[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H. Res. 163 Engrossed in House (EH)]
In the House of Representatives, U.S.,
October 10, 2000.
Whereas postpartum depression is the name given to a wide range of emotional,
psychological, and physiological reactions to childbirth including
loneliness, sadness, fatigue, low self-esteem, loss of identity,
increased vulnerability, irritability, confusion, disorientation, memory
impairment, agitation, and anxiety, which challenge the stamina of the
new mother suffering from postpartum depression and can intensify and
impair her ability to function and nurture her newborn(s);
Whereas as many as 400,000 American women will suffer from postpartum depression
this year and will require treatment. This constitutes up to 20 percent
of women who give birth. Incidence of mild, ``transitory blues'' ranges
from 500 to 800 cases per 1,000 births (50 to 80 percent);
Whereas postpartum depression is the result of a chemical imbalance triggered by
a sudden dramatic drop in hormonal production after the birth of a baby,
especially in women who have an increased risk. Those women at highest
risk are those with a previous psychiatric difficulty, such as
depression, anxiety, or panic disorder. Levels of risk are greater for
those with a family member suffering from the same, including
alcoholism;
Whereas women are more likely to suffer from mood and anxiety disorders during
pregnancy and following childbirth than at any other time in their
lives. 70 to 80 percent of all new mothers suffer some degree of
postpartum mood disorder lasting anywhere from a week to as much as a
year or more. Approximately 10 to 20 percent of new mothers experience a
paralyzing, diagnosable clinical depression;
Whereas many new mothers suffering from postpartum depression require counseling
and treatment, yet many do not realize that they require help. It is
imperative that the health care provider who treats her has a thorough
understanding of this disorder. Those whose illness is severe may
require medication to correct the underlying brain chemistry that is
disturbed. This often debilitating condition has typically been a silent
condition suffered privately by women because of the feelings of shame
or guilt;
Whereas postpartum depression frequently strikes without warning in women
without any past emotional problems, without any history of depression
and without any complications in pregnancy. Postpartum depression
strikes mothers who are in very satisfying marriages as well as those
who are single. It strikes women who had easy pregnancies and
deliveries, as well as women who suffered prolonged, complicated labors
and caesarean section deliveries. Symptoms may appear at any time after
delivery, often after the woman has returned home from the hospital. It
may strike after the first, third, or even fourth birth;
Whereas postpartum depression is not a new phenomenon. Hippocrates observed the
connection between childbirth and mental illness over 2,000 years ago.
Louis V. Marce, a French physician, detailed the identifiable signs and
symptoms of postpartum depression in 1858;
Whereas the most extreme and rare form of this condition, called postpartum
psychosis, hosts a quick and severe onset, usually within 3 months. 80
percent of all cases of this more extreme form present within 3 to 14
days after delivery with intensifying symptoms; once suffered recurrence
rate with subsequent pregnancies is high;
Whereas postpartum mood disorders occur after the mother has had frequent
contact prenatally with health care professionals who might identify
symptoms and those at risk. In the United States, where medical
surveillance of new mothers often lapses between discharge from the
hospital and the physical checkup 6 weeks later, the recognition of
postpartum illness is left mainly to chance. The focus of the 6-week
checkup is on the medical aspects of her reproductive system and not her
mental health;
Whereas having a baby often marks one of the happiest times in a woman's life.
For 9 months, she awaits her child's birth with a whole range of
emotions ranging from nervous anticipation to complete joy. Society is
quite clear about what her emotions are expected to be once the baby is
born. Joy and other positive feelings are emphasized, while sadness and
other negative emotions are minimized. It is culturally acceptable to be
depressed after a death or divorce but not by the arrival of an infant.
