What to Expect During Your Postpartum Depression Screening

When I had my second baby, I felt fine immediately after giving birth. Great, actually. I wasn't sore, I was full of that post-birth oxytocin rush, and I was raring to go. My midwife had to remind me that my body had just been through a major event, and I needed to treat it with TLC. I was told, firmly, to rest, to avoid stairs when possible, and to allow my body to recover. And at the time it made sense—my body had birthed a human!

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But the birth of my first child was very different than my second. And in those early postpartum days, it wasn't my body I was worried about recovering—it was my mind. I was in labor for 34 hours, three and a half of which were pushing. My baby was face up and required a lot of very painful procedures to get him out—ones that left me scarred both physically and mentally. I remember turning to my husband the following day and saying, "I think I might be traumatized."

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Yes, birth is serious for a parent's body—but we can't ignore the mental impact. "Postpartum depression is more common than many may think," says Sara Ramirez, M.D., OB-GYN with Mission Hospital in Mission Viejo, California. "According to studies, approximately 50 to 70 percent of women experience 'baby blues' after delivery. This condition usually goes away without treatment about two weeks after birth. Around 1 in 9 new moms will develop a more severe and longer-term form of depression, where there are prolonged periods of highs and lows, along with frequent bouts of crying, irritability, feelings of guilt, anxiety, and an inability to care for your baby or yourself."

Recognizing the need to address a parent's well-being, medical professionals have started incorporating a screening for postpartum depression(PPD) into physical postpartum check-ups—most commonly using the Edinburgh scale. And while there is zero pressure to "pass" this test for PPD (again, many don't) there are ways to be sure you benefit the most from it. Here's what to know.

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What Is the Edinburgh Postnatal Depression Scale?

"The EPDS is a screening tool that can help health care providers determine whether a new parent has symptoms that indicate postpartum or perinatal depression," says Mary T. Jacobson, M.D., OB-GYN and chief medical director at Alpha Medical. The parent is asked to respond to the questions in the following ways: "yes, all the time," "yes, most of the time," "no, not very often," or "no, not at all."

The scale's 10 questions are:

1. I have been able to laugh and see the funny side of things
2. I have looked forward with enjoyment to things
3. I have blamed myself unnecessarily when things went wrong
4. I have been anxious or worried for no good reason
5. I have felt scared or panicky for no very good reason
6. Things have been getting on top of me
7. I have been so unhappy that I have had difficulty sleeping
8. I have felt sad or miserable
9. I have been so unhappy that I have been crying
10. The thought of harming myself has occurred to me

A medical professional will make an evaluation by assigning each response a number. "The maximum score is 30. If you have a score of 10 or greater, you might have postpartum depression and should be screened further," says Dr. Ramirez. "Additionally, your doctor will pay close attention to your response to the final question—the thought of harming myself has occurred to me—as it could be a sign of suicidal thoughts."

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In addition to facilitating getting help for PPD, the screen can help a parent feel validation about their emotions. "A lot of the stress is just related to lack of sleep, difficulty with breastfeeding (which is a huge contributor), and lack of help from husbands/family and occasionally too much family interference," says Erika Nickelson, D.O., OB-GYN in Baltimore. "Often if the patient can bring her concerns to the doctor, then she can go back home and say 'the doctor said I need to (fill in the blank)' and they don't look like the 'bad guy' in the scenario."

Who Administers the Screen and When?

While the screen is self-reported, it should be given by a medical professional such as a doctor, nurse, or midwife. This helps to ensure the test is evaluated properly and resources are given if needed. Most commonly, it is administered at one or more of the postpartum appointments in the first six weeks after birth, but some care providers also use it throughout pregnancy and/or at well-baby appointments through the first year.

If the screen suggests postpartum depression may be present, the care provider will recommend next steps such as further screening, referrals to mental health specialists, medication, and support groups.

Does the Screen "Work"?

The EPDS is recognized as an accurate and useful tool for recognizing people who are experiencing or at risk for postpartum depression—but its effectiveness is only as good as its application. We talked with both experts and real moms about the factors that impact the effectiveness of the PPD test so you can be prepared to be your biggest advocate throughout the process:

Barriers to Getting Care

"While many mothers in healthy, supportive situations can be screened as part of their postnatal appointments, an alarming 40 percent of women do not attend these follow-up visits," says Dr. Jacobson. "These women tend to be poor and women of color. They represent the highest at-risk population for having a mental health condition that, if untreated, can create a high-risk situation for the child."

What you can do: Don't opt out of any postnatal appointments. If you are pregnant or have a new baby, make it part of your plan to make your mental health as big a priority as your physical health.

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The Screening Environment

The environment in which the screen takes place can also play a factor. Mom Jane Dello [name changed by request] suggests care providers spend some time with the parent alone. "I remember that I was so focused on my newborn that I basically responded 'yeah, yeah, I'm fine.' I wonder if someone had spent a little more time dedicated to me—literally if they had taken my partner and baby in another room for ten minutes—if I would have said something else."

What you can do: Request your PPD screening be conducted at a time when you can have a one-on-one conversation without distractions.

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Patient and Provider Follow-Up

"For my first baby, I most definitely failed [the screen]," says mom Lizzie G., who endured a traumatic labor that started with four hours of pushing and ended on the operating table. "I was devastated afterward. I couldn't connect with my baby, cried all the time, and was convinced my newborn did not even like me." Still, Lizzie admits what happened after she failed her PPD test wasn't ideal. "I was told [I didn't pass] by my midwife, who then asked me if I would like to be referred for counseling/therapy and I declined, downplaying the results as part of my general anxiety disorder."

What you can do: It's of the utmost importance for parents to be honest with themselves and their care provider during this process. Lizzie feels she would have benefitted from another screen in the following weeks and more offers of resources with encouragement to use them.

For help, call the Postpartum Support International helpline at 1-800-944-4773 or send a text to 503-894-9453.