Mixed Feelings About Postpartum Depression Screening

One of our local advocacy groups for parents just posted this NPR story on Facebook: “Depression Screening Recommended for All Pregnant Women, New Mothers”:

Pregnant women and new mothers need more attention when it comes to screening for depression, according to recommendations issued Tuesday by the U.S. Preventive Services Task Force.

That came as part of the panel’s recommendation that all adults should be screened, in a situation where they can be provided treatment or get a referral if they are clinically depressed.

The announcement follows similar recommendations in 2002 and 2009. What’s new this time is the special shout-out for pregnant women and new moms. They need special recognition, the task force says, because of evidence showing that they can be accurately diagnosed and successfully treated, and because untreated depression harms not only the mother, but her child as well….

This is all true but incomplete. I get anxious when screening is recommended without discussion of the stigma surrounding the diagnosis. It reminds me of the controversy over mandatory HIV testing for pregnant women. The Task Force’s proposal should have been accompanied by recommendations to educate health care providers so they won’t view depressed moms as an automatic danger to their kids, or as too irrational to make the informed choice to refuse certain treatments.

I learned the hard way to keep my struggles to myself during our adoption process. Our first application, to adopt internationally, was denied because the South Korean government decided that anyone who had been in psychoanalysis must be crazy. Then we hooked up with an unethical domestic adoption agency that labeled me with a “personality disorder” based on my stress responses to growing up with domestic violence and emotional incest. Our home study was denied when I refused to continue with the agency’s preferred therapy method because it was causing me to dissociate. By the time we had our 3-month post-placement interview (with a different agency), in the middle of a massive PTSD flare-up, I knew enough to smile sweetly and say I was fine when the caseworker handed me the info sheet on support for postpartum depression. Then I got on the phone to my best survivor gal pal (I think I called her from the bathroom floor where I was sobbing and holding a cow-shaped plush rattle) and got a referral to the trauma therapist who turned my life around. You can bet I didn’t come out as a survivor on this blog till our adoption was finalized in court.

And I’m white, straight-ish, and middle class. Moms who contend with racial prejudice or economic dependence on the government have even more to lose if a negative mental health diagnosis goes in their files. Stereotypes about black families lead Social Services to snatch kids for trivial offenses, like the mom who let her child play at the park unsupervised.

New mothers’ depression isn’t just a medical issue, it’s a political one. I hope that future studies recommend training health care providers to overcome sexism and ableism, so they can empower all moms to do our best.

For further reading, check out the website of feminist literary publisher Kore Press for this conversation among five women writers of color about postpartum depression, race, and culture.

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