Can Your OB/GYN Treat Postpartum Depression? How to Ask

It is your six-week checkup. You have been crying in the car on the way over. You haven't slept more than two hours in a row in weeks, and lately you feel like you're watching your own life from across the room. Your OB walks in, smiles, and asks how you're doing.

"Fine," you say. "Tired, but fine."

Almost every mom I work with has had some version of that moment. The truth was right there, and it didn't come out. So this post is the help I wish every mom had before that appointment: why it is so hard to say, the actual words to use, what happens after you say them, and what to do if the answer you get isn't good enough.

Why it's so hard to tell your doctor

The reasons I hear most are some of the most painful parts of postpartum depression, and every one of them makes sense.

• "I should be grateful." You wanted this baby. You love this baby. Saying you're miserable feels like betraying both. But loving your baby and having postpartum depression happen at the same time all the time. Gratitude does not protect you from depression.
• "They'll think I'm a bad mom." Postpartum depression affects about one in five moms. Your OB sees it constantly, and they know it is a medical condition.
• "They'll take my baby." This is the fear that keeps the most moms quiet, so I want to be very clear. Having postpartum depression, and telling your doctor about it, is not a reason for anyone to take your baby. Getting help is the responsible thing to do. A doctor only steps in for safety if you are in immediate danger, and even then the goal is to get you care.
• "Saying it out loud makes it real." It is already real. Saying it is what lets it get better.
• "I feel nothing for my baby, and I'm ashamed of that." Numbness, resentment, and trouble bonding are symptoms of postpartum depression. They are not evidence of who you are as a mom.

When to bring it up

You do not have to wait for the six-week checkup. Bring it up at any appointment where you're struggling: the two-week visit, a call to the nurse line, even your baby's pediatrician appointments, since pediatricians screen moms too. If you're pregnant and worried because you've had depression before, bring it up then.

What to say: scripts you can use word for word

The hardest part is the first sentence. Use these exactly as written, or change them to fit. If it helps, read it off your phone.

If you're pretty sure it's postpartum depression

This is the clearest version. Using the words "postpartum depression" tells your doctor exactly what to assess.

If you're not sure whether this is normal

"I'm struggling more than I expected. I thought I'd feel more joy, but mostly I feel overwhelmed and low. Is this normal, or could it be postpartum depression?"

You don't have to diagnose yourself. Asking the question is enough.

If you can't describe it

"I don't feel like myself since the baby. I can't really explain it, but something is off, and I'm worried."

Your doctor will ask the follow-up questions. You don't need to have it figured out.

If you're having scary thoughts

"I'm having thoughts that scare me. I keep picturing [the baby getting hurt / me hurting the baby / running away]. I don't want to act on them, and they upset me. I need help."

Most new moms have sudden, unwanted thoughts like these. I had them too as a new mom: the stairs, the bathwater, the knife on the counter. I knew they were normal, and they still gave me a jolt. The fact that they horrify you is a good sign. Saying them out loud to your doctor is safe, and it is how you get the right help. Here is more on what those thoughts mean. Thoughts that feel different, where part of you wants to act on them or you feel confused about what is real, are an emergency. Call 911.

If bonding is the main thing

"I'm struggling to bond with my baby. I'm doing everything, feeding and changing and rocking, but I don't feel the connection I expected. I feel guilty about it, and I wonder if it could be postpartum depression."

If your partner noticed first

"My partner is worried about me. They've noticed I'm crying a lot and not sleeping, and I think they might be right that I need help."

Partners often notice the shift before we do. It is fine to let their worry be the reason you speak up.

What happens after you tell your OB/GYN

Knowing the steps ahead of time takes a lot of the fear out of it.

