Dear Provider: What Your Health Care Provider Should Always Ask

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I am always learning. I learn from the perinatal women that sit across from me each week in session. I learn from the women who open up, post and share their experiences of perinatal and postpartum depression and anxiety. I learn from my colleagues and other experts in the field. Recently, I was inspired by Jessica Porten’s negative experience with her OB/GYN, which quickly went viral on Facebook and Karen Kleinman’s call to all health care providers to find out how the providers in my community were engaging with their perinatal patients.  I wrote this letter to the providers in my area in the hopes that by better understanding Perinatal Mood and Anxiety Disorders, we can collaboratively treat and heal the women who are suffering from this illness. I have included part of the letter below:

Dear Provider,  

Maternal suicide is the leading cause of death during pregnancy and within the first year after birth. About 1 in 7 women screen positive for depression during pregnancy and within the first postpartum year. Treatment of maternal depression and stress has shown to be very effective in both decreasing symptoms and improving functioning among children and families. However, many women with perinatal depression or anxiety are under-diagnosed and go untreated.

One of the problems with identifying and treating perinatal women in distress is that symptoms are hard to detect as they often overlap with normal, expected perinatal changes, such as feelings of exhaustion, isolation, changes in appetite and fluctuations in hormones and temperament. Perinatal distress is often subjective and the woman tends to experience her symptoms of depression as “self”—there must be something terribly wrong with me—rather than as symptoms. This irrational belief that she is somehow inherently flawed or an inadequate mother or somehow not worthy of this baby, is part of what drives the pain and potential for suicidal thoughts.

While circumstances for perinatal depression or anxiety may vary, the cost of untreated perinatal depression or anxiety is always high. This is why every single physician and provider who comes in contact with a pregnant or postpartum woman should talk about postpartum depression and anxiety (and use those words), screen for mood and anxiety symptoms and provide perinatal women with reputable, reliable and accessible resources in your area. If you are not aware of the resources in your community, try searching here or here or here.

Here are some ways that you can help:

• Educate yourself and your staff about Perinatal Mood and Anxiety Disorders
• Know the right questions to ask her
• Ask about suicidal thoughts even if she doesn’t “look” suicidal
• Screen every perinatal patient who comes in
• Provide every perinatal women with reputable and reliable maternal mental health resources, even if she doesn’t need the information now, she might one day

I look forward to connecting with you and together, ensuring healthy mothers and healthy families.

Warmly,

Jamie Kreiter, LCSW

To conclude this share, I will say this: women continue to die each day. The ones that do come forward asking for help continue to get poor or mistreatment, often by uninformed, but well-meaning providers. It is not okay and we need to be doing more. There is a strong need for medical vigilance, monitoring and collaboration with outside professionals.  If you are a healthcare provider and you have not asked your perinatal patient if she is having thoughts of harming herself, then you have absolutely no idea if she is having suicidal thoughts or not. If you are a perinatal woman and your health care provider hasn’t asked you, talk to them. We need to educate ourselves. We need to make sure resources are available. For our patients, our sisters, our friends, our wives and ourselves, we need to increase the likelihood that she gets the help that she needs and deserves when she needs it.

If you or someone you know is suffering from symptoms of depression or anxiety, reach out to Jamie Kreiter, LCSW here.

References:

CMAJ 2017 Perinatal Suicide in Ontario, Candada: a 15year popoulation-based study Grigoriadis, Wilton, Kurdyak, Rhodes, VonderPorten, Levitt, Cheung, Vigod

Kleinman, K (2018). Helathcare providers and your perinatal population: Your patients are at risk. Postpartum Stress Center. Retrieved from http://postpartumstress.com/2018/02/23/healthcare-providers-and-your-perinatal-population-your-patients-are-at-risk/

Stone, C. (2018). New mom mentions depression, doctor calls the cops to escort her to ER. Scary Mommy. Retrieved from http://www.scarymommy.com/jessica-porten-facebook-postpartum-depression/