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Depression Screening Urged for Pregnant Women

By Leha Byrd/University Public Relations

They are considered bundles of joy.

Still, from novices with newborns to veteran pros of motherhood, all pregnant women are susceptible to the not-so-joyous issues associated with postpartum depression, such as anxiety and sadness, which are unhealthy for both baby and mother.

The United States Preventative Services Task Force’s recent recommendation that pregnant women and new moms be screened for depression is necessary and critical, Virginia Commonwealth University Health experts said, even for women who have never experienced depression.

The task force panel, a group of experts appointed by the Department of Health and Human Services, suggests clinicians have the ability to diagnose and treat women or to give appropriate referrals. Additionally, experts agree that pregnant women with depression often take poorer care of their prenatal health and that maternal mental illness can cause behavioral problems and emotional instability in children.

Consequently, both baby and mother are on better footing if mental wellness measures are in place before and after pregnancy, and physicians should be prepared to diagnose and either treat or refer patients to providers who can help, experts said.

“All pregnant women are susceptible to postpartum depression because of a combination of factors, including changes in hormone levels, fatigue and emotional factors like feelings of doubt about pregnancy, guilt, sadness and anger that may accompany caring for a newborn,” said Frances Casey, M.D., director of Family Planning Services and assistant professor, VCU Department of Obstetrics and Gynecology in the School of Medicine. “At VCU, health providers screen all postpartum patients for depression using validated screening tools. Women identified as at risk or experiencing depression may be referred for counseling or group therapy or may be started on antidepressants.”

A woman’s social environment is important, too, Casey said, adding that lifestyle components, such as the presence of supportive partners and family members, are significant in mental health before and after a pregnancy. Some changes in a pregnant woman’s emotional state are routine, such as abnormal sleep patterns or crying for no clear reason. However, if symptoms persist beyond one to two weeks and prevent a woman from functioning daily, there is cause for concern.

A strategic support system can help.

Janet Abraham, clinical social worker in VCU Women’s Health at VCU Health, said access to excellent prenatal care is critical. A woman who makes routine doctor visits before giving birth is able to become an active participant in her care, helping to develop a trusted and balanced relationship with her health care team. In these circumstances, a woman becomes educated, aware of her body and prepared for the many changes that pregnancy brings. In the postpartum period, the prepared patient can plan and hope for a sense of personal accomplishment, calm and equilibrium, increased maternal satisfaction, and strong mother/baby bonding.

“An excellent example of a model or type of participatory care that we deliver at VCU Health is with our CenteringPregnancy program, where women meet with others in a group prenatal care setting and are educated and assessed medically for their prenatal care needs,” Abraham said. “This is a very comprehensive care model and we have found it to be quite useful in assessing women’s health statuses, as well as their personal mental health needs. It also creates a very strong and vibrant peer/community support environment.”

Overall, moms should be aware that some changes are expected with a newborn in the home, and they may even question their ability to care for a newborn. An estimated one in seven postpartum mothers experience similar symptoms. However, there are services available to help with the transition.

Nationally, Casey suggests National Women’s Health Information Center, Postpartum Support International and the American Congress of Obstetricians and Gynecologists for more information and resources.

Through a March of Dimes grant, VCU Health has been offering CenteringPregnancy group prenatal care as an option for pregnant women since 2005. It is a national program that provides innovative prenatal care intervention through treatment, collaboration and education to bridge the gap, Abraham said.

“The presence of the father of the baby or significant other is always important and helps a woman feel connected to what she has created. However, this is not always the case,” she said. “This can sometimes be mitigated by others in the mother’s support system, programs like CenteringPregnancy, as well as additional family members or friends that can serve in exceptionally supportive roles.”

For more information about VCU’s CenteringPregnancy program, call 804-628-1762 or visit www.obgyn.vcu.edu/pregnancy/.

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