Why Don’t Doctors Educate Pregnant Women About Postpartum Depression Before Birth?

We’re told what to eat and what not to eat, and advised often by well-meaning if intrusive family and friends on the best techniques with which to approach our newborn, like whether or not to use pacifiers, breastfeeding or formula feeding, and the best (or worst) products to use for our babies.

Somehow, though, the huge issue of postpartum depression – which affects nearly 20% of new moms – is noticeably absent from all of the rigorous preparation we go through to become parents. Even if new moms don’t suffer from postpartum depression, they still might develop overwhelming emotional and psychological responses to the birth of their child (like the baby blues, which can last from delivery up until a few weeks after birth) which may leave them feeling like they’re unequipped to both cope with their feelings and bond with their infants. 

Many new moms only learn about PPD by experiencing it firsthand, rather than receiving education and preparation techniques before birth, should they develop it afterward. Our society is militant in how we approach educating mothers-to-be, but why don’t doctors educate pregnant women about postpartum depression before birth?

Possible Symptoms

Postpartum depression can start out as the baby blues, which researchers say are general feelings of anxiety, mood swings, or feeling overwhelmed, but usually disappear a few weeks after delivery. If the baby blues progress and last far beyond that timeline, a diagnosis of postpartum depression is likely. Between 50 and 75% of moms may experience the baby blues, but 15% of them will have a longer-lasting and more intense experience – what we know as postpartum depression (PPD).

Postpartum depression affects nearly 20% of new moms.

Postpartum depression most often leaves new moms feeling overwhelmed, irritable, restless, or hopeless. It can manifest through withdrawing from friends and family, fearing that you’re not good at being a mom or caretaker to your newborn, insomnia, crying excessively, sentiments of inadequacy or low self-esteem, panic attacks, possible thoughts of suicide or suicidal ideation, and other hallmarks of depression, like decreased interest in activities or pastimes you used to enjoy. If left ignored or untreated, PPD can last for months on end and severely impact a mom’s relationship with her newborn and her loved ones.

Many new moms feel there’s a definite stigma around discussing PPD or even sharing their own experiences with it. After all, how can the happiest time of your life leave you feeling so broken down and hopeless? Hormonal changes in the body, compounded by factors like a previous history of depression, marital conflict, sleep deprivation, and possible genetic predisposition, are all facets that are believed to contribute to the development of PPD. While some factors may be biological, like having experienced anxiety or depression prior to pregnancy and delivery, PPD is most often attributed to environmental stressors, such as a mom’s financial stability and if her pregnancy was planned or unplanned. Additionally, the support from her spouse and family as well as co-workers or lack thereof can add to the likelihood of her developing depression after birth.

Treating PPD

Intervention in postpartum depression is key for delivering safe and effective treatment. A mom may not feel she can share her true feelings out of guilt or shame, but for herself and the good of her infant, she should absolutely find a trusted, knowledgeable confidante she can share these emotions with, whether it’s her own mom, close friend or relative, her doctor, or even a therapist.

We tend to view the development of postpartum depression as a roll of the dice – we’ll either get it or we won’t, and there’s no way to know for sure until after we have our baby. However, scientists in the field of maternal health are making interesting discoveries with regards to better treatment of PPD after delivery, and even possible prevention of it beforehand. We’re also fortunate now to know what indicators over others will more likely lead to developing PPD. If a mom has a previous history of depression, is single throughout her pregnancy, has an unplanned pregnancy, has other women in her family who have had PPD, is under the age of 20, is a current or past substance abuser, has been diagnosed with other conditions like bipolar disorder, lives in a metropolitan area or city, and has little to no social support, she is more likely to develop PPD.

Many new moms feel there’s a definite stigma around discussing PPD or sharing their experience with it.

PPD is most commonly treated by doctors through the prescription of antidepressants, selective serotonin reuptake inhibitors (SSRIs), or other psychotropic medications. However, researchers are also investigating how the use of biological agents can affect treatment. Estrogen and progesterone levels revert to their pre-pregnancy status just days after delivery, causing mom to experience a monumental fluctuation in their stability. Taking high doses of estrogen, as well as other supplements like omega 3 fatty acids, calcium, selenium, and thyroxine, have all seen successes in small-scale clinical studies, as have psychological interventions like interpersonal and cognitive-based therapy.

Researchers are also using gauging instruments to predict a mom’s likelihood of developing PPD after pregnancy, which usually include screening tools like the Predictive Index for Postpartum Depression (PIPD) and the Edinburgh Postnatal Depression Scale (EPDS), both of which are measures which look at a mom’s psychological, mental, emotional, and environmental factors and assign her a low, at risk, or high risk grade.

Can We Prevent Postpartum Depression?

Though we can’t prevent the development of PPD in an individual, we can make her better aware of the signs, symptoms, and her risk for developing it through education and increased awareness. One fundamental way we can implement this is by encouraging moms to talk about their past history with depression, as well as experiences with PPD they’ve had previously, and remove the stigma around moms receiving mental health assistance, in addition to being a stable and helpful support system for our loved ones who are new moms. 

Postpartum depression is too prevalent an issue to see it as something which can only be dealt with after birth.

We can also study and implement Practical Resources for Effective Postpartum Parenting, or PREPP, a maternal health program pioneered by Massachusetts General Hospital in partnership with Harvard Medical School. The PREPP program seeks to give at-risk women mood assessments during 34 to 38 weeks of pregnancy, in addition to coping tools which target the most efficient ways to respond to newborn crying and feeding, which ensure that mom gets plenty of sleep along with psychotherapy-based coaching sessions. Based on their assessment, moms received treatment sessions and check-ins from psychologists 18 to 36 hours after delivery, and two weeks after delivery. At six weeks and 16 weeks postpartum, their mood assessments were evaluated again. Moms who participated in the PREPP program reported fewer symptoms of depression and anxiety after birth than moms who only received basic information about PPD. 

While it’s crucial that we educate moms on PPD, as the PREPP program demonstrated, it’s also key that they receive valuable information on the most effective ways to care for their newborn while caring for themselves. Many new moms may feel overwhelmed by the newness and inexperience which confronts them after birth, and prioritizing mom’s mental health while preparing her for life with a newborn can better equip her to confront the symptoms of postpartum depression should they arise.

Closing Thoughts

Postpartum depression is too prevalent an issue to see it as something which can only be dealt with after birth. We build the basis for postpartum health during our pregnancies, meaning we should be educating ourselves and growing in awareness during the nine months we prepare for birth. 

We can’t always rely on our doctors to know what we need – that has to be communicated to them. If communicating our need for intervention and preparation ahead of potential postpartum depression is what’s needed, we’d do well to bring that to the attention of our providers well before it could affect us. Our future selves and our newborns will be glad we did.

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