The Mental Health Form No One’s Reading

*Warning, I'm post-call and feeling feisty.*

I recently made 3 TikToks about postpartum mental health screening, especially the fear so many moms have of being honest on those forms.

One comment stopped me cold:

“It makes zero sense to me that the postpartum questionnaire asks if you've ever had thoughts of harming yourself or your baby in one - those seems like two verrrry separate questions to me, and prevented me from answering honestly about myself when I was in the trenches.”

That didn’t sound quite right to me, so I looked up the EPDS (the screening tool used by hospitals and clinics across the U.S).

The question does technically ask only about self-harm. But I knew immediately what she meant.

The form is vague. The system is vague.

And for many new moms, it’s easier to stay silent than risk being misunderstood.

A Deep Dive I Wasn’t Expecting

The EPDS was developed in 1987 in the U.K.

It’s ten questions long. It’s brief, free, and easy to score.

And it’s the standard, embedded in EMRs everywhere, including mine.

I’ve used it for years. I’ve taught others to use it.

I’ve never stopped to ask if we were using the right version.

And then I found it: the EPDS‑US, a culturally adapted, trauma-informed revision created by U.S. researchers.

It rewords unclear phrases. It separates self-harm from harm-to-baby.

It finally accounts for how moms in this country talk, think, and fear.

I was today years old when I learned that someone had updated it.

No one ever told me.

It’s not in our EMR.

It’s not in ACOG’s guidelines.

It’s not what we use.

And Even If It Were…

Let’s be honest: even the perfect form would fail in a broken system.

A therapist mom I know screened positive. No one read her form.

Another mom said she lied on hers because she didn’t want CPS involved.

I’ve seen forms handed out in pediatric waiting rooms instead of OB visits, collected without comment.

In my PSI training, I learned that many parents with clear postpartum depression or anxiety never screen positive.

Not because they aren’t suffering.

But because the questions don’t land, or the consequences of honesty feel too risky.

And when moms do score high, what happens next is… nothing. Or panic. Or, worst of all, blame.

Meanwhile, In Other Parts of the Hospital…

I’ve walked the hallways.

Neurosurgery wings sparkle with funding.

Emergency departments hum with tech.

Labor and delivery units are often outdated, cramped, under-resourced.

When I asked why, I was told, flatly:

“Obstetrics is always a loss.”

But postpartum moms are not a loss.

They’re the foundation of every family, every future patient, every system we claim to care about.

So Now I’m Asking:

What are we doing?

Why are we still using a form from the 1980s?

Why did no one tell me there was a better version?

Why are we screening without follow-up?

Why are clinical breastfeeding tools still pen and paper?

Why is it so much easier to fund a surgical robot than a new lactation lounge? (Don’t get me started on my experience at a huge health tech conference for 10k people with literally ONE LOCKED lactation room.)

And most importantly…

How many more moms have to suffer before we change something?

Want to share your story?

Reply here or leave a comment.

What was your experience with postpartum mental health screening?

Did someone follow up? Did anyone really see you?

Because I want to change this.

But I can’t do it alone.