Postpartum University® Podcast

Does the Edinburgh Postnatal Depression Scale Really Work? EP 202

• Maranda Bower, Postpartum Nutrition Specialist

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Is the Edinburgh Postnatal Depression Scale (EPDS) Failing Mothers? What Providers Need to Know

Postpartum depression screenings are essential—but are we actually identifying the mothers who need help? The Edinburgh Postnatal Depression Scale (EPDS) is the standard tool used in postpartum mental health screenings worldwide. But here’s the hard truth: it’s not catching every mom who’s struggling. 

In this episode, we break down why the EPDS falls short and what providers must do to bridge the gap between a screening tool and real, effective postpartum mental health care. We dive into why mothers feel unseen and unheard in postpartum appointments, the danger of reducing depression screenings to a checklist, and most importantly, how we as providers can do better. Let’s Change the Way We Support Postpartum Mental Health, Moms deserve more than a checklist. 


Check out this episode on the blog: https://postpartumu.com/does-the-edinburgh-postnatal-depression-scale-really-work-ep-202


KEY TIME STAMPS:

00:00 – Why postpartum depression screening is missing the mark
02:29 – The truth about the EPDS and why it’s not enough
06:18 – When moms do report depression, but nothing changes
10:45 – The lack of postpartum mental health training for providers
14:25 – The missing tools for real postpartum support
18:07 – The danger of using checklists instead of real conversations
22:33 – Why trauma often goes undiagnosed in postpartum women
24:17 – The big takeaway: How providers can take real action

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Speaker 1:

The postpartum care system is failing, leaving countless mothers struggling with depression, anxiety and autoimmune conditions. I'm Miranda Bauer and I've helped thousands of providers use holistic care practices to heal their clients at the root. Subscribe now and join us in addressing what modern medicine overlooks, so that you can give your clients real, lasting solutions for lifelong well-being. Welcome back to the podcast. Today we are diving into a topic that's incredibly important for every provider out there the Edenberg Postnatal Depression Scale, or EPDS. Is it really working? Does it help us truly understand what mothers are going through, or are we missing the mark? We're going to get into this. We're going to be a little sciencey which is absolutely my favorite as a biological researcher but also very practical, with real insights and actionable takeaways that you can start using today. But before we jump into this important discussion, I want to take a moment to share something that has been so inspiring for me lately. I have been hearing from so many of you our incredible provider listeners about how this podcast has been impacting your work listeners, about how this podcast has been impacting your work, and just last week, a mental health counselor emailed me and said your podcast completely shifted how I approach postpartum depression with my clients. It's given me the confidence to dig deeper and offer real solutions, not just referrals. And here's another one from a postpartum doula who shared. Listening to your podcast has transformed the way I think about care. I've started having conversations with my clients about mental health that I never thought I could initiate before. So both of you, mary and Lindsay, thank you so much deeply for sending these to me and sharing with me your incredible vulnerabilities and thoughts and all of the things. I'm just I'm blown away by how amazing this community is, and it's stories like this that remind me why we do what we do. So, if you are tuning in, thank you. Thank you for being a part of this movement that is changing postpartum care for the better. I couldn't be more grateful to have you here Now.

Speaker 1:

Let's talk about the EPDS, because, while it is widely used in postpartum mental health screenings, there is so much more to the story. I was recently speaking to a mom who is one of my besties. She just had her baby, she went to her six week checkup and she said something that really struck me. And she said I you know I answered the questions on this scale, but I didn't really feel like they fully captured what was going, what she was going through, right, like her provider kind of just glanced at it, said she was fine, and then she walked out and she was like I just like I felt so alone in that moment, like is that really it? Like that was that, was it? Like I'm okay, but I don't feel okay. And it's not just moms, providers in our postpartum university community. They have echoed very similar concerns and I swear this one scenario happened my friend was telling me this and then it was like a couple days later a provider in the community reached out and she said, I quote, sometimes I feel like the EPDS is just a formality. If a mom checks, yes, I'm ready to help, but if she doesn't, it's hard to know if we're missing something important. So today we're breaking it all down what works, what doesn't, how we can do better as providers to ensure no mom feels unseen, unheard or unsupported.

