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Local health systems back national call to counsel new and expectant moms

Feb 15, 2019

 

A federal task force has announced new recommendations that encourage health care workers to refer many women who are pregnant or have just given birth to mental health counseling.

Local health care systems said they were already following the recommendations, published this week by the U.S. Preventive Services Task Force.

The task force, self-described as "an independent, volunteer body of experts in primary care and preventive medicine," printed its new advice in the Journal of the American Medical Association.

“We’ve known for a long time that it’s important to address depression during the perinatal period,” said Ellen Poleshuck, an associate professor in both the psychiatry and OB/GYN departments at the University of Rochester Medical Center.

Precise definitions of that time period vary, but generally, it spans the beginning of a pregnancy through a child’s infancy.

Poleshuck said the recommendations are an acknowledgement that women are at an elevated risk for depression during that period, and that for some women, the risk is higher still.

“Those are women with a history of depression, currently have depressive symptoms that might not quite qualify for a diagnosis of depression yet, or have risk factors such as low income, or a lack of social support, or being a mother,” Poleshuck said.

A children's room at Rochester Regional Health's St. Mary's campus allows new mothers to drop off young children to attend counseling programs aimed at preventing perinatal depression.

Erin Pixley-Thurston manages perinatal programs at Rochester Regional Health. She said the health system’s approach has long been to refer women for counseling if they show those risk factors.

“It gives you a chance to problem-solve. It gives you a chance to develop coping skills,” Pixley-Thurston said. “They’ll teach women different ways to deal with what’s going on – healthy ways – so that they don’t turn to things like drugs and alcohol.”

Despite years of research and public education efforts around perinatal and postpartum depression, Pixley-Thurston said many people, including new and expectant mothers, still carry outdated ideas about how they should feel.

“The moms are just beating themselves up when they have any sort of feeling that’s anything less than joy when it comes to thinking about their baby,” she said. “Just a lot of guilt and shame that comes along with that. We work really hard to say, ‘It’s OK. It’s normal, even.’ ”

Poleshuck said the new recommendations are “fundamentally pretty simple”: Clinicians should talk about depression with women who are at risk of becoming depressed.

“One would think it would be obvious,” she said. But “it’s not always the way our health care system works.”

Generally, Poleshuck said, the health care system is reactive. Doctors do not intervene until a problem has been diagnosed.

That’s why she’s looking forward to seeing the impacts of these new recommendations.

“It is exciting to think about, ‘What could we do to keep the problem from happening in the first place?’ ”