In last week’s post I wrote about the limitations of current postpartum depression screening guidelines. On that note, I am very honored this week to feature one of my favorite guest contributors, Dr. Julie Bindeman. Dr. Bindeman’s piece addresses some of the challenges faced in differentiating and assessing postpartum depression versus grief after a perinatal or neonatal loss. One of the problems, which Dr. Bindeman elaborates on below, is of proper screening and assessment following loss. Dr. Bindeman’s words are below.
We’ve heard the story of a new mom beset by overwhelming feelings of inadequacy, sadness or anxiety in the days and weeks following the birth of a baby. Our culture has started to hold in our vernacular terms like “post partum depression” or “post partum anxiety” to describe the most common complication of childbirth in the United States. What continues to be hidden from us is a context to understand the emotional state of a new mom that doesn’t have a baby to show for her efforts: the mom whose baby died.
When a person experiences the death of a loved one, grief is an expected reaction. Some token family leave might be given at work, hoards of flowers and food might flood the bereaved and friends or acquaintances might express sympathy. This may or may not happen after the death of a baby, especially if that baby was still gestating. Typically, after initial sentiments are shared, the event is forgotten by all except for the family who was anxiously awaiting this arrival. When this mom returns to work or re-emerges in the world, there is an expectation that she leaves her grief behind. She must weep behind closed doors and approximate a semblance of “normal”, partially because few people respond well to her tears or know what to do with such an emotional display.
It is interesting that most women who lose a baby aren’t also assessed for a perinatal mental health disorder. The conventional wisdom is that whatever she might be feeling is grief. This is a mistake made by many well-intentioned health care professionals, as a woman managing perinatal grief might ALSO be managing an undetected postpartum mental health disorder simultaneously. Teasing out between the two takes time and patience, but is worthwhile so that this sect of the postpartum community is getting the help that she deserves.
Time is one of the essential factors, so screening a woman two weeks post loss (which is when a normal medical follow-up occurs) might mischaracterize her grief as depression, given that the symptoms of sadness persist in both. Often, grieving women will endorse positively a postpartum depression survey question about not wanting to live—it is essential to differentiate whether this is active suicidal ideation or the longing to be with the lost baby and escape the intense and painful feelings. Depression is an illness where its symptoms do not remit until treatment starts to work. However, with grief, feelings of sadness aren’t a constant as some time passes (typically, within the first month, grieving people report small moments of relief from their sadness, but do not report experiencing happiness).
Most women will not have follow-up medical care following a loss after the initial visit, which means that they are often not screened as time passes. Typically, they don’t return to an OB’s office until they are contemplating or experiencing conception. This lack of follow-up provides a disservice to grieving women who might be experiencing depression. Often times, a common fantasy that is created by a bereaved person is that their grief will subside once pregnancy is achieved again, and many are surprised when this occurs without the wave of relief.
The bottom line: if you have experienced a perinatal loss, and six months after your loss you do not even have moments of relief, please seek out the care of a knowledgeable mental health provider that can assist in determining if depression is co-existing with grief.
Dr. Julie Bindeman graduated from the George Washington University and is the co-owner of the practice Integrative Therapy of Greater Washington located in Rockville, Maryland. As a result of her own reproductive story, she pursued post-graduate training in the field of Reproductive Psychology, where she actively writes, lectures, and presents on the topic. She has been on several committees for the Mental Health Professional Group of the American Society for Reproductive Medicine including serving as Chair of the Continuing Education Committee and on the Social Media committee; she served as a Board Member of the Maryland Psychological Association for 8 years, and was the first Early Career Psychologist Committee Chair; and has been on other boards such as Uprooted and JCADA. Additionally, Dr. Bindeman is a member of a variety of organizations that are focused on Maternal Mental Health. She was appointed by the Governor of Maryland to serve on the Maternal Mental Health Task Force representing psychologists in the state. In 2014, Dr. Bindeman was honored to receive both the Woman Who Dared Award conferred to her by the National Council of Jewish Women and the Volunteer of the Year Award from the Maryland Psychological Association.
For more info on Dr. Bindeman check out