Speaker 1:

So for those of you who might not be familiar, let's talk about the Edenberg Postnatal Depression Scale really quickly. It is 10 questions. It's a screening tool. It's designed to specifically identify postpartum depression and it's been translated to more than 60 languages and it's widely used across the world. The questions are really simple. It's asking things like how often have you been able to laugh? Or if you've been overwhelmed by anxiety. And don't get me wrong, this is a very important tool. Studies show that it has a sensitivity and specificity rate of 80 to 85%, meaning it's fairly accurate in flagging potential causes of postpartum depression or, excuse me, cases of postpartum depression, definitely not causes. This is where my brain goes. But here's the thing Even the best tool is only as good as the person using it and the environment that it's used in. And then what happens after? So the EPDS is not a magic wand. It's kind of like a flashlight. It can help us see potential issues, but it doesn't do the work for us.

Speaker 1:

And I want to share with you a personal story, one I know many of you can relate to or who. Maybe you've heard this from your clients. But after the birth of my first, I felt completely and utterly lost. I was exhausted, overwhelmed and, honestly, I was a little afraid of what was happening inside my head. But you know that I would never, ever tell a soul why. Because I was terrified, I was scared, I was thinking that I wasn't a good mother, that if I admitted that I wasn't okay. That would mean someone would come take my baby away or force me onto medications that didn't feel right to me. So I did what so many moms do I smiled, I nodded and I said I was fine. I checked all the right boxes and all the while I was silently begging for someone to see through this facade. I was silently begging for someone to see through me so that I could get the help that I needed.

Speaker 1:

This is the heart of why the Edinburgh postnatal depression scale often falls short, because it doesn't account for the fear and the shame or mistrust that many mothers feel when they're asked to be vulnerable, especially in this kind of sterile clinical environment, with someone they might not even know that well. And the truth is, this is just a tool, but it's not a magic wand. As I had said before, it's kind of like checking boxes yes or no, and then, if it comes with no acknowledgement about the complexity of their experiences, it doesn't take into account the fear, the judgment or the cultural stigmas around mental health and motherhood, and so for many moms, the idea of admitting they're not okay feels like admitting they failed, and for others it's the fear that their honesty might get their baby taken away or that they'll be labeled as unfit. And these fears are so real. They create an environment where mothers are more likely to under-report their struggles and it leaves the EPDS incomplete or inaccurate. And this is why trust is everything. If a mother doesn't trust her provider or doesn't feel safe sharing her truth, it doesn't matter how comprehensive a scale is or how great a test is. It's only as effective as the relationship it's built upon.

Speaker 1:

And think about it. How can we expect mothers to pour their hearts out in 10 questions when they've barely been asked how are you really doing? Or when they sense the provider is just going through the motions and checking off a box? And looking back at my own experience, I can't help but wonder how things might have been different if someone had asked me what are you afraid of? What would make you feel safe to talk about what you're going through? Because that's what so many mothers need a chance to feel seen, without fear or judgment or repercussion.

Speaker 1:

So what do we do? How do we, as providers, bridge this gap between a tool like EPDS and the real human experience of postpartum mental health? First appointment, the very first appointment, should be focused on creating a safe, non-judgmental space in which to build trust. Let mothers know that you're there to support them, not judge them, and ask open-ended questions, instead of relying solely on the scale. To ask the questions like how are you really feeling or what's been the hardest part of this experience for you, like look, mom is in the eye, acknowledge their fear, be proactive in addressing the stigma and the fear around postpartum mental health, and then reassure them that their feelings are valid and that asking for help is a sign of strength, not weakness. And here's the truth that we all need to embrace. The EPDS is a tool. It's not a relationship, and healing doesn't happen because of checked boxes. It happens because of connection and trust and the courage to meet mothers where they are, and so, by creating an environment where moms feel open and safe to connect, we can use the EPDS for a better in a better way, and it starts with us, as providers, being willing to look beyond this form and start looking into the hearts of women and the people we are here to serve.

Speaker 1:

Okay, here's the second part of why the EPDS falls short. Let's talk about what happens when it flags an issue. So a mother checks those boxes. She's admitting that she's not okay. Maybe she scores high enough to indicate postpartum depression or anxiety, like what happens next. And here's the hard truth the skill only works if the provider is truly prepared to respond, and this is where so many mothers fall through the cracks, even when they find the courage, to be honest, many providers don't have the tools, they don't have the resources or knowledge to offer meaningful support. And that's not a shortcoming, it's a failure of the system.

Speaker 1:

So really imagine a mom. She's walking into her six-week postpartum visit. She is sleep-deprived, she is overwhelmed, she feels like she's drowning. She finally works up the courage to answer these EPDS questions truthfully. But then what If her provider is unprepared, if they don't have a plan for what to do next, what messages does that send to her? It tells her your struggles are valid enough to check a box, but not enough to act on. It tells her that your answers are data points, not cries for help. And you're not, it's fine, this is a normal part of motherhood and you did it and it's over and whatever, move on. And this isn't just frustrating, it's seriously harmful. It leaves mothers feeling dismissed and unseen and even worse off than before.

