Three reasons why pediatricians should be screening new parents for postpartum mental health disorders

I know, that title is a mouthful... but I had to get your attention, because the way we are helping new parents now is not working. And pediatricians are just ONE spoke in the wheel, but a very important one. Yet, the majority of pediatricians are resistant to screening new parents for mental health concerns. Why? The most often cited reason is that "Mom is not my patient- baby is". If you believe that, or if your pediatrician has not screened you at a well-baby check, please consider the following reasons why this belief can lead to serious consequences:

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!

The mixed feelings of fundraising

Having been part of the non-profit Pregnancy and Postpartum Support MN (ppsupportmn.org- check it out), for the past eight years, and co-running it for the past two, I have had plenty of experience with fundraising. I am here to tell you that fundraising really sucks. You get more nos than yesses, and making phone calls is just not fun for me to begin with. 

Except when it doesn't. 

Last night, we had a winter fundraiser at a restaurant. A gathering to mingle, drink, eat and hopefully raise a little money. I spent much time securing donations, and creating gift baskets to raffle off. I am not terribly creative. I was already exhausted before it began. I was stressed all day worrying about the baskets freezing in the back of the van, but not having enough hours in the day to come up with a different solution other than to leave them in the back of the van ALL DAY. In Minnesota. Where it is cold. 

And yet... 

I pulled into the restaurant parking lot, excited at the prospect of spending a fun evening with a group of women that I adore, who have come to be family. The Steering Committee of PPSM. I get a text from the other co-director telling me she's on her way. I see the beautiful room we are going to be spending the next few hours in, complete with a fireplace, and a white board where we can write inspirational messages. We bring in the baskets and arrange them, and exclaim over the wonderful donations that we received. 

People start to arrive, and we have a wonderful night. Meeting new people, seeing familiar faces. And hearing stories... 
The mom who needed to be admitted inpatient postpartum, because she really thought it would be better to die than to deal with a new baby. 
The woman who I networked with two years ago, when she was making a decision about going to grad school. Guess what?  She has now completed grad school, and is lining up her internship in maternal mental health. 
The man who is a dad of six children, that tells us how wonderful it is that we are helping moms, but also recognizing that dads are important too. 
The people who want to know how they can get involved, and help give back and help further our mission. 

I left exhausted but exhilarated. Emotional. Excited. Glad to be done, but looking forward to the next event. Ugh. 

And then I went home and looked at how much we raised.... after expenses, $1000. I felt like Oskar Schindler. The exhange towards the end of the movie where he is lamenting, "I could have got more out. I could have got more. I don't know. If I'd just... I could have got more." I felt like I should have been able to accomplish more, raise more money, get more people. What did I do wrong? 
And then I had to step back and realize that to many people, $1000 is a LOT of money. And the people we had there... it wasn't the number that mattered, but the hearts in the room. 

So, dear reader... I have decided to follow my own advice, to treat myself today with "loving kindness" and instead take a different quote from the movie: "It's Hebrew, it's from the Talmud. It says, "Whoever saves one life, saves the world entire.""
The purpose of my writing this is NOT to get attention, and have people pat me on the back. It is to give yourself credit for the difference that you can make by small changes. Don't focus on the dollar amount, or the amount of time, but rather the impact. You can make a difference. 

If you would like to know more about PPSM, or make a tax-deductible donation, visit our website, http://www.ppsupportmn.org/. Thank you!

Best Books of 2015....

Happy New Year from The Shrink Rap and Stages Counseling (www.stagescounselingmn.com). Here is my annual post about self-help and memoirs that I have read, and found helpful, this past year. Please note that this is only MY opinion.

 For those in a relationship that needs a little tweaking... 
 
Snap Strategies for Couples: 40 Fast Fixes for Everyday Relationship Pitfalls Staheli, Lana
This book is easy to read, not boring or too research-laden and has great tips to try for all couples. I loved how it was not too long, and if a particular "fast fix" was not a problem area for you, you can just skip over that section, and move on to the next one.



For biography lovers... (Or for those who loved SNL in the 90s)

The Chris Farley Show: A Biography in Three Acts   Tom Farley, Jr.
Not a self-help book, per se, but a biography written by Chris Farley's brother about his rise and fall, due to anxiety, low self-esteem and addiction. He interviewed those close to Chris, so it is his own info, then commentary mixed in from others who knew Chris. A great biography.

For those who have had a connection with birth trauma...

Heal Your Birth Story: Releasing the Unexpected   Maureen Campion
This is combination memoir, combination self-help for those who have lived through a traumatic birth, and their partners. It would also be helpful for those, like myself, who are helpers of those who have experienced a traumatic birth. It has great tips and exercises at the end of each chapter. Not a book to sit and read, but rather to digest and use to heal.


For those with a narcissist in their life... 

Disarming the Narcissist: Surviving and Thriving with the Self-Absorbed    Wendy T. Behari
Whether you live with one, work with one, or were raised by one, narcissism is everywhere in many forms. This personality type can leave people feeling quite helpless and hurting. This book is one of the better ones I have read on this subject, and felt very helpful.

For those who wonder if there is any good left in the world... 

Ask Me Why I Hurt: The Kids Nobody Wants and the Doctor Who Heals Them  Randy Christensen
Dr. Christensen in a doctor in Arizona who creates a mobile medical unit to help the homeless youth living on the streets. A great story of hope and a reminder that there are people in the world that really want to make the world a better place.

For those who want something different in their parenting style...

The Conscious Parent: Transforming Ourselves, Empowering Our Children  Shefali Tsabary
Mindfulness is a big buzz word. But do you use it in your parenting? When you feel like you have exhausted your last nerve, this book has some wonderful ways to help you feel empowered as a parent while also empowering your children.

For those who question their value...

Look up for Yes Julia Tavalaro
Another memoir written by a woman in her early 30's who ended up paralyzed and unable to speak. Those around her figured she was a "vegetable", but boy, she proved them wrong. A look at how we all have value and worth!

For parents of tween or teen girls...

The New Puberty: How to Navigate Early Development in Today's Girls  Louise Greenspan
I mostly read this because I have a 10 year old daughter!! But there was great information in it that contradicted a lot of what is out there. Girls are developing earlier, but it's not just about the hormones we are putting in our food. Evidence-based information and great tips for parents while navigating this stage of life.

For those who need to SLOOOOOOW DOOOOOWN...

Margin: Restoring Emotional, Physical, Financial, and Time Reserves to Overloaded Lives  Richard A. Swenson
We are all SO busy, busy, busy these days. How do we even try to have balance? Read this book- you will be glad you made the time. 

For postpartum parents who need to know they are not alone...

Inconsolable: How I Threw My Mental Health Out With the Diapers  Marritt Ingman
A memoir about Ingman's experience with motherhood and a postpartum mood disorder. With perinatal mental health being the bread and butter of my therapy practice, it is so important to have real, raw information to recommend. This was a good one. 

If you have read any books that you found helpful this past year, please send me an email at stagescounseling@gmail.com. I will do my best to read it! Thank you, and happy reading!