Postpartum mood and anxiety disorders — including postpartum anxiety (PPA), depression (PPD), psychosis, and obsessive compulsive disorder (OCD), though colloquially referred to as PPD — are being diagnosed in an increasing percentage of women. A recent study published in JAMA Network Open shows that PPD rates have jumped over the past decade, from 9% in 2010 to 19% in 2021. Other sources show that “somewhere between 10 and 15 percent of mothers experience postpartum depression,” as I noted recently at The Federalist. While some of the past decade’s increase in diagnoses could be due to greater awareness, it is clear that more can and should be done for mothers experiencing PPD.
What needs to change, on a policy level and at the cultural level, to drive down PPD rates, and to help women to thrive as mothers?
Earlier postpartum follow ups with healthcare professionals
While prenatal care in the United States involves a regimen of increasingly frequent office visits as the pregnancy progresses, clinician-patient contact falls off a cliff after women give birth. Following weekly visits in the last month of pregnancy, new moms are likely to see their OB/GYN just once at six weeks postpartum.
While the American College of Obstetricians and Gynecologists urges a postpartum followup within three weeks after birth for every mom, followed by a second visit 12 weeks after birth, this is nowhere near the norm.
Increased access to direct primary care doctors
In 48 states plus Washington, D.C., 1300 direct primary care practices now exist. Direct primary care doctors pursue a low-cost, high-quality approach to medicine, and emphasize that they “work for the patient and not for an insurance company.”
These physicians opt to charge a flat monthly membership (or, in some cases, annual) fee for a defined set of primary care services, rather than billing insurance. Rather than calling a call center after-hours or having a receptionist and then nurse as a go-between, patients have direct access to their doctor.
One such doctor who practices this way shared with me the ways direct primary care can particularly help with early identification and treatment of PPD. Like other direct primary care doctors, Dr. Marguerite Duane, a board-certified family physician, does house calls for new baby wellness checks.
When direct primary care doctors go into their patients’ homes and observe them in their home environment, they’re not just saving new moms the hassle of packing up a new baby (and perhaps older children) into the car. They are able to get a feel for how new moms are doing in a way that a PPD screening questionnaire (often administered in the pediatrician’s office, since pediatricians see new mothers long before their OB/GYNs do) cannot.
Dr. Duane shared multiple stories of identifying patients who were starting to show signs of PPD and were successfully treated with progesterone or ongoing emotional support.
Increased insurance coverage for doulas
Doulas are non-medical, trained professionals who serve women throughout pregnancy, labor and birth, and postpartum. While they do not provide medical services, they can help improve women’s physical and emotional experience of pregnancy and postpartum through education and emotional support.
The trust and rapport they build up with the mothers they serve uniquely positions them to identify early signs and symptoms of PPD, and encourage moms to seek treatment. This may be particularly the case for black mothers, who are more likely to experience PPD but less likely to receive treatment, according to research.
Since doulas do not provide medical care, they were at one time entirely ineligible for insurance coverage. But that’s gradually changing. In some states, insurance now covers doula care. At present, just nine states mandate Medicaid coverage for doula services, and only one state (Rhode Island) requires private insurance programs to cover doula services.
READ: Pro-life doula creates clinic to improve birth outcomes for Black mothers
Broader access to effective, affordable postpartum depression treatments
We can also increase public awareness of and access to progesterone (prescribed by healthcare professionals trained in restorative reproductive medicine) as a treatment for postpartum depression (PPD). Progesterone would not prevent PPD, but could supplementation stop PPD in its tracks, whether alone or alongside therapy or other treatment options, before it spirals out of control? It can be a lifeline for many. Best of all, it’s widely available at standard pharmacies and relatively inexpensive.
This is in stark contrast to the only two FDA-approved medications to treat PPD. Brexanolone (Zulresso) and zuranolone (Zurzuvae), which are respectively given via IV over three days in a hospital and orally, are synthetic forms of allopregnanolone, a neurosteroid the body naturally makes from progesterone. Unlike progesterone prescribed by a RRM clinician, Zulresso and Zurzuvae are not easy to access and may be highly cost-prohibitive.
Paid family leave for all
Treating postpartum depression effectively with hormonal supplementation, and getting women timely follow-up care (from direct primary care doctors and postpartum doulas, as mentioned) can all help drive down PPD rates, but they’re not all we can do. At the policy level, we can also absolutely advocate for paid family leave.
Unsurprisingly, less than 12 weeks of maternity leave “was associated with higher maternal depression, lower parental preoccupation with the infant, less knowledge of infant development, more negative impact of birth on self-esteem and marriage, and higher career centrality,” according to a study in the Journal of Applied Developmental Psychology.
Yet even as 12 weeks of job-protected unpaid maternity leave are guaranteed under the Family Medical Leave Act (FMLA), nearly one in four moms return to work just two weeks after giving birth.
As Vox previously reported, under 10% of low-wage workers (think those working in food service, retail, etc.) in this country have access to paid family leave. Paid Leave for Families explores creative options for paid family leave with “budget-neutral proposals and no mandates on business.”
Relearning how to ‘mother the mother’
Preventing PPD and treating it in a timely manner is not ultimately about implementing a single one-size-fits-all policy solution. Even a shift in the medical field’s approach to postpartum is inadequate. What’s necessary is a broader cultural recovery of the idea of ‘mothering the mother,’ as author Heng Ou advocated in The First 40 Days.
This is the antithesis of expecting her to “bounce back” or to “do it all” and it looks far more intimate, humbler, and much smaller-scale than any broad piece of legislation. Our culture as a whole must regain our grasp on the necessity of caring for the new mother, understanding the crucial tethering between her wellbeing and her child’s, as well as that of her whole family.
Even though we have DoorDash and modern medicine now, a new mom still needs to be supported through provision of nutritious food (which someone else makes for her) and through childcare for her older children plus community support (especially from grandma-aged women with time and expertise to share), as in days of old. She needs to be encouraged to engage in gentle exercise, encouraged to breastfeed and coached if necessary, and she needs to be regularly exposed to the sun and nature.
When she receives this kind of care, she knows deep in her soul that she is not alone in her motherhood, that there is nothing wrong with her needing help, and that she (and her child) are deserving of others’ ongoing attention and care.
If we seek to drive down PPD rates, we must come alongside new mothers. And if they should experience PPD, we must do everything in our power to get them access to the kinds of help they need.
Tell President Trump, RFK, Jr., Elon, and Vivek:
Stop killing America’s future. Defund Planned Parenthood NOW!