Speaker 1:

And the reality is many providers are trained to ask questions but not handle the answers. So postpartum mental health isn't adequately covered in most medical or professional training programs. And even if you're a counselor or a therapist or someone coming in for a perinatal, coming in from this background, you know there is zero perinatal mental health training. You have to go to a separate learning facility to gain access to education on this topic Isn't that insane? So for providers who are not even in the psychology field, they're absolutely not getting this training whatsoever either. Like if a counselor and a therapist aren't getting the training, then certainly you know your OB or your family practitioner are also not getting this training. And so providers may not know how to recognize the signs, but they often and maybe they do, maybe they are starting to learn anything in today's world they are starting to recognize the signs and they're paying attention a little bit more, but they don't necessarily know how to address them Right. And even when a provider wants to help, they may not have the access to, like, a robust referral network, or they might not know that nutritional testing is the essential next step. They may not have any evidence-based tools whatsoever, and so the solutions offered is usually a prescription and a referral to therapy and that can be helpful, but it's not a holistic approach, it's not going to address the root causes of the problem and it's certainly not enough on their own.

Speaker 1:

And this lack of preparedness can really cause harm. When a provider offers little more than like a quick mention of antidepressants or therapy without a deeper exploration, it can leave a mom feeling like she has zero options. It also reinforces this idea that her struggle is just part of motherhood and that this is just her new reality that she should just accept, like she's become a mom. Welcome to the world. It's hard as heck deal with it and for mothers who are hesitant about medications or therapy, that feels like a dead end, like what do you do then? Where do they turn? And this is where preparedness really needs to go beyond the basics, because a mom who is depressed and feels even worse leaving that appointment it's a recipe for absolute disaster, including things like self-harm and harming their baby. We have to be on top of this and this preparedness goes beyond the basics.

Speaker 1:

Providers have to have a range of tools at their disposable to truly support mothers Like what's her next steps? Nutritional support, right? Are you equipped to talk about nutrient deficiencies, how they can mimic or exacerbate postpartum depression? Do they know how to guide moms in repleting their bodies? Can you offer like practical strategies for calming the nervous system, such as breath work and mindfulness or grounding exercises, and a referral of like holistic providers, not just lactation consultants and pelvic floor therapists, but also like wraparound care and also therapy and counseling?

Speaker 1:

And the tricky part is the therapists and counselors who have availability to support them right away? I know so many people across the country have zero support. They've been referred to get help, but there's no one there to help them because the wait list is months or even years long. Then what happens then? How do we help? Then it becomes our responsibility and that can be a huge responsibility on our shoulders and we know because of the evidence that we've seen over and over again I talked about this a lot in my perinatal mental health certification program that this is a really big deal where providers don't even want to talk about perinatal mental health in the least bit, because if they can't get somebody in to get the therapy that they need or to get them the care that they need, then they ultimately become responsible and that burden is often too much to carry. It's hard, and we have to admit that there is some big rooms for improvement here. So how do we fix this? How do we address this?

Speaker 1:

And I tell providers these three things Educate yourself. Get time to learn about postpartum mental health beyond what's taught in traditional training If there's been any traditional training whatsoever. Understand the root causes and what healing truly looks like, and then build a toolbox. Equip yourself with a range of holistic tools, from nutrition to strategies with emotional support techniques, to really meet moms where they are, and then create a network. Find other professionals who can fill the gaps in your care, whether it's a therapist or a nutritionist or a yoga instructor. Have trusted referrals that can make a big difference.

Speaker 1:

The EPDS can be a valuable tool, but only if it's part of a larger framework of care. So we can't stop at checking boxes. We have to dig deeper, we have to ask better questions and we have to be ready to meet moms with the support that they deserve. Otherwise, the scale is just like this piece of paper, and moms deserve so much more than that. And I want to talk about one other really important shortcoming, too really quickly, before we close this. And I noticed that the questions that are asked. They don't always resonate with how mothers are actually feeling. And again, this is a standardized tool and it can be helpful, but it has limits and many moms report that the questions don't fully capture their experiences.

