Postpartum screening and what to do if missed

Post partum depression/psychosis screening and punishment

Postpartum depression affects nearly 13% of mothers.1 There are two ethical concerns in the spectrum of postpartum depression. First, is there any way to implement screening to assist mothers who are experiencing postpartum depression? Second, in regard to those women who experience postpartum psychosis, a more severe form of postpartum depression, how should they be punished if they do not receive treatment and harm their newborn?

New Jersey has already implemented legal action to require doctors’ offices to screen each postpartum woman for postpartum depression. Screening can be as simple as a nurse asking mothers a few questions, such as the quality of their sleeping. If these questions and answers can be discussed during one of the several newborn’s medical check ups, there is no additional cost. While further treatment, should a mother fail screening, will not be feasible in such simple circumstances, assisting those women understand they need treatment and assist them in getting that treatment is certainly worth a nurse taking the time to ask a few additional questions as he or she takes the infant’s vitals at an already scheduled visit (of course, this does not provide the opportunity for screening in those who do not follow the recommended well baby visits schedule).

In the last few years, there have been several well publicized cases of women who harmed their children after suffering from a more severe form of postpartum depression, postpartum psychosis. The most well known is the Andrea Yates case, where she killed her 6 children. She was first found guilty, but her conviction was overturned by the perjury of a prosecutorial witness. She was sentence to time in a psychiatric facility after her second trial.

If Texas, the state where Andrea Yates lived, required postpartum screening, medical professionals probably would have recommended further treatment for her, and her 6 children might have been alive and well today (however, recommendation of treatment does not necessarily mean she will seek further treatment). A few simple questions might have saved the lives of those six kids. Since she did not seek treatment, her mental suffering was severe, and her reality was quite different from what was truly real. As much the blame for actual physical killing those children can only be placed on Ms. Yates, she honestly believed what she was doing was the best for her children – she was saving them from the monster in her head that she believed was real and was very much after her children. Because she did what she truly felt was in the best interest of her children, I don’t think I can classify her behavior as criminal. However, I do believe that she needs a great deal of treatment and should not be put in the same position again.

The catalyst to her disease was giving birth and the hormone fluctuation that follow. While a very careful family may be able to prevent her from harming another child should she again give birth (ie, not allowing her to be alone with the child, insisting upon psychiatric treatment after birth no matter her symptoms, etc..), perhaps sterilization is in order to ensure she is never put in a situation where she may cause harm to any child that she may have in the future. No matter what the preventative measure put in place for her reproductive future, she would only repeat the act if she gave birth and was not treated. Placing her in a jail cell will certainly not solve anything.
As screening could have saved those children, which is an obvious argument for implementing mandatory postpartum screening. As postpartum depression and postpartum psychosis are legitimate disease, if either disease is missed and disastrous results occur, the focus should be on treatment and prevention rather than punishment for something the perpetrator did not realize her or she was doing.


Maternal and Infant Health: Home. Pregnant-related Illness. Center for Disease Control and Prevention. Available at: http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/. Accessed September 30, 2007.