A recent UC Berkeley School of Public Health study found that midwives are more likely than obstetricians and gynecologists, or OB-GYNs, to screen patients for postpartum depression, or PPD, despite having similar guidelines for addressing the illness.
The study was published in July after more than two years of research by Berkeley Public Health team leader Althea Bourdeau and co-authors Kim Harley and Angela-Maithy Nguyen.
Postpartum depression affects one in eight people who give birth, a Centers for Disease Control and Prevention, or CDC, study found in 2018. When detected, PPD is highly treatable, Bourdeau explained.
“I try to really hit home in this paper that screening is only useful if there are also robust referral and treatment pathways for people with a positive screen; the screening process itself is just the first step in potentially saving a life,” Bourdeau said in an email.
While the CDC recommends universal screening for the condition, Bourdeau found that screening for postpartum depression is far from universal. In fact, there are a number of reasons PPD goes undetected.
Perhaps highlighted most in the study were the discrepancies found between the different types of doctors survey participants had.
According to the study, respondents with midwives rather than OB-GYNs had “2.6 times the odds of reporting being screened for PPD.”
While differences in guidelines can account for why midwives screen for PPD more than other doctors such as Advanced Care Practitioners, the study could not account for why midwives screened for PPD more often than OB-GYNs. Midwives and OB-GYNs both receive clear guidelines about PPD from their regulatory boards.
Bourdeau noted in the email that “41.5% of (midwives’) patients were White vs. 27.5% of OB-GYNs’ patients,” meaning that white patients had more access to screening for PPD.
“Non-White birthing people are less likely to be screened for PPD and more likely to suffer the consequences of the disease going untreated,” Bourdeau said in the email. “It is imperative that all types of providers understand their own biases and that (they) prioritize equitable screening and treatment.”
To conduct the study, Bourdeau noted that she used public data from Listening to Mothers in California and looked at data from Californians who gave birth in 2016.
The study also found that younger patients, less educated patients and those without private insurance were less likely to have postpartum appointments.
By not receiving postpartum care, nearly 9% of surveyed patients had no opportunity to be screened for PPD.
Patients with feelings of anxiety and depression were another group less likely to go to postpartum appointments in weeks following delivery.
“Even if providers are screening every patient that comes to their office postpartum, it’s important to note that because people with anxiety and/or depression during pregnancy are less likely to return for postpartum care, they are still likely to get missed,” Bourdeau said in the email.