Speaker 1:

So what happens when a mother doesn't see herself? You know, sure, their experiences. So what happens when a mother doesn't see herself, you know, reflected in that scale, does her suffering or her confusion get dismissed? What if she dismisses it herself? Right, and that's even worse. You know I was sharing about my friend who just felt like you know, this isn't addressing my needs, this isn't what I'm doing. And then she was also like confused, you know what if I don't score high enough? You know, if I'm having these feelings, then like, what do I do if they tell me like I just don't need help at all? And this is really a common story where the EPDS relies on, like these, specific phrasing of symptoms.

Speaker 1:

But postpartum mental health doesn't always fit into neat boxes. So a mother might not cry often, but she feels completely numb, right, she might not feel hopeless, but she's angry all the time. Or her anxiety might not show up as worry. It might manifest as constant overthinking or physical symptoms like heart palpitations. And so when these nuances aren't captured by the scale, mothers can feel invalidated. They might think, if I don't check enough boxes on this form, maybe what I'm feeling isn't real. And that's not just discouraging, again, it's dangerous. Is it real? And that's not just discouraging, again, it's dangerous.

Speaker 1:

So if it doesn't reflect the reality of what a mom is feeling, then it can lead to dismissal on two levels by providers right, if a mother's score below the thresholds, her concerns might not be taken seriously or she might not talk about her concerns anymore, just like mom's just going to move on. Providers just move on. Concerns anymore, just like mom's just going to move on. Providers just move on. And then dismissal of moms themselves. When a mother feels like she doesn't fit the criteria, she might be questioning her own feelings. She might think that she's overreacting or that this is just how motherhood feels, and both scenarios are harmful. They perpetuate this idea that suffering is normal in motherhood and discourages mothers from seeking further help. So there's so many things that we can do to really fix this scenario, and I gave you so many examples in here.

Speaker 1:

And it's really about understanding that postpartum mental health isn't one size fits all. At the end of the day. This is what it all sums up with that the experience of depression and anxiety or even trauma varies widely from one mom to the next. And while the EPDS can provide the snapshot, it's just one piece of the puzzle. And don't even get me started on trauma, right, that is not even a conversation that often enters in the perinatal mental health. How many moms present as depression, anxiety or even OCD or intrusive thoughts? And it's not, and they're being treated for these things or potentially treated for these things, and it's not those things at all. It's the trauma that she experienced in the birth room and not a single person asked her about her birth story. And yet here she is getting the care that someone with postpartum depression would get or postpartum anxiety would get, and it's not the same treatment whatsoever. And so she's not getting the care that she's so desperately needs to support her and actually healing and integrating her trauma and and being okay in her body and no longer having those those feelings anymore.

Speaker 1:

It's like we're it's completely dismissed, so sidetracked. There's so much more that we can do, and then we have to consider cultural and linguistic and individual differences, right? So the words of the EPDS might not resonate with mothers from diverse cultural backgrounds, who have different emotional expressions right, or a mom with a history of trauma might not experience postpartum symptoms that don't align with this standard criteria of depression or anxiety. And so there's so many different things that we can we can get into in this conversation, but what we know is that we have to ask better questions, we have to go beyond the form. We have to talk to a mom, we have to pay attention to cues, we have to trust a mother's instincts and we really need to support ourselves and educating ourselves on what this really looks like and how we can go beyond. How can we expand beyond? As we kind of wrap up this conversation, let me leave you with this yes, the EPDS is just a tool, a starting point, but it's not the whole picture. Postpartum mental health is nuanced, it's complex and it's deeply personal, and as providers, we have this incredible responsibility to go beyond the checkboxes and truly see the mothers sitting in front of us. If we rely solely on the scale, we're missing the very real struggles of postpartum women. But when we approach each mother with curiosity and compassion and the right tools, then we can catch what EPDS might miss and we can offer more than a diagnosis or a referral. We can offer hope.

Speaker 1:

If you're listening to this and you are a provider, thank you so much for being here Click, follow our podcast. If you haven't already, leave a review. And if you're a mom listening into this and you made it all the way to the end, thank you so much for tuning in. Send this to your favorite provider or a provider you know would love to hear this. We would love to get the word out even more about this. Thank you again for joining me in this crucial conversation. We love you and we'll see you next week. Thanks so much for being a part of this crucial conversation. I know you're dedicated to advancing postpartum care and if you're ready to dig deeper, come join us on our newsletter, where I share exclusive insights, resources and the latest tools to help you make a lasting impact on postpartum health. Sign up at postpartumu the letter ucom, which is in the show notes, and if you found today's episode valuable, please leave a review to help us reach more providers like you. Together, we're building a future where mothers are fully supported and thriving.

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Maranda Bower

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