Changing laws, guidelines increase screening for postpartum depression

Postpartum depression that may follow a baby may surprise many families and become worrying not only for the mother who is suffering from it, but also for the baby whose mother may have excessive concerns about the safety of that baby or to feel your baby

This maternal connection is important in the first years of life because babies learn that if I smile at you, you smile back. If I cry because I'm hungry, you feed me.

"When a baby is parented to a depressed or anxious mother, there is evidence that a long-term exposure can lead to learning disabilities, cognitive delays, or motor delays." says Elaine Cavazos, a licensed social worker specializing in postpartum depression. She is also an Assistant Professor at the University of Texas and clinical director of the Alliance for Pregnancy and Postpartum Health of Texas.

Postpartum depression rates range from 10% to 20% compared to 1 in 7 women after childbirth. It depends on the study you are quoting.

One of the issues among medical care providers has been who can screen and when should it be done.

In May, the American College of Obstetrics and Gynecologists recommended that physicians offer more postpartum care for women by adding follow-up in the first three weeks of delivery in addition to 39, a full visit within 12 weeks after delivery. Part of this recommendation is a response to the recognition that symptoms of postpartum depression often occur before the traditional six-week checkup.

Mothers see their child's pediatrician more regularly in the first year than their own doctors. Usually within a few days of birth, then to a month, two months, four months, six months, nine months and a year.

"Access to moms is one of the most important things because we have fairly frequent access to babies," explains pediatrician Louis Appel.

Acknowledging that, the Texas Legislature 2017 pbaded Bill 2466 that allows pediatricians to implement Medicaid programs and infant health plans for the screening of mothers during the first year of their lives even if the mother not covered by these programs, but the child is. Medicaid covers low-income mothers during pregnancy up to 60 days after delivery, at which time they might not have the badurance of being screened for post-depression. -partum. Now, they can still be examined after 60 days through the pediatrician and the child's insurance.

Once selected, pediatricians can refer mothers to mental health services.

Call, said about seven years ago, pediatricians where he works at the People's Community Clinic started doing the screenings because they were looking for what they could do to help early development of the brain.

"The thing we landed on was screening for postpartum depression," he says. "This early link is so important for early brain development in children."

The Community People's Clinic conducts screening by asking the nurse or physician to ask two questions: The Patient Health Questionnaire 2:

1. During the past month, have you often been disturbed by feeling depressed, depressed or hopeless?

2. In the past month, have you often been bothered by the little interest or pleasure in doing things?

If they answer yes to one or the other of these things or if there is a noticeable lack of interaction between mom or baby or an anxiety around this interaction, the patient will receive a longer form of 10 questions to complete.

Doctors and nurses then refer patients to the clinic's social workers, sometimes in person that day or by phone later. If Appel did not have these internal resources, he said he would direct the mother to her primary care physician or to other community health resources or the national crisis line for postpartum depression. Pregnancy and Postpartum Health Alliance Texas also keeps a list of providers and what insurance companies they take.

It's not just moms who can have postpartum depression. This can also happen to dad, and the Centers for Disease Control and Prevention estimate that about 4% of new fathers also experience it. Cavazos says that in her practice she sees fathers as well as adoptive parents.

Depression for moms could begin during pregnancy. "The most severe cases we could have possibly seen while she was pregnant," says Cavazos.

This week, the American Academy of Pediatrics recommended parents to have a prenatal visit with pediatricians. This can help pediatricians to anticipate postpartum depression by looking for any perinatal depression and to provide guidelines for the first few weeks of infant care. It also helps to establish a partnership between the doctor and the family, and allows the doctor to have an idea of ​​the complications of pregnancy, family medical history and any exposure the baby might have had to the drug or to the family. alcohol during childbirth.

Cavazos says that the characteristic of postpartum depression is an intrusive thought that something terrible is going to happen to the baby or that they're going to do something terrible for the baby or something terrible for them and the baby. The mother becomes very vigilant about the baby's care and does not let anyone take care of the baby, or she is unable to take care of the baby because she is afraid to do something wrong.

Cavazos says that it's as if she thought, "What's the worst thing that can happen to her?" And she plays it again and again in her head, but it's not a child protection case, because it's fear and anxiety, not something on which she will actually act , says Cavazos.

Her family will notice that she does not look like him.

Postpartum psychosis, however, can happen, but it is very rare. It's when she does not feel scared or anxious. She almost feels like a deity or something outside of her makes her do things, says Cavazos, and it's a psychiatric emergency. The mother must be separated from the baby and get help immediately.

With postpartum depression, Cavazos will ask the mother if she sleeps, and it will laugh. She worries if women sleep less than five hours a day. She also wants to know if they have access to nutritious food and eat. She might want their vitamin D and thyroid levels checked to rule out other possibilities.

Sometimes antidepressants will be needed. Even for badfeeding mothers, "the general consensus is that if the mother is depressed, the benefits far outweigh the risks of the drug," Appel says.

Other times, the treatment consists of taking care of yourself and talking.

Cavazos will work on the mothers' feelings about the baby, what makes them feel overwhelmed by the baby's care, the resources they have to get help and normalize what they feel.

Mothers often do not stay in therapy for long, usually four or five visits to eight visits because of the amount of bandwidth they have. After all, they have a new baby, but sometimes they make therapy a part of their self-care plan. Sometimes Cavazos will recommend a support group or some kind of parent group to help the mom not feel so alone. And it will help rebadure mothers that they have good parenting skills and find ways to strengthen those skills.

Call encourages the partner or support system of a mother to help as much as possible and to "give new mothers permission to … take any help that people can give," he says. That "sleep when baby sleeps" is important. "You should not do the laundry or clean the house," he says.