Stigmas attached to postpartum depression make it difficult for many women to ask for help. During routine office visits, physicians can make critical inroads by starting conversations about maternal mental health.
During the early postpartum period, 70 to 80 percent of women experience sadness, fatigue, low moods or minor anxiety, according to the American Pregnancy Association. These mood changes, commonly known as the "baby blues," typically resolve without treatment. For the one woman in seven who develops postpartum depression, however, symptoms persist and may affect her ability to care for herself and her child, according to the American Psychological Association.
Depending on the severity of a woman's symptoms, she may need outpatient treatment, which may include a combination of therapy and medication, or more intensive inpatient care. From outpatient services to partial hospitalization and inpatient programs, Northwell Health offers the full continuum of care for new and expecting mothers' mental health needs.
Media stories about women who have harmed their children have negatively influenced public perception about postpartum depression, according to Tina Walch, MD, medical director of South Oaks Hospital. However, public perception isn't the only barrier.
Dr. Walch noted that there is a clear link between in utero exposure to maternal illness and longer-term neurodevelopmental issues. There is also evidence that children raised by mothers who suffer from untreated postpartum depression suffer deficits. Studies haven't consistently shown long-term neurodevelopmental issues caused by in utero exposure to medications. Studies also haven't consistently shown antidepressants to be major teratogens, although some studies show noncausal associations. Yet, physicians continue to shy away from prescribing such medications.
The risk of untreated illness in women with significant depression or anxiety typically outweighs the potential risks. Doctors may also feel uncomfortable initiating a conversation about mental health because they don't feel equipped to screen for and manage perinatal mood disorders.
A participant in the Greater New York Hospital Association's Maternal Depression Quality Collaborative, Northwell Health initiated the Ask the Question campaign to encourage medical professionals to inquire about women's mental health during and after pregnancy. During a routine office visit, incorporating one question about how the woman is feeling or coping with the changes of motherhood can increase the likelihood of detecting symptoms of anxiety or depression for women who may need further assessment.
Identifying the Appropriate Level of Care
To diagnose perinatal psychiatric disorders, psychiatrists may use one of several assessments, including the Patient Health Questionnaire-2, Patient Health Questionnaire-9 or the Edinburgh Postnatal Depression Scale. These rating scales help identify women experiencing:
- Anxiety and/or inability to cope;
- Feelings of being scared or overwhelmed;
- Frequent crying spells and overall unhappiness; and/or
- Suicidal thoughts.
Outpatient therapy, alone or in combination with medications, is typically succesfull in resolving symptoms. South Oaks and Zucker Hillside Hospital offer a range of outpatient services, including medication management, individual and group therapy, supportive therapy for fathers and partners, and parent/child coaching. In addition, the hospitals offer telepsychiatry services on a case-by-case basis for women throughout New York State who do not have psychiatry services offered in their area.
New Initiatives, Higher Levels of Care
This March, Zucker Hillside officially opened its new Perinatal Psychiatry Inpatient Program, located on the hospital's 20-bed Women's Unit.
"This welcoming environment features an interdisciplinary team of psychiatrists, nurse practitioners, nurses, social workers and rehabilitation therapists with expertise in both the psychosocial and medical issues specific to pregnant and postpartum mothers," said Marybeth McManus, RN, chief nursing officer and associate executive director of patient care services at Zucker Hillside. "Our nursing staff has completed rotations with labor and delivery nurses to learn how to care for the medical needs of women who have recently given birth. The team has also performed sensitivity training and received education on topics such as breast-feeding."
This May, South Oaks officially opened a partial hospitalization track of its Perinatal Psychiatry Program, which provides care five days a week between 9 a.m. and 4 p.m. Each day consists of five sessions, which may include interpersonal group therapy, art therapy, infant massage classes and mindfulness exercises. Individual counseling and family sessions also assist patients in their recovery.
"The partial hospitalization option lets women access a higher level of care while still maintaining an intimate connection with their families," said Gina Molinet, LCSW, administrative director of adult services at South Oaks. "We provide step-down services for women who have recently been discharged as inpatients, and we oversee the administration of psychotropic drugs, which helps optimize medication management."
The continuum of care for perinatal psychiatric disorders at South Oaks and Zucker Hillside begins during pregnancy. Before birth, psychiatrists perform risk assessments to determine if moms should begin treatment. If pharmacotherapy is warranted, physicians work closely with women to dose medications appropriately. The goal is to ensure women receive the full benefit from their medication while also minimizing fetal drug exposure.
Many physicians refrain from prescribing medications for perinatal psychiatric disorders during pregnancy. However, the risks of withholding treatment can exceed the risks of untreated maternal depression or anxiety.
"Data shows that babies born to mothers with untreated mental health disorders have poorer neurological outcomes," Dr. Walch said. "Women who are depressed during pregnancy are more likely to have a C-section or to use alcohol, drugs or cigarettes during pregnancy and are less likely to receive perinatal care."
An Around-the-Clock Resource
South Oaks and Zucker Hillside each provide a Warmline that women can call day or night for information or to schedule an appointment at either facility. If their needs are more urgent, women may walk in 24/7 for an evaluation at South Oaks. Physicians may also call the Warmline to refer a patient or learn more about perinatal psychiatric services.