Why Postpartum Depression Screening Failed Me

The receptionist at my newborn daughter’s pediatrician eyes me curiously as I walk into the office, struggling to balance a car seat (and tiny, 4-week-old human), my pocketbook, and diaper bag. I give my name and am handed a tablet to check in.

I settle on one of the couches and start clicking through the tablet’s on-screen prompts. There’s the usual “verify your information,” and the all-important “who is paying for this visit?” In the few short weeks since my daughter’s birth, I’ve all but memorized these prompts over the seemingly endless checkup visits. So it catches me by surprise when, during my cruise control clicking, an unfamiliar screen stares back up at me. It’s a questionnaire . . . for me. 

Or more importantly, about me.

A stack of questions ask whether or not, over the past seven days, I have “been able to laugh and see the funny side of things,” or if I have “blamed myself unnecessarily when things went wrong.” The tablet wants to know if I have “felt anxious or worried for no good reason” (which, what new parent hasn’t?!), and then finally whether the “thought of harming myself has occurred to me.” 

I quickly realize these questions are actually a postpartum test to gauge whether I’m exhibiting signs of anxiety or depression. And while I answer honestly, I also realize that for those afraid of judgment, it would be just as easy to pick the “right” answer rather than a truthful one. I wait for my daughter’s name to be called and wonder if a nurse, or even her doctor, will go over the results with me or ask how I’m doing. No one ever does.

This interaction (or lack thereof) left a nagging feeling with me. Surely this couldn’t be all that was required when it comes to postpartum screenings, right? 

Unfortunately, as it turns out, this is an example of doing more than is required by New York state. “There is not by law a mandate that everybody needs to be screened,” says Dr. Stephanie McNally, an OB/GYN at Northwell Health. “There are certain regulations for paperwork that needs to be handed to patients before discharge, but that’s different than a proper screening process.”

I later found out that the questionnaire I answered in the waiting room of my suburban Long Island pediatrician’s office was called the Edinburgh Postnatal Depression Scale (EPDS), which is administered to identify patients at high risk for depression and mood disorders. Ideally, McNally says, the screening should be followed up with a conversation between patient and provider, as well as a review of the patient’s answers.

Setting, she says, is also key. “The communication really should be focused on the obstetrician’s office where the visit’s about you, not the baby,” says McNally. While pediatrician offices administering screenings like EPDS act as a good safety net, McNally asserts that obstetricians are the ideal providers to screen for postpartum mood disorders—especially in those early postpartum weeks—because they typically have an established relationship with the moms and may better gauge the situation. This is particularly true for first time mothers, who do not yet have an established relationship with their pediatricians.

But that wasn’t my experience, either. Despite research showing that perinatal mood disorders (such as postpartum depression and postpartum anxiety disorder) occur in roughly 10% to 15% of all births, a routine six-week checkup with my OB/GYN, followed by another appointment at 12 weeks to discuss birth control, left me feeling like I was a number, rather than a patient. None of my providers asked me in any meaningful way whether I was OK, and I certainly wasn’t given any questionnaire. Weren’t these the same providers that had smiled cheerfully and asked with genuine concern how I was every month, then every two weeks, and finally every week during my pregnancy?

All the while, my ability to cope with everyday life began to shift. Even before I returned to work, the normal worries that come with being a new parent, being in a marriage, and living everyday life began to spiral, until they seemed altogether insurmountable. 

My daughter had lost weight after birth and struggled to gain it back. I wasn’t producing enough breast milk. She had a hard time latching due to a lip and tongue tie. I researched tirelessly to find a doctor to correct it and then discovered insurance didn’t cover the nearly $1,000 procedure. I began having to supplement with formula. My baby’s head circumference consistently measured above the 100th percentile at monthly check-ins—disproportionate to her height and weight. Her doctor used words like “macrocephaly” and ordered an ultrasound of the head. Depending on the results, our pediatrician explained, my daughter might need a drain placed from her brain to her abdomen (thankfully, this was ultimately unnecessary, and she was OK).

I returned to work at my New York City office, commuting three hours and working an additional nine each day. I left home hours before my daughter woke up and returned just in time to put her to sleep. My husband and I enrolled her in daycare, where I was paying what equated to a second mortgage to have relative strangers spend more time with my child than I was. I worried over the many things that could hurt my child, my brain unable to distinguish whether my fears were warranted or unrealistic. 

Individually, these things aren’t unmanageable. But altogether? I was on a one-way cruise to a breakdown.

It wasn’t until one week in late May, a full seven months after my daughter was born, that something in me finally broke. Suddenly, and without warning, several months’ worth of pent-up emotions came bursting to the surface. I had accidentally double-booked myself for an upcoming Saturday (an entirely uncharacteristic error on my part). One set of plans would take me to a concert in the city with my best friend, the other to a fundraiser at the organization where my husband volunteers—and I had forgotten to arrange childcare for both.

Though usually I’m a straight-shooting problem solver, this scheduling snafu derailed me. I sat in silence for days, wrought with anxiety at the thought of having to disappoint either person. All I wanted to do was to curl into a ball and shrink away from the world. My anxiety over trying to appease everyone kicked into overdrive.

The next morning I woke up with double pink eye. 

I sobbed that day as a lightbulb finally went off and I realized I wasn’t OK—and I hadn’t been for a long time. 

As it turns out, my experience of developing mood disorder symptoms months rather than weeks postpartum isn’t so uncommon. “This postpartum period of six weeks is not enough,” says McNally. “It takes years for your hormones to change during adolescence and for you to then re-identify who the new you is. Why do we assume a new mother can transition in six weeks? Herein lies the idea of matrescence—which is defined as the process of becoming a mother. Like adolescence, we should consider the hormonal and emotional changes that women experience during their transition into motherhood.” Ideally, McNally says, screenings should extend from the beginning of pregnancy through the first year of a baby’s life and beyond, depending on risk.

“Really we should be expanding this postpartum period for at least a year,” she says. In an ideal world, McNally asserts, there would be healthcare check-ins once a trimester, postpartum prior to discharge, at your postpartum obstetrician visit, and then at six- and 12-month intervals to fully capture a longer period of time that allows for hormonal and emotional transition.

However, even regularly administering self-identifying screening tests like the EPDS might not be enough if providers aren’t following it with honest communication with new moms, says McNally.

As the days stretched into summer I began to feel more and more like myself. I slowly taught myself how to process emotions again, self-identifying when a thought or worry was more irrational than logical. I constantly had to correct my friends and family members (and reassure myself) that no, my troubles would not simply melt away and be forgotten with a manicure or a night out with a friend. I learned firsthand the stigma around the term “postpartum depression”—and with some research, found that I likely actually had postpartum anxiety or another form of postpartum mood disorder, things I didn’t even know existed before.

I learned that despite everything my brain, body, and sometimes even my loved ones were telling me, my feelings were valid; I wasn’t guilty of anything; and needing to prioritize my mental health didn’t make me a bad mother.

Ultimately I chose not to seek help through a professional—mostly because at that point just acknowledging it seemed to lift a huge weight. But I frequently wonder how much sooner I might have been diagnosed and gotten help if proper and adequate screening and treatment was the rule, rather than the exception.

• My Battle with Postpartum Depression.
• 5 Things I Wish My Wife (and I) Knew about Postpartum Depression.
• Not feeling sexy after baby? It’s all about patience and communication.
• Wondering about Postpartum Depression? Learn more.