PPD: What Does It Mean? And How Do You Diagnose It? [Mental Health Awareness Series #1]

The other day I met a woman who inspired me. She was a Haredi (ultra-orthodox) woman in her 40’s who had two children. As this is surprising in the religious community, I wondered if this was by choice or she had fertility challenges. It turns out that she had suffered such severe post-partum depression that her Rabbi (and her psychiatrists) strongly urged her not to have more children. I thought to myself, “wow, when every now and again, we hear stories of women who killed themselves and/or their children in the midst of a severe postpartum mental health issue, we are saddened, disturbed, fearful. But here is a woman who knew that getting pregnant would pose enough of a serious health threat to her, and thus endanger the lives of her current children, that she did not cave to strong societal pressure or her own overwhelming maternal urge but put that aside for her well being and that of her family’s.

What is post-partum depression? And how do you diagnose it?

To quote myself in a post from last year after the tragedy in Jerusalem:

“Post-partum depressive order, which includes anxiety, panic, and obsessive-compulsive disorders, are also technically considered post-partum if they are diagnosed within four weeks of delivery. However, most providers agree that if an incident occurs within one year of delivery/pregnancy, it’s post-partum related.”

Statistically, 1 out of every ten women who give birth will suffer some type of postpartum depression that needs to be treated. While we do not know the origins or cause of PPD, we do know that some women seem to have a propensity for developing it, as revealed in an Israeli study that found women’s who had PPD in the past, even when they no longer had clinical symptoms, had a different gene expression than those women who had never reported PPD. This discovery shows us that there is a group of susceptible women, who, once they develop the illness are much more susceptible for it to recur.

Tipat Chalav nurses have been trained to identify women who may be suffering from PPD, according to guidelines of a mandatory training. However, the success of this plan obviously depends on the authenticity and expertise of the nurse and the openness, and self-awareness of the mother.

In 2014, the Ministry of Health updated their policy regarding identifying women with possible PPD to the following. All women, from the 26th week of pregnancy on, and during 6-8 weeks postnatally, should be evaluated by a doctor and/or nurse using the official Edinburgh Postnatal Depression Scale, the gold standard in easy evaluation of a woman’s mental health. I don’t know about you, but I don’t remember any doctor asking me anything about my mental health.

It does seem that there is change, however.  According to one researcher in the field who’s been lobbying for change, the Ministry of Health just announced at a recent conference an extensive three year project to improve Tipot Halav and work with families with children during the first year of life and Bituach Leumi announced they were starting to think about allowing Nechot Klalit to provide compensation to mothers with PPD who have a diminished work capacity because of the illness.

What other policy changes do you think we should make?

 

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