Here’s Why Your Doctor May Not Catch a Postpartum Mood Disorder–And How To Get Help

Maternal mental health is a big topic these days. And it’s no wonder since an estimated 1 in 7 women in the postpartum period experience things like depression, anxiety, and even psychosis. Just knowing these postpartum mood disorders are common and actually diagnosing and treating them are two different stories, though, according to the American College of Obstetricians and Gynecologists (ACOG). That’s because screening for postpartum depression and other mood disorders can be challenging.

One problem? ACOG reports that women may be reluctant to share their symptoms with a healthcare provider—even if they are screening for postpartum depression. Another issue is women may be likely to attribute their symptoms, such as problems sleeping, changes in appetite, or decreased libido as changes that are normal after having a baby.

Identifying all of those factors seems to rest in the hands of obstetric healthcare providers. After all, they care for pregnant moms during and after their pregnancy, so it’s easy to put the responsibility for detecting and treating these disorders solely with this specialty. But a maternal mental health expert says it’s important to take a pause and re-frame this line of thinking.

“There tends to be a narrative where the underlying emphasis of ‘why aren’t the obstetricians picking this up?’” says Catherine Monk, PhD, Diana Vagelos professor of women’s mental health in the department of psychiatry at Columbia University Vagelos College of Physicians and Surgeons. “It’s not really understanding the tremendous pressure on the obstetricians—they have not just one, but two patients.”

With that said, there are strides being made the help providers identify mood disorders in postpartum people, and get them the help they need. Here’s what we know.

“Just as someone who is trained in mental health doesn’t know how to deliver a baby, someone who is trained in obstetrics may not be able to recognize the disorders.”—Catherine Monk, PhD, Diana Vagelos professor of women’s mental health at Columbia University

What are the current standards for identifying post-partum mood disorders?

ACOG recommends that all obstetric care providers ask patients to complete a full assessment of mood and emotional well-being during a comprehensive postpartum visit. This screening helps to identify both postpartum depression and anxiety.

ACOG also recommends obstetricians provide close monitoring for patients with a history of depression, anxiety, suicidal thoughts, or a history of perinatal mood disorders. If a provider recognizes the patient is having anxious, depressive, or suicidal thoughts, they should be prepared to refer the patient to a mental health provider or start medical treatments.

It’s important to remember these are standards—obstetricians aren’t required to perform these screenings, but they do want to care for their patients and many do offer screenings. Though, Dr. Monk says it’s important to note that healthcare providers have specialties because significant training is required. “Just as someone who is trained in mental health doesn’t know how to deliver a baby, someone who is trained in obstetrics may not be able to recognize the disorders,” Dr. Monk says.

Another challenge, Dr. Monk says, is if a new mom answers screening questions that indicate she could be experiencing a postpartum mental health disorder, the obstetrician may not know where to refer the patient. So, sometimes when postpartum mood disorders are “missed” it’s really more about a lack of resources.

What kind of change is occurring to help with these issues?

The good news is there is a greater shift in attention to the issue of maternal mental health, says Dr. Monk. One new trend she says she’s seeing is mental health professionals working in obstetrics practices. This effort ideally provides a referral source and access to a mental health professional more quickly. She also points to the increasing availability of telehealth for mental health needs, which allows new moms to find mental health providers in areas they may not physically practice.

A few other promising changes in this space include:

•  In 2022, the Health Resources & Services Administration launched a National Maternal Mental Health Hotline, where you can call or text 1-833-943-5746 (1-833-9-HELP4MOMS) from the Health Resources & Services Administration. The hotline offers 24/7 access to professional counselors who can provide referrals to local mental health professionals and support groups.
• In June 2022, the U.S. House of Representatives passed a mental health package that included the TRIUMPH for New Moms Act that would create a national strategy to help address maternal health and provide more support for new moms.
• Perinatal Psychiatry Access Programs exist in states such as Florida, Wisconsin, and Washington that provide training and support to healthcare providers to help them better counsel and coordinate care for pregnant and postpartum people.

“What I really think is that we could and should be moving in the direction of support for people who are transitioning into parenthood,” Dr. Monk explains. “We identify people at risk earlier, and we are providing more support for knowledge about what is essential to you for maintaining your stability.”

How to find help for a postpartum mood disorder

When you’re a new mom, it can be understandably hard to want to seek help for a postpartum mental health disorder. However, if you recognize that certain feelings and emotions aren’t a normal part of the postpartum process, you can talk to your doctor about ways to get help. They may be able to refer you to a mental health professional or provide information on telehealth services and other resources (like the numbers listed above). No matter how you’re feeling, you’re not alone, and help is available.