Women in their childbearing year account for the largest group of Americans with Depression.

Postpartum Depression is the most common complication of childbirth.

Postpartum Depression impacts 15-20% of women after birth. Depression occurs during pregnancy too, at a rate of 10-20%

S ymptoms of Depression Trouble sleeping or sleeping too much Lack of interest Feelings of guilt Loss of energy Difficulty concentrating Changes in appetite Restlessness, agitation or slowed movement Thoughts or ideas about suicide

The terms “peripartum” and “perinatal” refer to the period surrounding birth (pregnancy and the postpartum period)

Up to 80% of mothers will experience the “Baby Blues” after the birth of a child. Symptoms mimic mild depression. The Baby Blues go away within 2 weeks without treatment.

Some women are at greater risk: - History of, or family history of depression or mental illness -Greater life stressors -Lack of social support, particularly from a spouse or significant other -Greater Susceptibility to Changing Hormones -Sick/Colicky Babies -Prone to Insomnia

Psychosis can happen in the Postpartum Period. A mom may act strangely, see or hear things that aren't there. This requires immediate treatment by a psychiatrist and is considered an emergency, because it can quickly get worse and put her or others in danger.

The American Academy of Pediatrics has noted that Maternal Depression is the most under diagnosed obstetric complication in America.

“In a short time it’s become quite clear that the Collaborative is a force to be recognized in peripartum mental health.” Laurie Gregg, MD Chair, The American College of Obstetrians and Gynecologists (ACOG), District IX

Postpartum Support International has declared the month of May ‘Maternal Mental Health Awareness” month Internationally.

Other Maternal Mental Health Disorders include: -Anxiety -Obsessive Compulsive Disorder -Post Traumatic Stress Disorder

“When my first son was born I knew there was something wrong with me. My husband was so confused and didn’t know what to do to help. I saw several doctors, then insisted I be admitted to a psychiatric unit. I was there for four days. I slept, and slept.” -Mom, now grandmother

“This is an issue whose time has come.” Caron Post, PhD Executive Director, L.A. County Perinatal Mental Health Task Force

“Almost all quality improvement comes via simplification of design…processes and procedures.” Tom Peters

“If we had only known that my wife was at greater risk for maternal mental illness, we might have made different choices, and she might still be with us today.” Raul Martinez, Husband of late Kelly Martinez

Why aren’t women being diagnosed? Barrier #1: Though there are screening tools (surveys) which have been validated for use during pregnancy/postpartum. There isn’t a ‘perfect’ tool.

Why aren’t women being diagnosed? Barrier #2: Physicians are Challenged OBGYNs say: They don’t feel qualified to screen They don’t have time to screen They don’t know where to send women for help

Why aren’t women being diagnosed? Barrier #2: Physicians are Challenged Pediatricians say: They don’t feel qualified to screen They don’t have time to screen They don’t know where to send women for help Concerned that the mom is not their patient

Why aren’t women being diagnosed? Barrier #3: Moms May Not Speak Up - Moms don’t understand what is happening to them & the impact of untreated depression on the development of their baby -Stigma of Mental Illness/Postpartum Depression -Time constraints, cost of care, unsure where to get help

“If you are going through hell, keep going.” Winston Churchill

“My first born had Downs Syndrome. I was bombarded with support in the hospital, including mental health counseling. When my second was born she was healthy but I was suffering and didn’t know where to turn for help.” CA Mom

“Optimism is essential to achievement and it is also the foundation of courage and true progress.” Nicolas M Butler.

Consideration #1: Shortage of psychiatrists (MDs who prescribe drugs for treatment of mental illness) Looming shortage of primary care physicians, including OBGYNs/Pediatricians

Consideration #2: Greater Awareness can aid in Early Diagnosis and Intervention Moms who understand untreated depression may impact their infant’s health and development are most likely to get help.

Consideration #3: Six Sigma Quality theory suggestions that removing variability (or improving consistency) in systems leads to fewer “defects.” There is substantial variability in our current system.

Consideration #4: We can’t reduce a mom’s risk factors, perhaps with the exception of providing social support, through things like birth classes and mom-and-baby classes.

“ I believe in being an innovator.” Walt Disney

“I remember feeling so weird after getting home from the hospital. I was crying for no reason and exhausted. A nurse from my health plan called me to check in, and she new immediately that I could use some help. She helped me find a therapist and checked in with me from time to time.” Customer, Western Health Advantage