5 Types of Support Needed to Complement PPD Screenings
Screenings, while critically important, are only a part of what's needed.
Posted Jan 29, 2016
A government-appointed panel recently recommended that women be screened for depression during pregnancy and after giving birth. Universal postpartum depression (PPD) screenings are a great first step. What’s also needed is more support for new moms – especially in the form of evidence-based programming, government policy, and professional collaboration. We need to replicate promising initiatives and create new ones where gaps exist.
Postpartum depression and anxiety are real and very prevalent - about 14% of parents have postpartum depression and about 20% have postpartum anxiety. These numbers refer only to the people who “show up” on scales. Many more parents are (naturally) coping with fatigue, anxiety, stress, guilt, loneliness, or “the blues” that are never uncovered through formal screenings. Parents may also feel fine during pregnancy or just after having a baby but have a much harder time when their children grow to be toddlers or preschoolers. Others don’t have access to health care or do not go to follow-up appointments where a scale such as the Edinburgh Postnatal Depression Scale (EPSD) would be administered.
It’s imperative that, in addition to tertiary prevention (methods that detect and reduce the impact of symptomatic disease), we expand primary prevention (methods to avoid occurrence of disease). Postpartum depression has complex contributing factors - a single support could not address them all, but each of them may help.
Here are 5 ways we could provide moms with additional support to complement universal PPD screenings.
1.) Family, Educational, and Social Support
Many parents feel isolated or cut off from others. One 2015 study showed that 24% of parents feel lonely, with the statistics getting worse with the greater number of children one has. One model to improve social support and combat loneliness is the Minnesota Early Childhood Family Education (ECFE) program for all Minnesota families with children aged 0 to 5 that “works to enhance the ability of all parents and other family members to provide a positive environment for their child’s learning and growth.” Beyond skill-building, this program naturally helps parents fulfill the fundamental human need to make friends and build community.
Another program to strengthen parental confidence and social ties are parent-child drop in groups, such as the ones run by Vancouver Coastal Health in British Columbia. These Vancouver-based groups give parents a chance “to connect with and get support from other parents and health care professionals.” Each session includes health and development topics presented by a health care expert such as a nurse or a nutritionist. At the end of these sessions, there is ample time for conversations with other parents.
2.) Support with Prenatal/Postnatal Stress
While a slew of prenatal programs teach parents about childbirth education and taking care of baby, few help parents cope with their own stress. One model initiative is The Gottman Institute’s Bringing Baby Home program, which has been shown to decrease maternal symptoms of postpartum depression, the baby blues, and other indicators such as anxiety, among other impressive results.
Another extremely promising program is a Mindfulness Based Stress Reduction (MBSR) for pregnant parents, an intervention which has been shown to reduce anxiety and negative affect for mothers in the third trimester. MBSR has also been shown to be highly effective to help parents who have young children with developmental delays to reduce stress and depression as well as to improve life satisfaction. Parents who participated in MBSR reported significantly less stress and depression as well as greater life satisfaction compared with wait list-control parents.
3.) Ongoing Support from Health Visitors
One study showed that “many mothers would be far happier to have a manual, more help, or instructions on how to cope with certain aspects of motherhood.” Feelings of stress, uncertainty, or overwhelm could be addressed by programs such as the Colorado Nurse-Family Partnership, which utilizes ongoing home visits from registered nurses to first-time moms. From pregnancy until the child is two years old, the nurses form a “much-needed, trusting relationship with first-time moms, instilling confidence and empowering them to achieve a better life for their children – and themselves.” This program has resulted in: improved prenatal health, fewer childhood injuries, increased maternal employment, and improved school readiness.
4.) Mental Health Support (made more accessible through professional partnerships)
People who have PPD often have a very hard time finding a suitable, specialized counselor with an opening, who is in their insurance network, who is nearby to their home, who is a good fit, who will be supportive of them bringing their baby to sessions. We need to make it easy for moms to get support at the very OB/GYN offices where they are screened. Collaboration and shared office space between mental health professionals (including psychiatrists and psychotherapists) and doctors would make it easier to attend sessions. It would help normalize and de-stigmatize the process of securing help. Collaboration could also aid in the process of providing effective resource referrals (such as links to housing or government benefits), prescribing medication, offering additional screenings (for postpartum anxiety, for example), or giving detailed treatment recommendations.
5.) Financial Support - Extended and Paid Parental Leave
Improving the U.S. Family Medical Leave Act (FMLA) would help many parents who experience financial, work, and child care stress. Some parents would rather return to work right away, and others prefer to stay home longer - but they should have the choice to do what's best for them. The United States continues to lag ridiculously behind many other countries in terms of the benefits extended to new parents. The Pew Research Center showed that a comparison of 38 countries showed that while 37 countries have paid parental leave (many of them having 1 to 2 years of paid leave), the U.S. was the only “outlier” that had “protected but not paid” leave.
In addition, nearly half of all U.S. workers are not covered under the FMLA, mostly because they work part-time or because their employer has fewer than 50 employees. Imagine if FMLA was extended to a paid year (like in Canada, Estonia, or Hungary, for example).
There are plenty more effective programs that could help parents build resources to cope with difficult aspects of the transition to parenthood. With additional research, funding, and replication, they--along with universal PPD screenings--can be an integral part of a systemic approach to helping mothers thrive during this beautiful but challenging time.
Copyright Erin Leyba, LCSW, PhD
Erin Leyba, LCSW, PhD, author of Joy Fixes for Weary Parents (2017), is an individual and couples counselor in Chicago's western suburbs www.erinleyba.com. Follow her on Facebook or Twitter, read her personal blog, or sign up for email updates on tools to build personal and family joy.