Because of the social stigma surrounding depression after delivery,
women are afraid to say that something is wrong if they are experiencing
something different than what they are expected to feel. Mothers are
ashamed, fearful, and embarrassed to share their negative feelings and
can also be fearful of losing their babies;
Whereas treatment can significantly reduce the duration and severity of
postpartum psychiatric illness;
Whereas postpartum depression dramatically distorts the image of perfect new
motherhood and is often dismissed by those suffering and those around
her. It is thought to be a weakness on the part of the sufferer--self-
induced an self-controllable;
Whereas education can help take away the ``stigma'' of postpartum depression and
can make it easier to detect and diagnose this disorder in its earliest
stages, preventing the most severe cases;
Whereas at present, the United States lacks any organized treatment protocol for
postpartum depression. Sufferers have few treatment resources. The
United States lags behind most other developed countries in providing
such information, support, and treatment;
Whereas the United States Government and its agencies collect very little data
on postpartum illness;
Whereas if early recognition and treatment are to occur, postpartum depression
must be discussed in childbirth classes and obstetrical office visits,
as are conditions, such as hemorrhage and sepsis;
Whereas early detection, diagnosis, and treatment of postpartum illness will
become easier if public education is enhanced to lift the social stigma,
thereby increasing the chance that women will inform others of her
symptoms as she would for physical complications;
Whereas research shows that in the first few weeks after delivery, a woman's
chance of requiring a psychiatric admission is 7 times higher than at
any other time in her life. It is estimated that as many as 90 percent
realize something is wrong, but less than 2 percent report symptoms to
their health care provider. The remaining individuals are either
undiagnosed, misdiagnosed, or seek no medical assistance;
Whereas it is estimated that as many as 90 percent of women realize something is
wrong; however less than 2 percent report symptoms to their health care
provider. Only about 20 percent of women with the disorder receive
treatment. The remaining individuals are either undiagnosed,
misdiagnosed, or seek no medical assistance;
Whereas in addition to the mother, the effects of postpartum depression can also
impact the child and the father significantly. Infants of mothers with
postpartum depression are at risk for socioemotional difficulties in
life. Maternal depression can affect the mother's ability to respond
sensitively to her infant's needs. A depressed mother is less likely to
provide her children with appropriate levels of stimulation and to
express positive affect. Research generally shows that children who
receive warm and responsive caregiving from the moment of birth and are
securely attached to their caregivers cope with difficult times more
easily when they are older. They are more curious, get along better with
other children, and perform better in school than those who are less
securely attached;
Whereas a mother's marriage can also become severely strained when dealing with
a postpartum illness. Husbands/fathers feel anxious and helpless, not
understanding what is going wrong or what is the source of the
depression. They can express exasperation and even resentment as a
result of the problems created by the illness. They are also more likely
to become depressed themselves, further compromising the functioning of
the family. Lack of support from the partner can contribute to the
development or continuation of postpartum depression. Husbands,
partners, family members, and friends need access to information on
these issues in order to support their wives, relatives, or friends;
Whereas severe postpartum illness can obstruct the important pattern of
friendship and support that most couples with newborns tend to form.
Family units as a whole can experience isolation;
Whereas education is helpful to new parents coping with these emotional and
hormonal changes and also helps them to decide if and when they need to
seek outside help; and
Whereas postpartum depression is one of the most treatable and curable of all
forms of mental illness. Learning about postpartum depression helps
prevent it and relieve it: Now, therefore, be it
Resolved, That the House of Representatives--
(1) recommends that all hospitals and clinics which deliver babies
provide departing new mothers and fathers or family members with
complete information about postpartum depression, its symptoms, methods
of coping with it, and treatment resources;
(2) encourages all obstetricians to inquire prenatally about any
psychiatric problems the mother may have experienced, including
substance abuse, existence of the above in any family members, and,
ideally screen for ongoing depression;
(3) encourages all obstetricians to screen new mothers for
postpartum depression symptoms prior to discharge from the hospital and
again when they bring in their babies for early checkups;
(4) recommends that appropriate health care professionals be trained
specifically in screening women for signs of postpartum depression in
order to improve chances of early detection;
(5) recognizes that a coordinated system of registry should be
developed to collect data on mental disorders in the new mother and that
the National Institutes of Health should undertake additional research
on postpartum psychiatric illnesses;
(6) recognizes the impact of a mother's postpartum depression on
fathers and other family members as well and strongly encourages that
they be included in both the education and treatment processes to help
them better understand the nature and causes of postpartum depression so
they too can overcome the spillover effects of the condition and improve
their ability to be supportive; and
(7) calls on the citizens of the United States, particularly the
medical community, to learn more about postpartum depression, how to
educate women and families about it, and thus ultimately lower the
likelihood that women around the country will continue to suffer in
silence.
Attest:
Clerk.