I got the following email this week from a reader (who agreed to let me share it with you anonymously):
"I am 6 months postpartum and just found out today that I have Postpartum Autoimmune Thyroiditis and I am currently hyperthyroid. I don't know how long this has been going on. Dr. ________ has tested me 3 times over 3 months and it was creeping up on every test, but this last test confirmed it. I just wanted to thank you again for sending me to Dr. _______. I think other doctors wouldn't have even tested me again after the first month because the test results were only "slightly abnormal". I have an appointment with an endocrinologist this Monday. Hope it goes well and relief is on the horizon.
THIS is why I love perinatal mood and anxiety disorder specialists. Awesome.
I am so glad things are going well for this patient with her doctor. I know that that is way too often not the case. But I still have worries about the implications of this post in terms of where we should be focusing our efforts. Yes, it would be awesome if every woman with a perinatal mood or anxiety order could see a perinatal mood specialist. But with a 20% incidence rate among women,and with the huge shortage of even general psychiatrists that this country has, this is just never never going to happen. This is why I keep saying that we need to focus efforts on regular providers. Knowing when to test a thyroid panel and following up on abnormal results (even just borderline abnormal results) should be standard operating procedure for every provider who cares for postpartum women. This is something that *every single* OB/Gyn, Midwife and Family Physician should know how to do. In training, we teach OBs and Family Physicians and Midwives to detect and care for gestational diabetes and gestational hypertension. So why are we letting them off the hook when it comes to perinatal mood and anxiety disorders which are even more prevalent? My dream is for every woman (whether she lives in a large urban area or not, whether she has good insurance or not, whether she has been lucky enough to stumble onto this blog or not) to get competant and caring postnatal care. If we keep believing that only a specialist can "make the difference" we are never going to realize that dream.
My sister had this – if developed into full blown bipolar disorder – it was her trigger for something which was waiting in the back ground basically – it runs in out=r family.
You have a great resource here. Please consider joining a new linky over at http://wordsinsync.blogspot.com/ called Monday Madness – It's in support of bloggers who are involved in mental health/illness. I'd like it to grow steadily, to allow for a solid support community for those of us who could use it/who can help, to tackle stigma and enable awareness. Do pop by. Be great to have you with us. Shah .X
I totally see your point. It's not that I believe only a specialist can make the difference, I suppose. It's more that I believe that people with special training can make the difference. We need to do better to provide specific perinatal mood and anxiety disorder identification and treatment training to ALL OB/GYNs, midwives, pediatricians, etc. Just the other day I was at a large Atlanta area pediatric practice at an appointment for my son, and the pediatrician we saw admitted that she wasn't even sure what they do to support the women who have it. We have so much work to do. I think you and I are in agreement more than we are not. Thank you so much for your input.
Katherine, Great post! I have just gone fulltime with my private practice and among my specialties is working with women with postpartum issues. I am a psychologist and have a specialty in working with children and families. I have worked extensively with the children birth-5 years and with adults with anxiety and depression. It's not uncommon for the little ones to have behavioral and emotional issues. Oftentimes tied to this is a complicated pregnancy, delivery and/or postpartum issues. Sometimes the PPD is provoked by marital or family relationships that are stressful or abusive.
Having a community of specialists to address the variety of issues that arise is critical to providing good care. I am in the process of developing that community and, fortunately, we have good resources in my region.
Again, many thanks for this excellent post.
Katherine,Been trying to get in touch with you,please contact me. JV