An article on Postpartum Suicide discusses the risk factors we should be on alert for - but the part I want to discuss comes near the end of the article:
While Dr. Schiff's study highlights the red-flag characteristics of mothers who need closer postpartum follow-up because of increased risk of suicidal behavior, the question of which physicians are best positioned to provide that follow-up was a topic of spirited audience discussion.
Recent mothers generally think of themselves as still under their obstetrician's care, but they typically see the obstetrician just once at the 6-week postpartum visit.
Another option that some audience members suggested would be for the pediatrician or family physician to briefly assess the mother's mental health when she brings her neonate to the office for the 2-week visit.
The entire article is powerful, but this problem of who is supposed to tend to a woman's psyche postpartum is a huge one.
One of the best things (most) homebirth midwives provide is on-going support and a connection, if not out-and-out relationship with the client and her family.
Because not all know, postpartum visits occur on 1 and 3 days at the client's home. The 2 week visit is usually in the office, but if mom is still working on nursing issues or is very tired, I will go back to their home. I then see mom at 6 weeks postpartum and again at 3 months. The visits are our weaning. After nearly a year of ever-increasing visits, it takes some gentle pulling away to be able to send families off to live their lives with their new babies.
I've known for a long time that women fall into a who-takes-care-of-me world after they have their babies. A breast infection needing antibiotics? Who does a woman see? The OB/GYN or the Pediatrician?
Breasts and Psych issues are in that grey area that can leave women lonely and not getting help at all. I've personally taken women to a kind psychiatrist who would see them on the spur of the moment because their OB either was too busy or wanted to prescribe Prozac without even seeing them. (I reiterate - Psych meds should be prescribed by Psychiatrists!)
I keep hoping the OB/GYNs and Peds will figure out an answer to these questions and let us all know where to send women who need medications and help with grey areas.
Back to the article.
So, do we educate our clients and their partners about postpartum depression and postpartum suicide risk? Especially when they have one or more of the risk factors? Do we make a postpartum risk factor sheet for women to fill out prenatally and act on that? Do we visit at-risk women throughout the first year? Are emails and phone calls enough?
I'm curious to know what other care providers do regarding this issue. I think that with this article, I may be changing my own spiel and even give more information prenatally about postpartum depression. The concern is having the woman think I am suspecting she will be depressed when it really would be the standard discussion. (When I've had a woman I am concerned about, I do discuss it with her and her partner.)
Where do we go from here so we are able to save lives?