Postpartum Depression Affects 1 In 5 Women, But Many Don't Get The Care They Need
LAUREN GILGER: In OBGYN offices around the country, you’re likely to see a poster that says "postpartum depression is the most common complication of childbirth." Up to one in five women will experience it after giving birth to a child, yet, for many women, recognizing their symptoms and getting help is all too difficult.
Now, new research from Northwestern University narrows down the risk factors to help doctors and mental health professionals plan treatment for mothers — and predict how severe someone’s postpartum depression may be.
According to the Washington Post, the factors range from education and the number of children a woman has to her ability to function at work and home, and how severe her depression is at 4 to 8 weeks postpartum.
The American College of Obstetricians and Gynecologists — or ACOG — has said that screening for depression during pregnancy and for the year afterward is important for all mothers, but research also shows that less than half of women say they received enough information about postpartum depression and other issues at their postpartum visits.
According to our next guest, screening is just one barrier women face in getting a diagnosis and getting care and a lot of it she says has to do with stigma. Kim Kriesel is a perinatal mental health therapist in Gilbert who specializes in working with women experiencing postpartum depression. I sat down with her recently in her home office and she says when it comes to screening, she sees a lot of women falling through the cracks.
KIM KRIESEL: Well I think that you know they're finding it on social media a little bit more. Their friends might be talking about it a little bit more. But from my experience, they're not hearing more about it from their physicians and in their doctor's offices.
GILGER: ACOG has said right that there should be screening, that OBGYNs should be screening before someone has a baby and afterward. Where is the ball being dropped? I guess like is the message not getting across or are the screenings not widespread enough?
KRIESEL: I don't know that the screening has been consistent, and, in my experience as a mother, I did receive a screening as I was leaving the hospital but it was with a stack of paperwork that I had to sign before I got out of the hospital. And then I did not get screened at my pediatrician's office. I did not get screened with my OB who I felt was very competent and wonderful, you know, physician practice, but I was not screened. I'm not sure where the disconnect is if it's the offices aren't just following through or they don't know where to refer women if it is positive. Oftentimes a lot of the really good professionals in our city don't take insurance. And so it's a huge out-of-pocket cost for women.
GILGER: Counselors often don't take insurance, right. What are ... the barriers there? Why is that the case and how do I know you will kind of work around that in some of your work, right?
KRIESEL: Yes, so I'm in my private practice, I do not take insurance because it pays so little that for me to hire an insurance biller to take care of those responsibilities, it's better for me to just charge a lower rate to people so that's what I do I charge a lower rate. And then I also work in a birthing center. So I have the opportunity to see women who can use their insurance there. So if somebody calls me and says they want to see me but they don't have the funds and they have insurance, I can say, well why don't you make an appointment and see me at Willow birth center and then they can use their insurance at that location.
GILGER: Costs can definitely be a barrier for a lot of women there. And there are other barriers I understand, including just this fear, I think, that many women might have about saying that they are having thoughts about maybe harming their child or something like that. That I'm sure still has quite a stigma around her, right.
KRIESEL: Yes, it sure does. Women tell me all of the time that they were afraid to tell anybody they might be having a thought of harm coming to their baby whether they're imagining the harm being done by themselves or it happening in a natural way, such as like a SIDS, or just the preoccupation with these scary thoughts that they're having. You know it oftentimes make them feel crazy or not like themselves. And so they're afraid to let their physicians know this because they might say, you know, oh well I don't know that you're capable of taking care of your baby and which is their worst fear their children being taken away. And so even if they are capable, a lot of times their thoughts are a little bit distorted because of the depression and anxiety, and they feel like they are not a good mom, even though they are are doing a wonderful job.
GILGER: Does that happen? Do women, you know, say to an OB or to a pediatrician, you know, I'm having some scary thoughts, and then you know CPS shows up the door?
KRIESEL: It has definitely happened. I have heard many cases where a woman will share that she's either, you know, having thoughts of suicide or self-harm or maybe feeling like, you know, things would just be easier if she just went to sleep and didn't wake up, or, you know, doesn't feel like she's a good mom and maybe you know her family would be better off without her. In those cases, I have seen where people who aren't educated in perinatal mood and anxiety disorders and will call crisis because they're not equipped to deal with the situation. And oftentimes women are further traumatized by this.
