Pediatricians: They’re Not Just For Kids Anymore

One in seven women experience postpartum depression. The percentage of women who struggle with anxiety and depression during pregnancy is even higher. Perinatal mood and anxiety disorders don’t discriminate—women of all cultures, ages, income levels, races, and educational backgrounds are impacted.

All told, approximately one million women each year are affected by a mental health complication related to pregnancy.

Prevention, early identification, and effective treatment options should be a public health priority. Given the fact that perinatal mood disorders are common, fully treatable, and heavily stigmatized, families globally would undoubtedly benefit from a more proactive mental health stance.

Pediatricians are in a perfect position to spot potential mental health challenges. Given the inherent intimacy in this relationship throughout the child’s life, there are many opportunities for informative bidirectional conversations about mental health issues related to pregnancy, postpartum mood disorder risk factors, research, and resources. In an ideal world, women receive this kind of information from their obstetricians/midwives throughout pregnancy. However, in a more realistic view of the pace of healthcare these days, if new mothers and their families do not receive this kind of care during pregnancy, there are additional medical professionals who come into contact with infants from the moment they are born and have the opportunity to screen for postpartum mood disorders — namely the pediatrician.

Burgeoning families ideally arm themselves with a community of healthcare practitioners with whom they feel aligned. Some women opt to surround themselves with a throng of prenatal wellness providers in an effort to bolster inner calm, connectivity, and support whereas others may desire a more private experience throughout pregnancy. These wellness practitioners may include: acupuncturists, psychologists, doulas, massage therapists, reproductive endocrinologists, midwives, obstetricians, and pediatricians. All of these practitioners have the opportunity to positively impact the mother and her feelings about pregnancy and the postpartum period in their own unique way.

The pediatrician may encounter mothers and their baby’s during the post-pregnancy transition more frequently than any other healthcare provider.

Typically pediatricians will see the baby and mother (or other caregivers) for at least six appointments—at two to four weeks, followed by visits at two, four, six, nine, and twelve months. In addition to expectable appointments, mothers of firstborn babies tend to make contact by phone multiple times during the first year. The mother-baby-pediatrician relationship that develops within the infant’s first year of life provides myriad chances for identifying postpartum mood disorders, which invariably impact attachment, bonding, and relational attunement.

Here are eight ways pediatricians can make strides toward better serving pregnant women and their families:

1. A Family-Oriented Approach. The American Academy of Pediatrics Task Force on the Family (2003) underscores the importance of “family-oriented” pediatric care with the aim of improving family outcomes. The “health and well-being of children is inextricably linked to their parents’ physical, emotional, and social health.” Emotional development is greatly impacted by the quality of mother-infant attachment and bonding. When a new mother suffers with an untreated postpartum mood disorder, it is likely that her children will suffer in a multitude of ways. Pediatricians must consider both the child and the mother as patients.
2. Prenatal Information. If the pediatric practice distributes information about postpartum mood disorders at the prenatal visit, expectant mothers and their families will have the opportunity to discuss any perinatal anxiety, family history of mood disorders, or ambivalences regarding parenthood. Prenatal discussions about postpartum struggles may also help encourage the patient to feel safe revealing herself if she does in fact find she is suffering in uncharted territory.
3. Assessment of the Birth Experience. After delivery, pediatricians typically have contact with mothers and their newborn within the first 1–3 days postpartum. This is an important time for doctors to assess how the labor and delivery process went and if any significant trauma was incurred. Trauma may be felt when there is a highly difficult labor and delivery experience, the new mother was not able to have the birth she envisioned, medical complications occurred, and/or there were unexpected medical issues and concerns related to the newborn. In addition, women with a history of sexual abuse or other physical or relational traumas may find that the birth process reignited memories that are re-traumatizing. Though it is quite common for new mothers to experience postpartum blues within the first two weeks due to hormonal shifts, sheer exhaustion, and monumental changes in identity, birth trauma is a noteworthy risk factor in the development of postpartum mood disorders. Pediatricians can discuss referral sources and assure the patient that resources are available for processing traumatic and non-traumatic births.
4. Checking Up… On Moms Too. The most critical time for the pediatric staff to identify a postpartum mood disorder is during one of the first three postpartum visits—two weeks, two months, and four months. Symptoms usually peak at about three months. Postpartum mood disorders tend to worsen during this time. The four month pediatric visit is an important milestone appointment in identifying postpartum mood disorders because unless the baby has severe medical, sleep, or feeding issues, new mothers tend to feel less tired, more confident, and less anxious. But, it is important to keep in mind that postpartum depression can show up anytime within the first twelve months after giving birth. The pediatrician may need to rely on clinical judgment when differentiating between expected challenges in new motherhood versus ongoing, worsening, or potentially worrisome difficulties that may be symptoms of a postpartum mood or anxiety disorder. Asking the new mother how she is feeling and sensitively attuning to her affective response as well as her interactions with her child may provide important insight into her current emotional world and overall functioning. Research has found that new mothers might be reluctant to speak openly with pediatricians about their feeling states for fear of being judged. The fear of being perceived as a “bad” mother hangs in the balance.
5. Universal Screening. Research has shown the value of universal maternal screening. One study revealed that without the use of screening tools, 50% of women with clinically significant symptoms of depression went undetected by clinicians (Chaudron, 2003). During the first year, identification of at-risk mothers improved from 1.6% to 8.5% (Chaudron et al, 2004) and from 29% to 40% in another study (Heneghan, Silver, & Stein, 2000). Screening tools must be simple and accessible. Optimally, screenings are used in combination with clinical evaluation through the process of getting to know the mother, her newborn, and witnessing their interactions over time.
6. Know More to Support More. Lack of confidence in educational breadth and depth about postpartum mood disorders as well as a shortage of time during well-baby appointments are two contributing roadblocks within the pediatrician-patient dyad. These obstacles may inhibit identification, diagnosis, and timely treatment of postpartum mental health complications. Taking strides to overcome these potential barriers should be a priority given the glaring postpartum mood disorder statistics and their impact on developing children. Fortifying the health of the mother-infant relationship is a central theme in family-oriented care. As such, pediatricians should feel conversant in postpartum mood disorder risk factors, signs, symptoms, treatment options, and medication regimens that can safely be used in concert with breastfeeding.
7. Holistic Help. Creating office-wide postpartum mood disorder screening protocols in pediatric practices would streamline identification. Referring identified patients to mental health professionals who specialize in perinatal and postpartum issues for diagnosis and treatment can benefit both mother and baby.
8. Follow-Up. Studies have found that many women who have been identified with postpartum mood disorders through the use of screening tools are not necessarily referred to mental health professionals. Following up with a mother who is struggling in her newfound role as a parent is paramount. All too often, friends and family members encourage new mothers to “think positively” or normalize feelings that are actually not part of the expectable course of new motherhood. Minimizing profound struggles only furthers the silence and sequesters the suffering.

A version of this article was originally published on PBS This Emotional Life.

Jessica Zucker, Ph.D. is a Los Angeles based psychologist specializing in women’s reproductive and maternal mental health. Her writing has appeared in The New York Times, The Washington Post, BuzzFeed, and elsewhere. She is the creator of the viral #IHadAMiscarriage hashtag campaign that she kicked off with her first New York Times piece in 2014 and launched a line of pregnancy loss cards in October 2015 in honor of Pregnancy/Baby Loss Awareness Month: shop.drjessicazucker.com. Find her online: www.drjessicazucker.com and follow her on Twitter: @DrZucker.

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