I have often wondered why The Postpartum Stress Center, LLC never really received many referrals from other therapists. Understandably, most of our referrals come from OBs, Peds, PCPs, Internists, midwives, birth centers, hospital maternity units, and the like. Recently, I've been thinking about all the psychologists and social workers in private practice who may be treating individuals or couples and, unless they are inclined to look for it, may actually not realize that any new mother seen in treatment for something else may be at risk for, or already experiencing, a postpartum mood or anxiety disorder. It may not be something that jumps out on their radar in terms of early assessment questions.

But it should be.

I wonder about the multitude of reasons that justify this gap in the referral process. 

Perhaps the therapists don't yet reconize that the mother or couple they are treating has a 4-month-old baby at home, for example, that may be contributing to how the client or couple is feeling, thinking, or behaving.


Perhaps they understand that having a baby will certainly bring on tons of changes and challenges, but may not adequately understand how to differentiate these normal changes from symptoms that could actually be problematic.


Perhaps they miss it entirely and do not realize that having a baby is paramount and part of the psychological picture.


Perhaps they are perfectly qualified to treat one or the other partner for depression, anxiety, or psychosis, if it presents itself.


Perhaps they don't see the value of bringing in a specialist if they have been successfully practicing psychotherapy for decades.

All of these are valid reasons.  

Even so, I worry about the therapists and their clients, who might, in fact, need to have this issue raised so we don't, inadvertently, miss significant variables that could be contributing to high levels of distress.

There is a lot at stake if therapists miss this. Therapists who do not specialize in this area of treatment may not be attuned to the nuances that can easily slide by unnoticed. After all, postpartum women are incredibly good at looking good, even when they are suicidal.

Furthermore, what about all the other healthcare professionals who see this population on a regular basis? Are they asking the right questions? And even if they are, are they in position to respond appropriately? To be sure, all primary care providers, obstetricians, pediatricians and midwives should feel obliged to attend to the emotional well-being of their perinatal patients. With recent awareness campaigns, more and more providers are, indeed, tuning in to the possibility of prenatal and postpartum mental health illnesses. 

Still, healthcare providers should ask themselves these questions

  • Do you screen every patient for prenatal or postpartum mood and anxiety disorders?
  • Do you have a reputable resource(s) for mental health referrals?
  • Do you feel you have a reasonable amount of knowledge when it comes to state-of-the-art treatment for perinatal mood and anxiety disorders?
  • Are you prepared to experience the consequence of failing to screen for maternal mental health concerns?
  • Do you feel comfortable probing further if you are concerned or suspicious about any response, lack of response, or behavior you may observe?
  • Do you feel capable of providing supportive intervention if needed?
  • Do you feel adequately informed about the nature and high rate of occurrence of negative, intrusive thoughts that are anxiety driven?
  • Do you feel able to differentiate between anxiety related intrusive unwanted scary thoughts and those that are the result of psychotic and delusional thinking?
  • Do you appreciate the serious risk of not addressing the mental health of each and every perinatal patient?
  • Have you sufficiently trained your staff to respond appropriately when they suspect symptoms of severe depression, anxiety or psychosis?  
  • Do you feel prepared to get accurate information and/or psychological support, if necessary, for yourself and/or your staff in order to insure proper care of your patients?

There is a huge push for universal screening for postpartum depression and anxiety. This is only a good thing. Still, there are barriers too numerous to mention here, that continue to impede the process. We need to work at this from both sides. Health professionals, including psychotherapists, need to be comfortable asking the hard questions and moms need to let their providers know how they are really feeling and what they are most afraid of. Only then can we hope to see a significant change in the treatment of perinatal depression and anxiety and a decrease in suffering.

© 2014 Karen Kleiman, MSW  


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