GILGER: So if they were referred to somebody like you who's trained in this way, what is the appropriate response? Like what are the ways in which you can really help somebody who's in that kind of situation?
KRIESEL: So I feel like a huge key for four women getting relief from this is is knowing the facts. What we call psycho education, just educating them on what postpartum is that they are going to get better. Give them that hope; reassure them that they are not going crazy. And often you know medication is helpful in cases where they're still not feeling better after a couple weeks of talking to somebody or joining a support group. And they might need a little extra help from some medication for a period of time, usually the period of time until they're getting regular sleep, they're not feeling depleted, their body has recovered from birth and/or a C-section, you know, their their bodies getting back to normal. And at that point, you know, that could take up to a year for a woman's body to get back to normal. And so oftentimes that is the period of time that they might need to be on medication.
GILGER: We talked a little bit about risk factors that lead to this, but I want to talk a little bit about causes. Like are there any known causes for this? Like are there any, is this, you know, you hear about the baby blues, right? Like a couple of weeks after you have the baby, your hormone levels will change, and you might feel this way. Is that a cause of this or is this just something that is about, you know, being a new mom being really, really difficult.
KRIESEL: I kind of consider at the perfect storm. So it's the depletion of, you know, you've been growing a human for about a year and then you're not getting sleep usually in that last two to three weeks of your pregnancy. And oftentimes, you know, women are up for 48 to 72 hours if they have a natural birth. And their body is still recovering after that. And if, let's say they have a C-section, you know they're in the hospital recovering from a major surgery and then somebody hands them a baby and says, "Go take care of this baby." Meanwhile, the mother should actually be being cared for she's just had a major surgery and oftentimes that isn't the case. Instead we give her another fragile human to take care of. So I see those as causes. We do have the hormonal shifts. The way I often explain it to moms is, you know, many years ago a lot of our families live close together. Now we're sort of spread out. You know, we may have just moved to a state. We don't have the kind of support that that we need, where we can call our mom and say, come over. Or our auntie, cousin and say, I need help come make me food, come let me get a shower, come hold my hand. We don't really have that anymore. At times it's couples you know we're in kind of a newer state in Arizona, where you know couples may be here just the two of them, and family may come out but maybe they're not coming out till the four-week mark or the six-week mark, or maybe they came out for the birth and then they're gone. So I see that happening a lot as well.
GILGER: So you've worked with a lot of women through this I'm sure you've seen many of them come out of it but what would you like to see change in terms of catching this sooner and and changing the conversation around this?
KRIESEL: So it's very interesting. I kind of had an eye-opening experience. I was invited to a new-mom event. So there was lots of vendors there, and they were selling things. But somebody got my name and asked me if I would speak there and it was actually the first opportunity I had to speak to women who were still pregnant. And I felt like that was the ideal time to talk about this, because now I had a group of 80 women and they're going to know, you know, if they start having symptoms, they're going to know exactly what's going on. They're going to have already have resources to get in touch with somebody. And that was something I never had that opportunity. Often I meet women in support groups, and they call me in after they've been struggling for a couple months. But I feel like if there's some way to get this information to them ahead of time or while they're pregnant, I think that is ideal. I don't remember hearing much about postpartum symptoms when I was in my pregnancy. I don't remember any brochures or anything up in the doctor's offices, you know, of course screening at pediatrician visits because you see them right after the birth or during your pregnancy visits during the prenatal period. I think that would be great, great opportunity.
GILGER: Do you see any momentum in that direction? Do you see that that happening in any way?
KRIESEL: In my own personal experience. I have not seen that. I have called doctors offices to get in there and tried to train their staff. And the responses has not been great, but these are busy professionals. You know there have a very important job of delivering healthy babies and keeping the moms safe during the pregnancy. And so I'm not sure that this is the highest priority on their list, but I do believe it is a priority. And it's a valid concern.
GILGER: Kim Kriesel, thank you so much.
KRIESEL: You're welcome.
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