There has been much discussion about the need for inclusion of maternal mental health curriculum in medical provider education programs. Such awareness is necessary in order to increase detection and early treatment rates of women experiencing perinatal mood disorders. In one dissertation “Adaptation of a best practice model for recognition and treatment of postpartum depression in a private obstetrics practice”, maternal child health researcher Vicki Long notes the improved detection and treatment of early perinatal affective disturbances when protocols for consistent screening of pregnant women were implemented in an obstetrical practice.
In their article “Educating pediatric residents about developmental and social-emotional health”, the authors included assessment of postpartum depression among the four early childhood disorders which have a most significant negative impact on early childhood development. In another article, “The association between maternal depression and frequent non-routine visits to the infant’s doctor- a cohort study” the researchers noted that while perinatal depression is common, women typically do not seek help for it. Therefore, the proactive outreach of the treatment team was necessary to assess and engage potentially depressed mothers.
The need for such collaborative approaches is not disputed, but moving the ball forward to create such liaisons between medical and mental health practitioners has been slow. While lectures or presentations on perinatal mood disorders are becoming more frequent at medical conferences, mainstreaming the issue as a central component of obstetrical/pediatric curriculum has proved more challenging.
The engagement of medical providers in the detection and treatment of perinatal mood disorders is critical but has presented many challenges, primarily stemming from the need for reliable referral resources once such illnesses are detected. While mental health practitioners are equally charged with developing a competent specialty in this field, often such referrals are not presented to them until well into the postpartum. So again we first look to the medical providers who will initially engage with pregnant mothers and follow them from obstetrics to pediatrics to help detect the up to 20% of women who may experience a perinatal mood disorder.
When an expert practitioner and highly respected educator at one of our nation’s most outstanding programs includes maternal mental health in the curriculum, we make enormous strides toward creating the health partnerships needed to reduce suffering and ignorance. As important, the discussion of these common but highly treatable disorders during a prenatal doctor’s visit “normalizes” the possibility of occurrence, thereby reducing the stigma which often acts as a barrier to treatment.
Dr. Isaac Schiff, chief of the Vincent Obstetrics and Gynecology Service at Massachusetts General Hospital in Boston and the Joe Vincent Meigs Professor of Gynecology at Harvard Medical School recently invited Former NJ First Lady Mary Jo Codey to address students, interns and faculty at world renowned health care facility Mass General Hospital.
Says Dr. Schiff, “I heard Ms. Codey speak before and she changed my views on postpartum depression. As a chief of a department, I felt it my responsibility that our students, residents and faculty be aware of the pain women feel who are afflicted with depression postpartum and that we must screen our patients for it in order to help them!” Dr. Schiff adds, “ Unfortunately, in the past, the subject was not taught in any depth in medical schools or residencies. Ms. Codey has made a difference!”
To those of us long associated with this issue, Mary Jo is a well known and beloved national figure for her fearless use of her personal experiences and her platform as NJ’s First Lady to advance awareness, treatment and state and federal legislation to defeat the ignorance that has plagued these often closeted disorders. Her “Speak Up When You’re Down” campaign has been adopted by many national organizations across the country which have joined her mission to eradicate suffering and beckon mothers, families and providers to awareness.
And how was Codey’s address received? Says Dr. Schiff, “Her presentation was outstanding and captured the attention of everyone present. We were all moved by her eloquence, elegance and candor. In fact, we were spellbound and wished that she would go on for hours! The impact was powerful. The medical students, residents, nurses, midwives and faculty were touched by her lecture and the message was delivered in such a way that we have increased sensitivity to postpartum depression. We have all changed our practice after her visit!”
And what do women want from medical providers during pregnancy and the postpartum? One of the most frequent statements I hear in my practice is “I wish that I had known”. The prolonged suffering which results when patients are unaware of what is happening to them and erroneously attribute symptoms to personal failings has profound, long lasting and multiple health and mental health consequences to the woman, infant and family.
Thank you Dr. Schiff and Massachusetts General Hospital in Boston, MA for offering this life-saving seminar to your associates, all of whom are in positions to powerfully impact the professional perspective and treatment of these disorders throughout their careers. And thank you to Mary Jo Codey for helping to arm a nation of current and future practitioners with the knowledge and compassion needed to manage the challenge of perinatal mood disorders.
Bauer, Smith, Chien, Berry, Msall (2009). Educating pediatric residents about developmental and social-emotional health. Infants & Young Children, Vol 22 (4), Oct-Dec 2009, pp. 309-320.
Chee, Chong, Ng, Lee, Tan, Fones (2008)The association between maternal depression and frequent non-routine visits to the infant’s doctor a cohort study.(Journal of affective disorders, Vol 107(1-3), Apr 2008, pp. 247-253.
Long, Vicki Elizabeth (2011)Adaptation of a best practice model for recognition and treatment of postpartum depression in a private obstetrics practice. Dissertation Abstracts International: Section B: The Sciences and Engineering Vol 71 (6-B), pp. 3597.