Category Archives: Edinburgh Postnatal Depression Scale

TIME Magazine misfires debate on MOTHER’S Act

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Awhile back, I was contacted by Catherine Elton regarding an article which was to examine Postpartum Depression and the Mother’s Act. The email somehow got buried and I did not get a chance to participate in the discussion.

It seems that it would not have mattered if I had been able to discuss my story with her.

Time published the story this week. While the online version has been modified to correct an error with Ms. Amy Philo’s story, you can still see the original version in the hard copy. (Which by the way, I am personally asking you to boycott – even asking if you can take the copy of TIME home from the doctor’s office in order to keep other moms from reading it! And make sure you ASK – because just taking it would be stealing and that’s illegal.)

The original version, entitled “The Melancholy of Motherhood” includes one quote from Carole Blocker, the mother of Melanie Blocker Stokes, a mother who tragically committed suicide after unsuccessful treatment for severe postpartum depression after the birth of her daughter. The quote reflects Ms. Blocker’s confusion as to how someone could oppose the MOTHER’S Act, a bill which is designed to increase public and professional education regarding Postpartum Mood & Anxiety Disorders. Frankly, I’m confused right along with Ms. Blocker.

The only survivor story featured in this article is that of Amy Philo, one of five recipients of an Outstanding Achievement for Mothers’ and Children’s Rights awards from the Citizens Commision on Human Rights or CCHR. CCHR was founded in 1969 by none other than the Church of Scientology, well-known to oppose the entire psychiatric field.

Amy has tirelessly worked against this bill for quite some time now but continues to be tragically misled. Few discussions with her have led to quite the round robin with Amy unable to come up with legitimate research to back up her claims. When asked for said research, Amy refers to her own websites instead of to specific research articles supporting her claims.

I happen to know that Ms. Elton did indeed interview fellow survivors who support the bill. One has to wonder then, why did their stories not make it into the article? Was it length? Was it editing? Or was it intentional? Regardless, the finished piece as published presents a very frightening and deceiptful picture of what new mothers face is this bill is passed. To begin with, the MOTHER’S Act no longer mandates screening. It requires a study to be completed by the Secretary of Health and Human Services (Kathleen Sebelius) as well as funds for an educational campaign for both caregivers and the general public.

I agree that just because a new mother shows emotion she should not immediately be diagnosed as having a PMAD. I also believe that a woman should have free choice when it comes to her treatment decisions and should NOT be judged for those choices. I chose to take Anti-depressants. My first prescription did not work out. But my second one did. Just as with any other medication, sometimes they don’t work so well with your system. So you try another one. You don’t suddenly take your own care into your hands – that’s ridiculous. Would you try to heal a broken leg or diabetes on your own? No? I didn’t think so. So why would you rely solely on self-care when it comes to mental illness? Self-care should be part of the picture but it shouldn’t be the ONLY part of the picture.

I am so tired of being judged and accused of not having informed consent. You know what? When I made my decision to go on Anti-Depressants, I had carried around an informational packet about AD’s & Breastfeeding given to me by the NICU Lactation Consultant with me for a week. I read that thing through and through. I was exclusively pumping for my daughter at the time and did not want to jeopardize her receiving my milk if I ended up having to take something. But I couldn’t function. I couldn’t take care of my family, I couldn’t take care of myself, and a lot of the same thoughts were coming back. Negative, scary thoughts about knives and hurting myself and my family. Yet I wasn’t on anti-depressants. I needed to be able to function. So I made a very informed decision to do so, one I do not regret to this day.

TIME – I am very disappointed in your lack of sharing both sides of this debate. Very very disappointed.

US Practitioners confident in use of EPDS; not charting results

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A study entitled “Universal Screening for Postpartum Depression: an inquiry into provider attitudes and practice”, presented January 2009 at the 29th Annual Meeting of the Society for Maternal Fetal Medicine, January 2009, evaluated usage of the EPDS in an academic based clinical center and also evaluated the practitioner’s knowledge of and attitude towards the EPDS.

A total of 512 records were studied with a rather large difference between percentage of documented screens and reported rates of confidence and knowledge of screening. Only 39% of records included notated screens, 35% charted counseling with patients about their results,  even though 94% of practitioners reported they are responsible for and comfortable with making a diagnosis of a Postpartum Mood Disorder.

The study’s authors concluded that even though practitioners are confident they are not charting the results.

What does this mean?

Either practitioners are not as confident as they claim and really are not screening at a higher suspected level or they are truly confident and not documenting the patient’s complete visit. Whatever the case may be, something needs to change. Increased documentation of Postpartum Mood Disorders would allow for better understanding of how many women really do suffer. It also raises the question if more women than we think are seeking treatment and this information is just not making into the documentation. But at least these practitioners are asking the questions and not wording their way out of it much like a recent UK based study, right?

