix was inflamed, though, so they sent me to the local women’s hospital for an internal ultrasound because they didn’t have any ultrasound techs in the office. I was only five weeks along, so all they could see what the egg sac and yolk sac, which was good enough for them to reassure me my pregnancy was fine. Only if I started seeing red blood along with cramping should I worry and give them a call.

I didn’t have to make another call like that, but my anxiety didn’t go away.

My inflamed cervix ended up needing to be treated, and I was prescribed MetroGel for it. MetroGel is considered Category B for pregnancy risk, but I was still in my first trimester, and I was terrified that something bad would happen if I introduced this foreign substance so close to where my baby was developing at such a crucial period. I ended up waiting until the first day of my second trimester to actually use the MetroGel. That decision in itself was risky, as an untreated infection can also potentially harm a developing fetus, but it was what I considered the safest route at the time.

Thankfully, my anxiety levels decreased appreciably once I reached 24 weeks. That was the magic number in my head where I felt I could stop worrying about a miscarriage, because about 50% of babies born prematurely at that fetal age survive. And with each passing day, I knew my son’s chances of surviving and being born relatively healthy were just getting better and better.

Unfortunately, my anxiety came back with a vengeance after my son was born, alongside my undiagnosed postpartum depression. If I’d known then what I know now, 10 years later, I would have talked to my doctor. I would have tried to get help. I know I would have avoided taken any medication during my first trimester, but I might have considered some of the lowest-risk medications during my second and third trimesters according to the best available information at the time. I certainly wouldn’t have waited until my son was three before finally seeking treatment from a psychiatrist.

I know I couldn’t have stopped worrying about losing my son, but I could have had someone to talk to about it if I’d looked into therapy. But that’s why I think Postpartum Progress is so important – so people like me can encourage other women to get the support we never had.