The EPDS is a widely used screening tool to evaluate postpartum depression. The EPDS is also recommended for use throughout pregnancy. We routinely screen patients between 12-13 weeks and 26-28 weeks pregnant during scheduled prenatal visits and again during the postpartum period. Early identification of mental health care needs ensures that we are able to connect patients with resources in their community.

In Massachusetts, Governor Deval Patrick signed into law, An Act Relative to Post Partum Depression, Chapter 313 of the Acts of 2010.

This legislation authorizes the Department of Public Health to “develop a culture of awareness, destigmatization, and screening for perinatal depression” and establishes a special legislative commission to investigate and study postpartum depression. In an effort to be inclusive as possible, the DPH established a PPD Legislation Implementation Working Group, inviting key stakeholders from across disciplines and the Commonwealth to provide guidance and assistance to the DPH through this process.

This report is focused on two requirements in the legislation for DPH to:

• Develop standards for measuring effective screening for postpartum depression

• Make recommendations for health plans and health care providers for data reporting specific to postpartum depression screening.

DPH worked collaboratively with the PPD Legislation Implementation Working Group, and specifically health care providers and health plans, on the following recommendations and standards. Further information on stakeholder engagement is described in the Department’s “Annual Summary of Activities Related to Screening for Postpartum Depression”, which was sent to the Legislature in October 2011.

Whether you are a first-time mom or becoming a mother again, you are about to experience one of the most amazing, rewarding and challenging times of your life. As you know, your baby needs nourishment to grow. Ultimately you will decide which feeding method is best for you and your baby. If you choose to provide breast milk for your baby, there are many ways to do this either by exclusively nursing at the breast, providing breast milk in a bottle, or providing some breast milk with formula.

We want to provide you with some tips to help guide you along this journey should you choose to breastfeed.

Stages of Milk Composition

Colostrum (First stage of Milk)

• Early days after birth

• Small amount, thick, yellow, sticky

• Protein rich, low fat, low sugar, packed with antibodies

• Natural laxative effect to help initiate those early stools

• Breasts will feel soft with colostrum

Transitional Milk

• Produced on average day 3-4 after birth (when milk comes in) until 10-14 days

• Creamy milk after colostrum

• More calories and larger volume than colostrum

• Breasts will feel fuller/larger

• You may experience engorgement. This can make latching the baby to the breast more challenging, as the nipple may become short as the breast tissue around it becomes harder. Seek help, if you are having difficulty.

Mature Milk

• Produced toward the end of the second week

• Thinner and more watery (sometimes appears blueish)

• Constantly changing for babies needs

• Changes flavors to what mom is eating
  
  

Milk Production

• The only way your body knows that there is a baby to feed is by removing the milk.

• The best breast pump is your baby – the baby is much better at removing breast milk than any artificial breast pump. This is, of course, if the baby is latching.

• You can produce more milk by frequently and efficiently removing milk.
  
  

Self-Care

• One of the most important things that you can do for your baby is to make sure you are well taken care of.

• We are not meant to do this alone. Use the support people around you!

• Let your support system do anything and everything – they can do the grocery shopping, the laundry, prepare food, burp, diaper, rock and clean the baby – while you sleep, shower, or take a little time for yourself.

• Let them be the gate keeper for visitors. You will need to rest any chance that you can get.
  

Additional Resources

Llli.org
La Leche League International

Lowmilksupply.org
Diane West and Lisa Marasco’s website

Kellymom.com
Kelly Bonyata’s website

Zipmilk.org
Breastfeeding support in your area (by zip code)

Vitalvillage.org
Breastfeeding groups calendar

New England Mothers First
One-to-one lactation support (Zoom and in-person)

New England OB-GYN offers appointments with our Certified Lactation Counselor and Nurse Practitioner Jen Harper. Our triage nurses can also help evaluate any problems over the phone and schedule an appointment if necessary.

We have partnered with FamilyWell to offer our patients access to mental health services via a collaborative care model. FamilyWell offers virtual care to our pregnant and postpartum patients that may need medication management, mental health coaching, therapy, or visits with another mental healthcare provider. Please talk to your provider or reach out to our nursing team to be connected with our FamilyWell intake coordinator.

MCPAP for Moms offers additional resources for moms in Massachusetts. Talk to our providers today if you would like help utilizing these services.

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