Helping the Child by Helping the MomHelping the Child by Helping the Mom https://pediatricsnationwide.org/wp-content/themes/corpus/images/empty/thumbnail.jpg 150 150 Dave Ghose Dave Ghose https://secure.gravatar.com/avatar/f146b259ebc8ba9d52ea9ef823792abf?s=96&d=mm&r=g
- September 29, 2015
- Dave Ghose
Pediatricians can help babies by doing a better job screening new mothers for postpartum depression.
Up to 20 percent of new mothers experience postpartum depression, but studies show that nearly half go undiagnosed. If pediatricians were to play a greater role in identifying mothers experiencing symptoms, they could play an important role in helping these women find treatment and strengthen the critical mother-child bond.
The American Academy of Pediatrics recommended in a 2010 clinical report (reaffirmed in 2014) that pediatricians should screen all mothers for postpartum depression. As much as 80 percent of new mothers experience “baby blues” — mood swings, crying spells and anxiety that typically dissipate within two weeks. But the condition doesn’t go away so quickly for some mothers, and if untreated, postpartum depression — and its more serious sister condition, postpartum psychosis — can have serious consequences, for both the mother and the child.
A growing body of research highlights the critical role adverse early-life experiences such as trauma and abuse can have on lifelong health. “You can see failure to thrive in infants,” says Duane Copenheaver, DO, lead physician at Nationwide Children’s Hospital’s Hilltop Primary Care Center on the west side of Columbus. “They’re not getting adequate nutrition if the mother has postpartum depression. Developmental delays can occur if the mom has postpartum depression. We can see if there is not an appropriate social attachment between the mother and the infant and her other children even. Worst case scenario, you can see non-accidental injuries to an infant and other children in the home.”
A pediatrician is in a unique position to help a new mother, as she visits her child’s primary-care physicians’ office numerous times during the first six months of her baby’s life. “Most of the time in the postpartum period, these moms see the pediatrician more than they see their regular doctor,” Dr. Copenheaver says.
But screening hasn’t taken hold everywhere. In August 2009, one of Dr. Copenheaver’s residents, Dr. Amanda Berger-Weber, DO, now a neurophysiology fellow at Nationwide Children’s, examined how commonly mothers were screened at the Hilltop Primary Care Center. Her findings were troubling — only 3 percent of the time were mothers asked about postpartum depression.
In response to the findings, Dr. Copenheaver instituted a uniform way to screen mothers at the practice using the Edinburgh Postpartum Depression Scale, a 10-item questionnaire that takes about five minutes for mothers to answer. Within a couple of months of implementing the new procedure, the Hilltop practice was screening 84 percent of new mothers. “We can’t diagnose the mother with postpartum depression, because if we do, then we’ve established the physician-patient relationship with the mother, and she’s not our patient,” Dr. Copenheaver says. “But what we can do is counsel her, show her she’s at risk and try to get her in contact with her provider that day.”
Dr. Copenheaver’s screening method has now spread to all 12 of Nationwide Children’s primary care clinics. “Before we were using this tool, we probably were not identifying many, so many were slipping through the cracks,” he says. “But at this point, as long as the mothers are answering honestly, I think we’re catching most them who complete the form.”
Pediatricians need to remember that they’re not just taking care of the baby. “Sometimes we get very focused on taking care of the infant,” Dr. Copenheaver says. “But part of taking care of the infant is taking care of some of the other family members. As much as we can, we should take the time to ask the mom how she’s feeling.”
Earls MF, Committee on psychosocial aspects of child and family health American Academy of Pediatrics. Clinical report — incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010 Nov;126(5): 1032-1039.
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