Therapy and the Postpartum Woman by Karen Kleiman

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Karen Kleiman, a wonderfully dedicated therapist to the PPD world,  has authored yet another wonderful book, Therapy & the Postpartum Woman. Available for pre-order now,  this book will release in September and is written for the benefit of both clinicians and women with PPD to maximize the therapy experience on both sides. Click here to pre-order: Therapy & the Postpartum Woman

Here’s an excerpt of what Shari Lusskin, MD says in the foreword of the Therapy & the Postpartum Woman:

Ms. Kleiman presents a theoretical framework in which the therapist “mothers the mother” by acting as the “good” mother, who “must achieve that equilibrium between absolute support and appropriate boundaries.” Using compelling patient narratives, she demonstrates just how to achieve that balance in order to teach the patient how to develop confidence in her own skills as a mother. There is a treasure trove of “clinical pearls” in this eminently readable book, which even the most experienced clinician will be able to use right away. For those new to the field, and for patients and their loved ones, the book offers a wealth of information on the nature of postpartum depression as a medical illness and the psychosocial issues that arise when a woman is faced with caring for a baby. Ms. Kleiman describes how the medical community tends to minimize the complexity of these issues and use a “one size fits all” approach to treating depression. Readers will learn to be more effective advocates for proper treatment of perinatal depression. Therapists will also learn how to draw from their own experiences to facilitate the human connection between therapist and patient at a time when women feel isolated by shame and insecurity. Together, the therapist and the patient can work towards discovering the innate resilience that has allowed women to raise children even in the most extreme circumstances. Ms. Kleiman has developed a humanistic approach to psychotherapy for postpartum mood disorders that gives recognition to psychodynamic theory, but then uses many cognitive–behavioral techniques to reach well-defined goals. Therapy and the Postpartum Woman is an elegantly written book that not only offers practical advice but also does so in a way that will touch the lives of both patients and therapists. It is destined to become a classic for those experiencing or treating perinatal mood disorders.

Petition in Support of the MOTHER’S Act

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Yes, we had a blog day.

Yes, we’ve called our Senators, written them, and speak out daily about the NEED for improved care for women just like us.

BUT… we’re not being heard. Instead, the voices of those who would argue that the MOTHER’S Act will force new mothers to take medication and submit to screening are the ones being heard. The MOTHER’S Act will not force medication on anyone – what it will do is provide the opportunity for every mother to have access to treatment for a PMD if she has one. The method of treatment is up to the mother and her physician (and frankly, if my physician wasn’t on the same page as I was or at least willing to back up his reasoning with some pretty strong fact, I’d find another physician!) and drugs may not be the best route for every mother – but EVERY MOTHER WHO SUFFERS DESERVES ACCESS TO TREATMENT.

Please sign the petition from the Depression & Bipolar Support Alliance in support of the MOTHER’S Act.

It’s urgent that your voice be heard NOW.

Mental Illness Awareness Week

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In continued honour of mental illness awareness week, I am posting the EPDS (Edinburgh Postnatal Scale) here at Sharing the Journey. It is one of the standard screening tools for new mothers – and is not used often enough by practioners here in the States. 

If you are a new mother experiencing problems or know a new mother who is, please use this self screening tool or pass it on to someone who needs to use it by printing it for them. This particular version was found at www.wellmother.com.

Instructions for users:

  1. The mother is asked to underline the response which comes closest to how she has been feeling in the previous 7 days.
  2. All ten items must be completed.
  3. Care should be taken to avoid the possibility of the mother discussing her answers with others.
  4. The mother should complete the scale herself, unless she has limited English or has difficulty with reading.
  5. The EPDS may be used at 6-8 weeks to screen postnatal women. The child health clinic, postnatal check-up or a home visit may provide suitable opportunities for its completion.

Name: _______________________________
Address:  ___________________________________________________
Baby’s Age: __________________
As you have recently had a baby, we would like to know how you are feeling. Please UNDERLINE the answer which comes closest to how you have felt IN THE PAST 7 DAYS, not just how you feel today.

  1. I have been able to laugh and see the funny side of things.
    As much as I always could
    Not quite so much now
    Definitely not so much now
    Not at all
  2. I have looked forward with enjoyment to things.
    As much as I ever did
    Rather less than I used to
    Definitely less than I used to
    Hardly at all
  3. * I have blamed myself unnecessarily when things went wrong.
    Yes, most of the time
    Yes, some of the time
    Not very often
    No, never
  4. I have been anxious or worried for no good reason.
    No, not at all
    Hardly ever
    Yes, sometimes
    Yes, very often
  5. * I have felt scared or panicky for not very good reason.
    Yes, quite a lot
    Yes, sometimes
    No, not much
    No, not at all
  6. * Things have been getting on top of me.
    Yes, most of the time I haven’t been able to cope at all
    Yes, sometimes I haven’t been coping as well as usual
    No, most of the time I have coped quite well
    No, I have been coping as well as ever
  7. * I have been so unhappy that I have had difficulty sleeping.
    Yes, most of the time
    Yes, sometimes
    Not very often
    No, not at all
  8. * I have felt sad or miserable.
    Yes, most of the time
    Yes, quite often
    Not very often
    No, not at all
  9. * I have been so unhappy that I have been crying.
    Yes, most of the time
    Yes, quite often
    Only occasionally
    No, never
  10. * The thought of harming myself has occurred to me.
    Yes, quite often
    Sometimes
    Hardly ever
    Never

Response categories are scored 0, 1, 2, and 3 according to increased severity of the symptoms. Items marked with an asterisk are reverse cored (i.e. 3, 2, 1, and 0). The total score is calculated by adding together the scores for each of the ten items. Users may reproduce the scale without further permission providing they respect copyright by quoting the names of the authors, the title and the source of the paper in all reproduced copies.