Postpartum depression and anxiety: How to start the conversation

Despite being quite common and treatable, postpartum depression is a mental health struggle that still carries a stigma in many communities and cultures.

Postpartum depression is a subset of perinatal depression, which is the most common obstetric complication in the United States. About 1 in 7 Americans experience PPD after giving birth.

Some parents feel the need to “just tough it out” or to sacrifice themselves for the well-being of their family. Others mistrust psychotherapy and the safety of medications. These things can prevent early identification of a problem and treatment — or recognition that there’s a problem.

But a well-placed question can open a crucial conversation that can make a big difference to the health of a parent, infant and even the whole family.

We asked four pediatricians to share the conversation starters that work best for them. Something more probing than simply “How are you doing.”

Los Angeles pediatrician ChrisAnna Mink, MD, FAAP, wants her families to know that every new parent needs help, so during well visits, she asks:

“Who’s got your back?”

“Who’s helping you at home?”

“I see from the form that you may feel overwhelmed.”

North Carolina pediatrician Marian Earls, MD, FAAP, asks:

“What are you doing to take care of yourself?”

“What’s the best thing about being a mom to this baby? Are there any hard things? How are those going for you?”

“Do you get any personal time any more? Is anybody helping you with that?”

Michigan pediatrician Tiffany Munzer, MD, FAAP, says lack of sleep often accompanies depression but may feel less stigmatizing than mental health struggles, so she often starts there.

“When we are missing sleep, sometimes we feel more moody or worried. How have you been sleeping? Have you been experiencing more challenges with moodiness or worries as a result of poor sleep?”

“Having a new infant is so hard—full of joys but also a lot of new adjustments. How are you all holding up?”

“What’s the hardest thing about your day?”

“Has someone mentioned to you that you haven’t been yourself?”

“When I had my baby, I remember being so overwhelmed. How are you doing?

“Would it be OK with me to share resources with you that other new moms have found helpful? Because you matter as a human being too.“

North Carolina pediatrician Theresa McCarthy Flynn, MD, FAAP, opens her pandemic-era conversations with: “This has been quite a rough stretch, hasn’t it?”

“And then If they screen positive I normalize it. I tell them that it’s very common for new moms to have lots of emotions with a new baby, and depression is very treatable. We have a lot of resources to help make things better."

In addition to coordinating access to further assessment and treatments after a screening, Dr Marian Earls engages parents with the following brief intervention techniques.

Promote the strength of the mother-infant relationship

Encourage the mother and reassure her regarding any concerns about breastfeeding

Encourage understanding and responding to the infant’s cues

Encourage reading and talking to the infant

Encourage routines for predictability and security, sleep, diet, exercise, and stress relief

Promote realistic expectations and prioritizing important things

Encourage social connections

To read more about how you can improve mental health screening and treatment for new parents at your practice, read this article breaking down AAP’s policy statement and guidance.