It is estimated that 50% of women with postpartum distress have symptoms that remain undetected (Peindl, Wisner, & Hanusa). A likely explanation is that this results from women's disinclination to disclose and providers' lack of screening knowledge. If healthcare providers do not ask every single postpartum woman if she is having thoughts that are scaring her, they have no way of knowing whether she is experiencing distressing thoughts or not
. To presume that she is not, simply because she looks good or says all the right things, will be ineffectual at best and, at worst, disastrous when it prolongs or aggravates the suffering. Thus, even if we envision that perfect scenario when all postpartum women are universally and routinely screened, the issue of asking the right questions remains a high priority.
If there are approximately 4 million babies born in the United States per year and up to 91% (Abramowitz) of all mothers (with and without a diagnosis of postpartum depression) experience obsessive thoughts - this means as many as 3,640,000 women will experience this phenomenon of having scary thoughts! These scary thoughts may be about themselves (suicidal thoughts) or their baby (fear that harm will come to baby by accident or intention).
It is recommended that healthcare providers attend to this reality responsibly and with compassion, by using the one question-screen for each postpartum woman in their practice: Are you having any thoughts that are scaring you? This is a question that should be asked of every single postpartum woman in any and all healthcare contexts.
Research shows that primary care providers most often identify postpartum distress (41.3%), followed by obstetricians (30.7%), and mental health providers (13.0%) (Dietz et al., 2007). Because a woman's history of depression and anxiety is a significant risk factor for postpartum distress (Wisner, Chambers & Sit, 2006), all providers should be diligent about gathering relevant history. The same principle applies to current information that might contribute to the manner in which a woman is currently feeling or may feel during the postpartum period (e.g., marital issues, environmental stressors, baby-related pressures, job stress). Understandably, each provider has his or her area of expertise and perspective. However, with increased awareness and education, there is a great potential for each medical discipline to find its own way past resistance and to the heart of a postpartum woman.
Clinician Note: If you are a mental health therapist and are treating an individual or couple who has had a baby within the last year, ARE YOU SCREENING THEM FOR POSTPARTUM MOOD AND ANXIETY DISORDERS AND SCARY THOUGHTS? You should be.
Adapted from Dropping the Baby and Other Scary Thoughts by Karen Kleiman and Amy Wenzel (Routledge, 2010)
Copyright 2011 Karen Kleiman postpartumstress.com