It Starts with a Question: Rethinking Screening, Support, and the Stories We Miss
PMH-C Training Reflection – Class 2: Screening, Intake, Breastfeeding & Treatment Options
Written by: Sarah Benitez-Zandi, LCSW
When someone says “you look great,” new parents often smile politely—even if they haven’t slept more than three hours in a week, their chest aches, and they’re quietly terrified of being alone with their baby.
From the outside, everything looks fine.
But as Birdie Gunyon Meyer reminded us in our Postpartum Support International training:
“You can’t tell by looking.”
That line has stayed with me. Because in perinatal mental health, it all starts with a question—the ones we ask, the ones we don’t, and the courage it takes to tell the truth when someone finally asks the right one.
Screening Isn’t a Checkbox—It’s a Lifeline
Universal screening is one of the simplest and most powerful tools we have, yet it’s still not routine. Too often, we rely on instinct instead of evidence. We assume we’d “know” if someone were struggling, but data tell us otherwise:
1 in 7 birthing parents and 1 in 10 non-birthing partners experience depression or anxiety during pregnancy or postpartum.
Many are never screened—especially fathers, partners, and people of color.
Tools like the EPDS, PHQ-9, and MDQ aren’t just forms—they’re bridges. They help us notice what might otherwise stay hidden and normalize that emotional health is physical health.
When screening is done with warmth and curiosity, it isn’t compliance—it’s compassion.
Connection Before Correction
Birdie shared her approach to intake: before diving into forms or checklists, connect. Ask about their birth story, their support system, their sleep, and their fears. Ask what’s felt hardest—and what’s helping them get through the day.
That philosophy—connection before correction—resonates deeply with me. A trauma-informed intake isn’t about getting every answer; it’s about creating enough safety that someone feels okay giving you honest ones. That’s where healing starts.
Feeding Choices, Not Guilt
Few topics carry more emotional weight than feeding.
For some parents, breastfeeding is grounding—a source of pride and connection. For others, it’s exhausting, painful, or even triggering. Depression and anxiety can lower prolactin and oxytocin, reducing supply. Stopping abruptly can worsen symptoms.
Then there’s Dysphoric Milk Ejection Reflex (D-MER)—a brief wave of sadness, irritability, or anxiety right before milk let-down that eases a few minutes later. It’s caused by a quick dopamine drop and is not the same as postpartum depression, though they can overlap.
The takeaway? Feeding decisions should center on wellness, not guilt. Most medications are compatible with lactation (see LactMed, InfantRisk, MotherToBaby).
“Breastfeeding can heal,” Birdie said, “but it should never harm.”
Practical Tips for Parents Experiencing D-MER
If you notice mood dips right before let-down, these gentle strategies can help:
Name what’s happening. Knowing D-MER is hormonal—not personal—often brings relief.
Ground your body. Try slow breathing, hand-over-heart, or gentle tapping during let-down.
Stay nourished. Low blood sugar or dehydration can worsen symptoms—keep snacks and water nearby.
Use comfort cues. Play calming music, look at soothing photos, or hold a warm compress while nursing or pumping.
Track your pattern. Symptoms often ease as supply regulates or feeding sessions shorten.
Reach out. Tell your provider, lactation consultant, or therapist—especially if sadness lingers beyond let-down.
Remember: choice is healing. If feeding harms your mental health, you have options. Your wellness matters too.
Healing Takes a Village
Treatment for perinatal mood and anxiety disorders isn’t one-size-fits-all—it’s layered:
Sleep and rest (not indulgent, essential)
Gentle movement or yoga to lower stress hormones
Mindfulness and breathwork to calm the nervous system
Community support—peer groups, therapy, or safe spaces
Medication and therapy, working together rather than apart
Healing happens when systems connect: medical care, therapy, social support, and compassion forming one web of care.
Asking the Hard Questions Saves Lives
One of the most sobering takeaways from this class was the power of direct, compassionate inquiry.
A simple question—“Have you had thoughts of hurting yourself?”—can change everything.
The EPDS item 10 and PHQ-9 item 9 matter. Any non-zero answer deserves same-day follow-up. It’s not intrusive—it’s care.
“The hardest question,” Birdie reminded us, “is often the most loving one.”
Why This Matters
Every statistic we discuss represents someone who just needed to be asked one more question—someone waiting for permission to speak the truth.
Maybe they were a mom blaming herself for not feeling joy.
Maybe a dad who didn’t know partners could experience postpartum depression too.
Maybe a parent who didn’t realize intrusive thoughts mean distress, not danger.
Screening isn’t paperwork—it’s presence.
Reflecting on the training
This class reminded me how much power lives in small moments of connection—the pause between questions, the choice to ask gently instead of assuming.
Parenthood is raw, sacred, messy, and life-altering. When we ask with compassion, we give parents something they rarely get: honesty without shame.
Because healing, truly, starts with a question.
If You or Someone You Love Is Struggling:
📞 Postpartum Support International Helpline: 1-800-944-4773
Text “HELP” to 800-944-4773 (English) or “TEXT EN ESPAÑOL” to 971-203-7773