What Really Happens When You Fail a Postpartum Depression Screening

One mom shares what she learned about the limitations to postpartum support after failing the Edinburgh Postnatal Depression Scale screening.

Woman sits in living room with newborn

Anchiy / Stocksy

I remember the day I rolled into my son’s eight-week checkup clearly and distinctly. I was tired and haggard and leaking from every orifice. I struggled to get his large jogging stroller up the ramp and through the swinging glass doors. Just as I got settled in, he began to cry. My nerves were shot. I was overwhelmed. But then I heard the nurse call out for me, H’s mom.

Relieved, I gathered up my belongings—and my son—and headed to meet her. At least, I thought, we don’t have to wait. But instead of taking us back, she handed me a clipboard and several papers. 

“We just need you to fill these out, Mom.”

Now, I cannot tell you what all those papers were. One may have been a lead screening. I remember completing those. One may have asked about his insurance or other personal data, but the final one was for (and about) me. I had been handed the Edinburgh Postnatal Depression Scale screening.

Ironically, this was my first time taking “the test”—in spite of this being my second baby. I was a bit taken aback and, admittedly, frazzled. I was trying to soothe a hungry newborn, after all, and steady my nerves. So I answered each question quickly and swiftly, giving only a few more than a second thought. But the ones that did give me pause did so for obvious reasons.

“In the past seven days, I have been so unhappy that I’ve been crying.”

“In the past seven days, I have felt sad or miserable.”

“In the past seven days, the thought of harming myself has occurred.”

Do I answer these questions honestly, I wondered? Do I be transparent and forthcoming and hope things change? And what do these answers say about me—and my parenting? I worried what the office would do with my responses. Would being “real” put me at risk of losing my child? 

I stared at the paper blankly while my mind raced. I didn’t know if this would get me the help I need or cause me harm. Ultimately, though, I opted for honesty. I hoped someone would ask how I was doing. I wanted, heck yearned, for someone to care and ask how they could help. 

Unfortunately, “failing” didn’t mean much. My son’s pediatrician mentioned her concern, swiftly and casually. She asked if I was speaking to someone, a counselor or therapist. Did I have a psychiatrist? And then she sent me on my way, not with a list of referrals and recommendations but with the suggestion I seek help. She said I may want to talk to someone. 

Of course, I don’t fault her for her response. She was my son’s pediatrician, after all, not my OB-GYN, doctor, or other health care provider. She was also (more likely than not) untrained in how to have a thorough discourse on this topic—and that’s part of the problem.

“The Edinburgh Postnatal Depression Scale (EPDS) is a screening tool, not a diagnostic one,” says Annia Raja, a licensed clinical psychologist in private practice in Los Angeles with specialized training in maternal mental health. “While a positive result on the EPDS may suggest that a person is at increased risk for postpartum depression, additional evaluation by a qualified health care provider is needed to make a diagnosis and develop a treatment plan,” a point which Elyse Rubio, part of the medical review board at Women’s Health Interactive and Roots of Loneliness Project, agrees with.

“Even though effective screening tools, like the EPDS, are available, rates of screening are low and providers often fail to follow through with appropriate intervention and referral to treatment,” Rubio says. “THE EPDS is just a tool, a jumping off point; it should not be the beginning and end of the discussion.” 

Another “problem” with the EPDS is that the information on it is self-reported, and this can lead to inaccuracies or flaws. 

“Some people underreport their symptoms due to fear of stigma or other reasons,” says Becca Smith, the chief clinical officer at Basepoint Academy in Dallas, Texas. 

“Some parents are so afraid that if they fill out the test truthfully, their children would be taken away,” adds Susan Hatters-Friedman, a professor of psychiatry at Case Western Reserve University. “As such, the screening will only pick up cases of postpartum depression if the person completing the test about themselves reports truthfully.”

The test is also only administered to the birthing parent—if it’s given at all—and, as we now know, both female- and male-indentifying partners can get postpartum depression, anxiety, and/or other-like disorders. 

In my case, I was lucky. I had resources available. I was able to (immediately) pull together a care team. But not everyone is as fortunate as I am. 

Providers are hard to come by in America, with many being overwhelmed and overworked. In some regions, accessibility is an issue. Individuals simply do not have access to appropriate mental health care. Making time is also a limitation many new parents face, i.e. in order to see a psychologist, psychiatrist, and/or counselor, you need to have child care. And insurance issues abound—if you have insurance at all.

The good news is that there is still help. There is still hope. Resources are available for parents with diagnosed (or suspected) postpartum mood disorders.

Resources for Support

  • Postpartum Support International: Postpartum Support International (PSI) provides peer support and offers online support groups. They also have a helpline for free, 24/7 support: 1-800-944-4773. 
  • National Maternal Mental Health Hotline: The National Maternal Mental Health Hotline provides support before, during, and after pregnancy. Simply call or text the free and confidential hotline (1-833-943-5746) for assistance, support, and help.
  • Crisis Text Line: Free and completely confidential, Crisis Text Line offers SMS mental health services to anyone "in crisis." Simply text "HOME" to 741-741 to connect with a trained counselor.
  • National Suicide Prevention Lifeline: This 24/7 service is free and available to anyone in suicidal crisis or emotional distress. Call 988.

Of course, these helplines, hotlines, and support groups are no replacement for thorough mental health care, especially if you're experiencing intrusive thoughts and/or thoughts of self-harm. People should seek help immediately or call 9-1-1 if they're having active thoughts of suicide. Still, they are great places to start. These trained professionals may also be able to offer you guidance and insight and help you find the support you need.

Learn More About Taking Back Your Fourth Trimester

Experts share more on how to take back your fourth trimester. Here, read Parents' guide to self-advocacy during postpartum and learn how communities can come together as support systems.

Was this page helpful?
Related Articles