1. Because time is of the essence. Statistically, postpartum psychosis (PPP) onsets within the first month postpartum. Most babies are brought to their well-baby check within 1-2 two weeks postpartum. When does mom go for her checkup, IF she goes? Six weeks- and often later. Even without the severity of PPP, depression and anxiety can begin immediately after the baby is born, and sometimes is occurring during pregnancy. Early intervention is key.
2. Because it is risky to NOT screen. Numerous studies point to the long-term effects on children raised by parents with untreated mental health issues. Developmental, emotional, behavioral. Having a parent who is depressed, and not taking good care of herself, is also at risk of not taking good care of her baby. She may have breastfeeding issues, may not address health problems in a timely fashion, and in tragic situations, is at risk of neglect, abuse or infanticide.
Hypothetically, if a parent arrived at your office who had clearly been using drugs or alcohol, it seems a no-brainer (especially as a mandated reporter) that you would not send a newborn baby home with that parent. That parent is impaired, and at risk of harming herself or others. Would you still believe that mom is not your patient? Depression, anxiety, and psychosis can also cause significant impairment that puts everyone at risk.
3. Because the American Academy of Pediatrics (AAP) has been recommending screening for several years. Yes- several years. Here is an abstract from a research article back in 2010 (!) that recommends screening new parents for mental health disorders because, "This system would have a positive effect on the health and well-being of the infant and family." Another, from 2009, cites that not only should screening occur during the first well-child visit, but found screening beneficial at the 2 month and 6 month postpartum visit as well.
What is the solution? If you are not screening in your office, or if you are a new parent reading this and your pediatric office is not screening, please consider the following:
-If you do not have a copy of the Edinburgh Postnatal Depression Scale in your office, please consider doing so. It is free to download and print. (There is one here- and it's on the AAP website... I'm just gonna leave that here).
-Determine your community resources. Many peds and OBs state that they are reluctant to screen due to the ethical dilemma of not having resources to offer to potentially depressed patients. But help is available. Postpartum Support International has a network in nearly every state with resources and a free HelpLine to get information. They also have great info on their website that can be printed and given to patients.
-Don't forget about DAD! Men get PPD too- and more often than not, if there is a partner involved, he comes to the first well-baby visit. This is a great way to not only get his perspective on how he thinks mom is doing, but also to see how he is doing. Having two parents struggling with mental health issues can be a poor environment to send a newborn home to.
In order to more effectively help families, we need to work as a team. Again, pediatricians are only one cog in the wheel, but, again, a very important one, and often the first one to get a look at how the family is doing. We all agree that we have a precious package to protect!
