IV

106TH CONGRESS

1ST SESSION H. RES. 163

Expressing the sense of the House of Representatives with respect to

postpartum depression.

IN THE HOUSE OF REPRESENTATIVES

MAY 6, 1999

Mr. KINGSTON (for himself and Mrs. CAPPS) submitted the following

resolution; which was referred to the Committee on Commerce

RESOLUTION

Expressing the sense of the House of Representatives with

respect to postpartum depression.

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’’
2

•HRES 163 IH

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
3

•HRES 163 IH

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 nerv-
4

•HRES 163 IH

ous 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;
5

•HRES 163 IH

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 gen-
6

•HRES 163 IH

erally 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
7

•HRES 163 IH

1 Resolved, That the House of Representatives—

2 (1) recommends that all hospitals and clinics

3 which deliver babies provide departing new mothers

4 and fathers or family members with complete infor5 mation about postpartum depression, its symptoms,

6 methods of coping with it, and treatment resources;

7 (2) encourages all obstetricians to inquire pre8 natally about any psychiatric problems the mother

9 may have experienced, including substance abuse,

10 existence of the above in any family members, and,

11 ideally screen for ongoing depression;

12 (3) encourages all obstetricians to screen new

13 mothers for postpartum depression symptoms prior

14 to discharge from the hospital and again when they

15 bring in their babies for early checkups;

16 (4) recommends that appropriate health care

17 professionals be trained specifically in screening

18 women for signs of postpartum depression in order

19 to improve chances of early detection;

20 (5) recognizes that a coordinated system of reg21 istry should be developed to collect data on mental

22 disorders in the new mother and that the National

23 Institutes of Health should undertake additional re24 search on postpartum psychiatric illnesses;
8

•HRES 163 IH

1 (6) recognizes the impact of a mother’s

2 postpartum depression on fathers and other family

3 members as well and strongly encourages that they

4 be included in both the education and treatment

5 processes to help them better understand the nature

6 and causes of postpartum depression so they too can

7 overcome the spillover effects of the condition and

8 improve their ability to be supportive; and

9 (7) calls on the citizens of the United States,

10 particularly the medical community, to learn more

11 about postpartum depression, how to educate women

12 and families about it, and thus ultimately lower the

13 likelihood that women around the country will con14 tinue to suffer in silence.

Æ