[Congressional Bills 106th Congress]
[From the U.S. Government Printing 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.