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Midwives are more likely than obstetricians to screen new mothers for postpartum depression

Condition can lead to lack of postpartum care

At a time when postpartum depression has increased in the United States, midwives are more likely than obstetricians to check for it, according to a new study by researchers at UC Berkeley School of Public Health.

Women who were cared for by midwives in the state of California in 2016 had 2.6 times the odds of being screened for postpartum depression as women who were treated by obstetricians, the study found.

The Centers for Disease Control and Prevention estimates that one out of every 8 new mothers suffers from postpartum depression, which can be severe. According to a 2019 CDC study, the rate of depressive disorder during delivery increased seven-fold between 2000 and 2015, from 4.1 cases per 1,000 delivery hospitalizations to 28.7 cases. The increases occurred in 27 of 28 states studied.

On August 3, the Food and Drug Administration approved  Zurzuvae, the first oral medication to treat the disease. In announcing its decision, the agency said, “Postpartum depression is a serious and potentially life-threatening condition, in which women experience sadness, guilt, worthlessness – even, in severe cases, thoughts of harming themselves or their child. And because postpartum depression can disrupt the maternal-infant bond, it can also have consequences for their child’s physical and emotional development.”

The BPH research team, led by Althea I. Bourdeau, MPH, found that participants who reported depression or anxiety were less likely to return for a postpartum visit, which, they wrote, was consistent with literature suggesting that depression, including untreated perinatal depression, can lead to poor adherence to medical care.

Writing in Birth, Issues in Prenatal Care, the authors note that the increased responsibilities in caring for a newborn may make it harder for new parents to seek mental healthcare.

“Unfortunately,” they wrote, “this suggests that patients who may already be at increased risk of postpartum depression due to existing mental health concerns are further disadvantaged by missing an important opportunity for screening and intervention.”

The Berkeley Public Health authors suggest that other practitioners who see new parents, such as pediatricians, might provide a safety net by conducting additional postpartum depression screening in the weeks and months after birth.

They also called for future research to analyze postpartum depression screening in other states, to determine whether their results would hold up on a national scale.

Additional authors are Kim G. Harley, PhD, and Angela-Maithy Nguyen, MPH, both of UC Berkeley School of Public Health.