When asked what I wanted to be when I grew up, the answer changed from ballerina to teacher to everything in between. One thing remained constant: I wanted to be a mother. I have narrowed my career aspirations to becoming a physician, but my desire to be a mom has been unwavering. In a climate where maternal mental health is so misunderstood, I constantly wonder what support I will have in balancing caring for a baby with the growing demands of a career in medicine.
The postpartum period is an incredibly stressful time for any new parent, juggling sleep deprivation, overwhelming responsibility, and changing routines, while meeting the physical and emotional demands of being a 24/7 caregiver. Yet, society continues to romanticize this time as one of incomparable joy and instant bonding. Women who need help may hesitate to ask for it out of shame or fear of being labeled a “bad mom.” These feelings, though isolating, are unfortunately not uncommon. According to the CDC, one in eight women experience symptoms of postpartum depression (PPD).
Symptoms and disparities in care
Mothers with PPD can experience many different symptoms such as loss of interest in activities, restlessness, and trouble bonding with their baby. They are at an increased risk for substance use and suicidal behaviors. Though anyone can experience PPD, women from minority populations and those from lower socioeconomic backgrounds are less likely to have treatment initiated or continued, serving as a reminder that social drivers of health must be considered. Furthermore, children of mothers with PPD are more likely to experience cognitive delays, stunted growth, and behavioral problems. This condition affects not only the mother but the whole family unit, emphasizing the need for thorough screening.
The pediatrician’s role in screening
The Bright Futures periodicity schedule, published by the American Academy of Pediatrics (AAP), suggests the average child will have seven routine clinical visits by the time they turn one. Meanwhile, most postpartum mothers, barring complications, will only follow up with their OB-GYN twice within the first 12 weeks. Therefore, the pediatrician is best positioned to assess the mother throughout the postpartum period.
The AAP and the U.S. Preventive Services Task Force (USPSTF) both recommend PPD screening at the 1- through 6-month visits. Likewise, the American College of Obstetricians and Gynecologists (ACOG) recommends screening at least once throughout the postpartum period.
The most common screening tool used is the Edinburgh Postnatal Depression Scale, a 10-item questionnaire to evaluate depressive symptoms, with a free online example available. Although useful, this tool may miss mothers who develop symptoms later in their postpartum journeys if it is not routinely administered. Symptoms can develop anywhere from a couple of weeks up until a year after birth, so clinics should continue to implement universal screening for mothers beyond six months. Given that the rate of PPD is on the rise, I urge the AAP to revisit and consider expanding its guidelines to encompass screenings for the entire year of well-child visits.
Bridging the gap in detection
Unfortunately, even with screening tools, it is estimated that up to 50 percent of cases of PPD go undetected due to stigma surrounding this diagnosis and, consequently, the underreporting of symptoms. Providers have a unique opportunity to combat this obstacle by learning to better understand a patient’s nonverbal cues, creating a safe space for patients to feel comfortable discussing sensitive topics, and ultimately, building trusting relationships with patients. Providers should remain open to hearing the postpartum experience of each individual patient. Used in combination, increased provider attentiveness and the implementation of universal screening for all postpartum mothers can help expand early identification of PPD signs in new mothers.
At the institutional level, health care organizations can establish policies ensuring universal screening for maternal depression at each well-child visit for the entire first year of life. This can be achieved through standardization within the electronic health record (EHR). The EHR can be programmed to alert physicians to implement PPD screening whenever a mother accompanies a child for a well-child visit within the first year postpartum. These reminders can populate as a “care gap” or “best practice advisory.” While already a practice in some clinics, larger organizations can broaden the impact by implementing these uniform EHR procedures across their entities.
In the time it took to read this, roughly 20 babies will have been born in the United States. With that comes 20 new opportunities to identify the signs early, initiate screening measures, and provide evidence-based support for women. To the one in eight, to those suffering in silence, to those unsure how to ask for help: We see you. By recognizing the need for advocacy and broader universal screenings, we are one step closer to ensuring every mother receives the postpartum care she deserves. Looking at my own future, both as a physician and hopefully as a mother, I will continue to advocate for policy changes that ensure women’s struggles are heard, not overlooked.
Mikenna Reiser is a medical student.