• A short questionnaire. Most OBs use the Edinburgh Postnatal Depression Scale, ten questions about the past week that take about five minutes. Here is how the Edinburgh is scored. One question asks about thoughts of harming yourself. Answer honestly.
• Some follow-up questions. When this started, how bad it gets, how you're sleeping and eating, what support you have at home, and whether you've had depression before. Your doctor may also order blood work, since thyroid problems and anemia after birth can look a lot like depression.
• A few safety questions, if they apply. If you mention thoughts of harming yourself, your doctor will ask whether you have a plan and whether you feel safe going home. These questions are routine. Having thoughts without a plan usually means a faster referral, not a hospital stay.
• A conversation about treatment. Usually that means a referral to a therapist who specializes in postpartum mental health, a medication, or both. Your doctor can recommend, but you decide. I wrote about the medication questions moms ask most.
• A follow-up plan. You should leave knowing when you'll be seen again, usually within a few weeks, and who to call if things get worse before then. If you walk out without a plan, call the office and ask for one.

What if your doctor dismisses you?

Most OBs take this seriously. Some don't. If you hear "all new moms feel this way," "just get more sleep," "give it a few more weeks," or "you don't look depressed," and nothing else, that is not good enough, and you are allowed to push back.

Things you can say:

• "I know something is wrong, and I need you to take this seriously."
• "Can I fill out the Edinburgh questionnaire today?"
• "Even if you think it will pass, I'd like a referral to someone who specializes in postpartum mental health."
• "Will you note in my chart that I reported these symptoms and asked for help?"

If that still doesn't work, you have other doors. Your primary care doctor can screen and treat postpartum depression too. You don't need a referral to see a therapist. And Postpartum Support International can help you find perinatal providers near you at 1-800-944-4773. Here is how to choose a postpartum therapist.

Making the appointment easier

Write it down first. When it started, what a bad day looks like, how you're sleeping, and what worries you most. Something like: "Started around three weeks postpartum. Crying most days. Can't sleep even when the baby sleeps. Don't feel connected to her. Nothing feels good." It is hard to remember everything once you're in the room.

Bring someone. A partner or a friend can back you up, fill in what they've noticed, and remember what the doctor says. Tell them ahead of time: "I'm going to tell my doctor I think I have postpartum depression. If I freeze, I need you to say it for me."

Say it out loud once before you go. To your partner, to the mirror, in the car. "I think I have postpartum depression. I need help." The second time is easier than the first.

If you can't say it out loud

Some moms freeze in the moment. That's okay. There are other ways in.

• Hand your doctor a note. "I've been struggling with postpartum depression and it's hard to talk about. Can you screen me and talk with me about treatment?" Hand it over at the start of the visit.
• Call ahead. Ask the front desk to let your doctor know you want time to talk about postpartum depression. Then nobody is surprised, including you.
• Write it on the intake form. Many offices hand you a questionnaire anyway. Be honest on it, and your doctor will bring it up for you.
• Let your partner say it. "We're worried she might have postpartum depression. Can you screen her?" Letting someone else say the words is still you asking for help.

Questions to ask before you leave

If you're offered medication: What is it, is it compatible with breastfeeding, what side effects should I expect at first, how long before I feel a difference, and how long will I take it?

If you're referred to therapy: Can you give me the name of a specific therapist who specializes in postpartum depression, and how soon can I be seen?

If you're told to wait and see: "I'm struggling now, and I'd like to start treatment now." Waiting is not the right plan for depression that is already affecting your days.

Working with me

I'm a licensed clinical psychologist, a certified perinatal mental health specialist, and postpartum depression is the work I do most. You don't need a referral from your OB to see me, and I'm happy to coordinate with your doctor once you're in care. Most moms I work with feel substantially like themselves within a few months. I see moms in my office in Austin or on video, and babies are welcome.

You don't have to be "bad enough" to benefit from support. Many of the moms I work with aren't clinically depressed at all. They're dealing with the everyday stress of becoming a mom, and therapy helps with that just as much as it helps with depression or anxiety.

The first step is a free 15-minute call. Tell me what has been going on, and I will tell you honestly what I think would help.

Book a free 15-minute call