Mental Health Screening for Pregnant and Postpartum Women

Every Mother, Every Time

Suicide is a leading cause of death for women during the first year after childbirth. Currently, care providers, midwives, general and family practitioners are not mandated to screen for symptoms of mental illness, or even family history of mental illness—a known risk factor for developing perinatal (the time around childbirth) mood or anxiety issues. One-in-seven women will experience a mood or anxiety disorder during pregnancy or postpartum, yet nearly 50% remain untreated. In pregnancy, maternal mental illness negatively effects fetal development, and leads to adverse birth outcomes such as low birth weight and premature delivery. Perinatal mood and anxiety disorders (PMADs) can impair infant and early childhood cognitive and emotional development. Despite overwhelming empirical evidence, there is no universal mandate for care providers to screen pregnant and postpartum women for depression, anxiety, or family history of mental illness.

The current White House petition, Every Mother, Every Time, asks the federal government to take up the long needed conversation about why we don’t screen for mental illness as routine prenatal and postpartum care. The petition has garnered strong response and reaction in the maternal mental health community, and lack of response from many others. Unfortunately, as long as we remain isolated from the rest of maternal health, we run the risk of marginalizing ourselves. I have had many conversations, and tried to have conversations, with leaders in the support community regarding their concerns on signing such a petition.

Argument 1: Universal Healthcare Screening for Moms = Big Pharma

The argument here is this: don’t sign a petition for mandating universal screening because Big Pharma will descend on every obstetrician’s and gynecologist’s office with free samples of Zoloft. This is internalized stigma, I am afraid, and becomes a micro-aggression toward mentally ill women, and mothers in particular. By worrying about big government for other women, we inherently devalue their ability to think for themselves. We become, ironically, paternal. This argument also perpetuates the myth that medical care providers are solely shills for pharmaceutical companies. Providers are professionals. We must move beyond demonizing the whole because of the poor performance of some of the parts.

Lastly, and most importantly, it is just not true. A petition would mandate a conversation, and the evidence is clear that most women don’t want to use psychopharmacology as a first line of treatment anyway. We can actually think for ourselves and make good decisions about our mental health care. But we need access to the information. Women are doing fine adding folate to their prenatal diets—we do what we must do when given the best information. Treating pregnant and postpartum women as children who inherently need permission to access mental health screening must end.

Argument 2: No Infrastructure for Mental Health Screening of Mothers

Basically the opinion here is: don't sign the petition because screening will not solve the lack of resources available. This is the main reason to sign. One hundred thousand signatures would mandate, by law, a national conversation about the lack of resources. We would demonstrate our lack of resources by signing a petition saying we need resources. If there were mandated universal screening, mental health would be part of the normal spectrum of care, prevention, and intervention for maternal health. There is no maternal health without maternal mental health.

This article was written by:

Walker Karraa, PhD is a perinatal mental health researcher, advocate, and writer. She hosts the community blog: Stigmama.com, a site dedicated to stigma against mothers with mental illness. She serves on the Wellness Advisory Council for NOStigmas.org, and is writing a book: "Postpartum Depression: Trauma and Transformation," on her research into the transformational dimensions of postpartum depression. You can find Dr. Karraa on LinkedIn, Twitter, and Google+.

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