California Gov. Jerry Brown signed a package of new laws that aims to the way postpartum depression is treated and screened in expecting mothers by increasing awareness, screening, and funding for treatment of maternal mental health disorders. Up to 1 in 7 women experience postpartum depression after pregnancy, according to the American Psychological Association, and the California Department of Public Health estimates this rate is 1 in 5 California. The rates are much higher among women living in poverty and California has some of the highest poverty rates in the country. Many pregnant mothers do not receive prenatal care or when they do, their mental health is not assessed. New mothers suffering from depression are less likely to breastfeed or have strong attachment to their babies, and the risk of suicide increases. Many expecting mothers or new moms are terrified to seek help for their depression symptoms out of fear their baby may be taken away. Stigma associated with postpartum mental illness has lead to decrease awareness and lower access to treatment. One of the many reasons why physicians do not screen for depression in pregnancy is because they do not know what to do with the patient if they screen positive.

As a result, California has increased laws that require the state department of public health to seek out more funding for maternal mental health from the federal government. The second law requires that hospitals educate their obstetrical and postpartum staff about postpartum depression, and also provide information about symptoms and treatment options to the women under their care. The third in the package is the most substantial. It requires practitioners who see women before and after pregnancy, whether it is a doctor, nurse practitioner or midwife, to screen for maternal mental health conditions.

Postpartum blues

Postpartum blues is similar to a mild depression meaning that symptoms usually peak on the 4th or 5th day after delivery and only last for approximately 2 weeks in duration. The symptoms include rapidly fluctuating mood, tearfulness, irritability, and anxiety and do not interfere with the mother’s ability to function and care for her newborn child. These symptoms are mild in severity and usually resolve spontaneously without any treatment.

Postpartum depression

Postpartum depression is more persistent and severe than postpartum blues and often interferes with the mother’s ability to care for herself and her newborn child. Postpartum depression occurs in approximately 10-15% of the female general population and develops most commonly in the first four months following delivery however it can occur anytime in the first year after delivery and therefore this disorder often goes unrecognized by many individuals including mental healthcare professionals. The risk of recurrence for postpartum depression is 25% and the signs and symptoms are indistinguishable from major depressive disorder. These symptoms include depressed mood, tearfulness, recurrent thoughts of death, insomnia, fatigue, feelings of guilt, poor concentration, appetite disturbance, suicidal thoughts, and lack of interest.

Postpartum Psychosis

Postpartum psychosis is the most severe illness on the postpartum mood disorder spectrum and occurs very rarely affecting approximately one to two per 1000 women after childbirth. Symptoms include mania, disorganized behaviors, delusional beliefs, depressed mood, irritability and thoughts about harming the infant or committing suicide. These symptoms usually present within the first two weeks after delivery and can present as early as two or three days after giving birth. Inpatient hospitalization is required in order to prevent harm to the mother and the baby. Medications include antipsychotics and mood stabilizers and studies have shown that electroconvulsive therapy (ECT) is well tolerated and rapidly effective.