For providers · Clinical resource

Mom screened positive at a well-child visit — now what?

By Josephine W. Hazeley, MSN, PMHNP-BC
Board-certified psychiatric mental health nurse practitioner with a perinatal & postpartum focus — nearly two decades in psychiatric nursing, including research nursing on the trial behind the first FDA-approved postpartum-depression therapy. About your clinician

Clinically reviewed by Josephine W. Hazeley, PMHNP-BC on · Last updated

Name the result to the mother, do a brief safety check, and — with her consent — send her contact details to a perinatal psychiatric prescriber before the family leaves. The American Academy of Pediatrics recommends screening mothers for postpartum depression at the 1-, 2-, 4-, and 6-month well-child visits (Earls et al., Pediatrics 2019); a positive screen is what the pathway below is for. It takes about the same time as documenting the result.

The AAP’s clinical report calls perinatal depression the most common obstetric complication in the United States, and notes that even when screening results are positive, mothers often do not receive further evaluation (Earls et al., 2019). Obstetric screening ends where obstetric care ends: ACOG’s touchpoints run through the postpartum visit (ACOG patient-screening program). That leaves the well-child schedule as the surveillance net for much of the first year. Your screens are often the only ones still happening.

She isn’t your patient — what can you do?

The mother is not on your panel, and her depression is not yours to diagnose or treat. Her depression does affect your patient, though — the AAP report ties untreated maternal depression to effects on the infant and the mother–infant dyad, which is why the screening happens in your exam room in the first place (Earls et al., 2019). Responding to a positive screen does not mean assuming her care; it means three things you can do in the visit:

  1. Name the result, plainly. “Your answers on this questionnaire suggest you may be dealing with depression. It’s common, it’s treatable, and it’s not your fault.”
  2. Check safety. Item 10 of the EPDS asks about thoughts of self-harm (Cox, Holden & Sagovsky, 1987). Any positive response needs same-day action — and active suicidal intent, thoughts of harming the baby, or any sign of postpartum psychosis (new confusion, hallucinations, delusions, mania) is an emergency: call or text 988, call 911, or send her to the emergency department. Postpartum psychosis never waits for an outpatient referral.
  3. Ask consent, then refer. “Would it be okay if a psychiatric clinician who specializes in pregnancy and postpartum reached out to you?” With a yes, the referral is one call or email with her contact details.

Where do you send her?

To a practice where the mother is the patient. Mindful Counseling & Wellness is a North Carolina telehealth psychiatric practice for adults, led by Josephine W. Hazeley, MSN, PMHNP-BC — offering psychiatric evaluation, medication management, and supportive therapy with a perinatal specialty. New patients are typically seen within 1–3 business days (current availability), and telehealth statewide means the referral works whether the family lives near your office or three counties away.

Send contact details only — no clinical records, and no patient health details by phone or email: (919) 739-3808 · info@mindfulcounselingandwellness.com. In-network coverage with major North Carolina health plans is available now (currently through Headway, with direct plan contracts being added), and self-pay is welcome now; any therapy the mother already has stays in place. With her consent, we close the loop so you know the referral landed.

If she declines the referral, that is her call to make. Document the screen, tell her the door stays open, and re-screen at the next well-child visit on the AAP schedule — a mother who says no at the 2-month visit may say yes at the 4-month one.

Triage tiers, consent language, and the rest of the referral mechanics are in the perinatal referral guide; if your practice screens with the EPDS, the score-specific version is the EPDS referral pathway.

If you or someone you know is in crisis, call or text 988 (Suicide & Crisis Lifeline) or call 911. Postpartum Support International also maintains perinatal-specific support resources at postpartum.net.

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