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Health Beat: Understanding postpartum depression

Dr. Ingrid Calle and family.

As a family medicine doctor who has always loved whole family care, treating postpartum depression seemed straightforward.

In medicine we have concrete definitions and clinical criteria of postpartum depression and postpartum blues. There are good, validated screening tools to help identify and treat people who are struggling and we are talking about it more often as a community. I was also very lucky- being a family medicine doctor, I often knew the patient before pregnancy and after the delivery of their child and was able to have real conversations about depression and make connections that I hope were helpful.

Then I had a baby. As it turns out, and as I should have known, nothing is black and white.

I do wonder if we do a disservice to make a complex issue such a small part of our medical care. Typically, a postpartum visit is scheduled out 6 weeks after delivery, which leaves someone who is struggling with postpartum depression responsible to take the initiative to reach out on their own.

By definition, Postpartum Blues- which can affect up to 75% of women- usually start in the first few days after birth and resolves in a few weeks. Postpartum depression, on the other hand, can start any time after delivery, sometimes even a year or more after a child is born. At Partnership Health Center, we want all patients, including and especially new mothers, to feel comfortable honestly sharing their feelings and experiences. Significant life changes like having a baby can be extremely challenging as we shift to a new “normal.”

New mothers may experience lower energy than usual; less motivation to pursue previously enjoyed activities, change in appetite, trouble focusing, and trouble sleeping. These factors often make postpartum depression difficult for a mom or dad to identify in themselves or their partner. Sleep deprivation can be severe and irritability feels rather normal in the context of consistent sleeplessness, a crying baby, the demands of feeding, a dramatic change in lifestyle and new, daunting expectations.

For myself, I had half expected pure joy and rainbows since we had been trying for two years for this pregnancy, so in many ways, I didn’t want to even admit that I may not be my best self. Plus, it was important to think of the wide range of normal, too. Who wouldn’t feel exhausted after sleeping in 2 hour stints for 6 months?

But this tendency to brush off symptoms likely gets in the way of honest conversations with patients and attention to those signals of struggle. The CDC suggests that at least 1 in 9 mothers experience postpartum depression, but some studies report significant under-reporting, suggesting that as few as 20% of mothers report their symptoms to their provider. This is not surprising to me in practice.

At Partnership Health Center, we screen everyone for postpartum depression with the aim of helping patients talk to their provider about symptoms. Further, we believe in whole person care. A patient’s experience with postpartum depression, or any other mental health challenge, is a part of their overall health, and we want to be a part of the solution. Patients can visit with a behavioral health provider (part of our wrap-around medical team) at the same time as a Well Child Check or postpartum visit.

As a community health provider and as a new mom I want to be an advocate and supporter in helping new mothers receive the compassion and support they need as they adjust to everything a new baby brings.

To learn about resources available at Partnership Health Center or elsewhere in Missoula, please call the PHC main phone line at 406-258-4789. As a community, we can address the issues of postpartum depression and help lift the stigma.

Dr. Ingrid Calle is a family medicine physician at Partnership Health Center. She works with patients in all stages of life.