Jessica Zucker, PhD, wrote a perfect blog post about the role of pediatricians in the screening of perinatal mood and anxiety disorders. Every single thing she wrote was spot on. Pediatricians are indeed in the ideal position to intercept postpartum women and screen for depression. It is true that pediatric settings have been identified as an optimal screening site, primarily due to the opportunity for repeated assessments and follow up contact with mothers. Additionally, from a psycho- educational viewpoint, early screening can launch a discussion about perinatal mood and anxiety illnesses as a preventive intervention.

There's only one hurdle left, and it's not a new one - mothers remain reluctant to speak with their pediatricians about the way they are really feeling.

Several years ago, we carried out an informal study at The Postpartum Stress Center and asked women to check off which healthcare professional they would be mostly like to confide in if they were feeling bad, or to whom they DID confide when they were experiencing symptoms of postpartum anxiety and/or depression. They were also asked to explain why they chose that provider and not the others. This list included: Obstetrician/Midwife, Pediatrician, Primary Care Physician, and "Other."

By far, the majority of women responded (after their husbands) that the healthcare provider, with which they felt most comfortable disclosing the nature of their symptoms, was their obstetrician. The women who selected the OB stated they felt most secure with that relationship, allegedly due to the long standing and intimate nature of the relationship.

Women also reported they were LEAST likely to disclose their feelings to the pediatrician. When explaining this, some referred to the newness of the relationship or it not being "in their job description." But most said they were afraid to expose this vulnerability to their baby's doctor and worried that it could influence the pediatrician's opinion of them. In other words, moms were worried that the pediatricians would perceive that they were not good mothers.

In contrast to this misperception, Dr Zucker points out in her article (Linda Chaudron, MD also writes in extensively on this subject) that pediatricians may be in the best position to help identify maternal depression, partly due to the fact that "the pediatrician may encounter mothers during the post-pregnancy transition more frequently than any other healthcare provider."

Still, those of us who work with this population, find ourselves facing perhaps the most imposing obstacle: the depressed mother herself. It is well known that depression itself often acts as a barrier to help-seeking solutions. Distorted thoughts, weary souls, hypersensitive and twisted perceptions often combine to paralyze a postpartum woman at a time when she dearly needs to advocate for herself.

If pediatricians are getting on board and responding appropriately to our call for attention to this huge public health issue, we need to urge postpartum women to follow through with their part of this equation. The healthcare system is slowly but surely beginning to respond to our push for greater awareness and more efficient, skillful intervention. Now, postpartum women need to persevere despite their resistance and believe that this process is evolving for the better. They need to trust this process and talk to their doctors and their baby's doctors. They need to believe that the pediatrician has the well-being of both the baby and Mom in mind. They need to answer the screening questions honestly. If the pediatrician doesn't initiate any formal screening, it may still turn out to be the best first place to start. Pediatricians are highly invested in maternal wellness; after all, the stakes are high. Personally, I am encouraged that screening for postpartum depression has progressed beyond the OBGYN parameters and into the Pediatric realm. It feels like a natural and necessary initiative.

Copyright 2012   Karen Kleiman, LCSW

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