Pediatricians are in a unique position to identify and intervene when postpartum depression (PPD) symptoms appear in new moms. At a time when awareness of mental health issues is increasing and associated stigma is decreasing, taking time to address this with new mothers is essential. Although many pediatricians do weave postpartum depression screenings into their visits, this condition is still overlooked in too many practices – here’s how to ensure these vital screenings are a pillar of newborn visit workflows.
Depression in New Parents: Always Ask
It is hard to say how many new parents don’t report symptoms of postpartum depression, which can appear in birthing and non-birthing parents, including in adoptive parents. A key 2006 study estimated that up to 50% of women did not report depressive symptoms to their child’s pediatrician or to their primary care physician.
The Cleveland Clinic reports that “Ten to 20 percent of the approximately 4 million women who give birth each year in the U.S. experience postpartum depression… Yet research shows that fewer than half of all affected mothers receive a mental health diagnosis, and only 15% of those who do receive a diagnosis seek mental health services.”
Despite these facts, postpartum depression is both under-recognized and undertreated. That said, screening alone is often not enough. It is important that pediatricians have follow up conversations with women whose screening results are positive for PPD.
What is Postpartum Depression?
Postpartum depression is a condition that affects some women in the months after giving birth. According to the American Academy of Pediatricians (AAP),
“PPD affects 10-25% of mothers, making it the most common underdiagnosed obstetric complication. Nationally, it is estimated that every year, more than 400,000 infants are born to mothers who are depressed.”
The depression some women can experience after having a baby falls into 3 categories: postpartum blues, postpartum depression, and postpartum psychosis. Each category has symptoms with varying degrees of intensity. According to the American Psychological Association (APA),
“It’s common for women to experience the “baby blues” — feeling stressed, sad, anxious, lonely, tired or weepy — following their baby’s birth. But some women, up to 1 in 7, experience a much more serious mood disorder — postpartum depression. (Postpartum psychosis, a condition that may involve psychotic symptoms like delusions or hallucinations, is a different disorder and is very rare.) Unlike the baby blues, PPD doesn’t go away on its own. It can appear days or even months after delivering a baby; it can last for many weeks or months if left untreated.”
A 2016 article published in the Maternal and Child Health Journal says,
“Postpartum depression is associated with impaired bonding and development, marital discord, suicide, and infanticide. However, the current standard of care is to not screen women for postpartum depression.”
Thankfully, since 2016 standards of care have been steadily moving towards implementing postpartum depression screenings at newborn visits as well as follow up visits. Pediatricians recognize that this intervention is not only crucial to support the health of the infant, but the health of the family. The AAP states:
“Pediatricians have the greatest opportunity of encountering the infant and caregivers regularly. Therefore, we have a responsibility to screen mothers for PPD and offer the most appropriate resources.”
Screening for Postpartum Depression
The AAP recommends universal surveillance and screening of postpartum depression by pediatric care providers, and national health quality measures now include maternal depression screenings. Fortunately there are several ways to help incorporate PPD screenings into your existing workflows.
Many pediatricians use the Edinburgh Postnatal Depression Scale (EDPS). Typically, this 10-question screening tool will be filled out by new moms at 2-4 weeks post-birth as well as at the 2, 4, and 6-month marks. This tool is available as a questionnaire in CHADIS, which PCC practice can integrate into their EHR at no additional cost.
Beyond the Exam
While physicians are skilled diagnosticians, pediatricians have unique skills in undertaking the compassionate conversations that may, more often than not, reveal health concerns under the surface. Often, new moms may appear to be just fine, but a more detailed conversation can reveal symptoms of PPD. Just a few of the questions a pediatrician can ask a new mom:
- Are you feeling especially sad or down lately?
- Are you feeling particularly anxious?
- Do you have recurrent thoughts or fears around the baby?
- Do you have trouble falling or staying asleep?
There are many resources available for pediatricians wishing to learn more about PPD, including some from the AAP and online collectives like postpartum.net, and the AAFP (American Association of Family Physicians).
When asked what she would say to a pediatrician who does not yet provide PPD screenings, PCC client Dr. Vineetha Alias from Watchung Pediatrics in New Jersey says:
“Initially when starting the screening process in our office, there were several concerns about how time consuming it would be and if it was really necessary. However, we’ve realized that addressing any depression issues with mom early on is greatly beneficial to the child. It prevents other issues down the road that are more cumbersome to deal with than a quick screening tool in the office.”
What Else Can Pediatricians Do for Postpartum Depression?
In addition to routine screening, pediatricians can have resources ready for parents in need. These might include informational handouts about PPD, a strong referral network to mental health counselors and local groups such as new mom groups where parents can share their experiences with others going through the same challenges.
Code, Bill, and Get Paid for Postpartum Depression Screenings
Whether or not a pediatrician gets paid for providing PPD screenings is largely payer and/or state-specific. Private payers may or may not cover this service, and at varying rates. Whether or not they get paid for PPD screenings, many pediatricians choose to provide this care for new moms. As PCC client Dr. Kevin Wessinger of the South Carolina Pediatric Alliance says,
“It [PPD screening] is quick and easy to do, improves care for the baby, and generates a little bit of revenue for the practice… a win/win/win.”
Pediatricians commonly use a modifier in the appropriate CPT code to indicate that the service for “postpartum depression screening” is distinct from “1 month visit”, for example. Be sure also to code appropriately to indicate that the patient is not the infant, but mom or dad.
How a Pediatric-Focused EHR Can Help
When a pediatrician uses an EHR built specifically for their branch of medicine, it becomes very easy to incorporate PPD screenings into a well-visit. For example, PCC’s EHR has the capability to build an order for the Edinburgh Postnatal Depression Scale (EDPS) Screening Tool right into a well-visit protocol. Results from the screening can be entered right into the chart. And with that, PPD screening can easily and seamlessly become a routine part of newborn well-visits.
We are at a critical time for the recognition and treatment of postpartum depression. Research shows more and more that PPD impacts more than just the new mom; there can also be consequences for the child’s brain development. With a pediatric-focused EHR, pediatricians can easily incorporate these important screens. It’s good for patients, families, and the practice. Dr. Alias says it best:
“Everyone dotes on a mother while she is pregnant, but then focuses on the baby after he/she is born. They forget that this woman has just gone through a major life event that has taken a toll on her health, physical appearance, hormones, career, relationships, etc. We need to factor that into our care of the newborn as it directly impacts the child.”
Mental health resources at your practice can extend beyond screenings for parents. Learn how to integrate behavioral health at any budget with PCC’s ebook below.
Editor's note: This blog post was originally published in 2018, and has been updated to reflect current resources for postpartum depression care.
