How to incorporate mental health screening into your lactation practice workflow

You don’t have to have been a parent yourself to recognize that bringing home a new baby can be one of the most disruptive events in a person’s life. It’s critical for lactation consultants to be able to screen for perinatal mood disorders, provide culturally informed and humble care, and have a referral network in place for parents in need.

How often do perinatal mood disorders occur?

Studies show that most birthing people experience some degree of sadness in the early weeks postpartum, and as many as 1 in 7 will go on to experience postpartum depression or anxiety. In a very small percentage of births, the parent goes on to develop postpartum psychosis, a potentially life-threatening condition.

Black parents are more likely to have their symptoms ignored or dismissed, and to be unable to access anti-racist mental health care. Queer parents face discrimination in the healthcare system that can amplify depression and anxiety. The rates of depression in indigenous (Native) birthing parents may be even higher than for white parents.

Why lactation consultants should screen for perinatal mood disorders

As research into the diagnosis and treatment of perinatal mood disorders develops, evidence seems to show that the mere act of administering a screening tool can have clinical benefits. The American College of Obstetrics and Gynecologists recommends screening once in pregnancy and at the first postpartum visit, and the American Academy of Pediatrics recommends screening at every well child visit.

Lactation visits in the outpatient setting often occur outside of routine postpartum care and well child visits, offering yet another opportunity for parents to have their mental wellness assessed. Discussing infant feeding challenges can also lead the lactating parent to share about their mental state in a more informal manner.

Using screening tools before and during a consult

The Edinburgh Postnatal Depression Scale (EPDS) is a free, validated tool suitable for use in any clinical setting. You can print out hard copies and bring them with you to the consult. It’s important to ask the parent to complete themselves, vs. asking them the questions and recording the response.

The Edinburgh can also be made available electronically and sent via email or through your platform’s secure portal. My form bundles for IntakeQ, Practice Better, and ChARM include a modified version of the EPDS that can be sent in advance of the consult. Simple Practice offers the EPDS along with other, more specific screening tools. You can also use a PDF editor like PDF Express to add fillable fields to the EPDS, and send it to the client by email.

What to do if a client needs help?

Remember your scope of practice! Unless you’re a licensed therapist—you’re not a therapist. It’s important to be empathetic and supportive when clients are voluntarily sharing their feelings, stresses, and traumas in the context of a consult. It’s also even more important to pair that empathy with appropriate referrals.

Wow, that sounds really stressful. Would you like to hear more about how you can get support for what you’re going through? Your mental health is really important in all of this, and there are wonderful people who would really love to help you.

Then have that referral list ready! Be prepared to provide your clients with a selection of names of therapists and support groups that you can vouch for. You’re never going to regret sharing a name with a family—and you really might regret it if you don’t.

Don’t be afraid to call the parent’s health care provider and/or the baby’s pediatrician if you’re concerned about something the parent has said or indicated.

How to boost your skills in mental health assessment and referral

Of all the clinical trainings I’ve done over the years, the ones I’ve taken that focus on mental health and communications skills have proven most valuable. In these trainings, I’ve learned what to say when a client expresses thoughts of harming themselves, been challenged to confront my own harmful biases, and shown how to prevent adding trauma to my clients who are already suffering.

Here’s a list of trainings and additional resources for self study:

Mental Health First Aid for the Perinatal Care Provider (4 R-CERPs + 4 CEUs + 4 CPEUs)

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