Interesting question! I think primarily that this is an unique opportunity for true early intervention and prevention. Most women are highly motivated to be the best mother than can be - more so than any other time of their lives, so you can eg get them onto methadone, start a new relationship (with their baby) with a clean slate. And it can make a huge difference for outcomes for the child

Roughly 1 in 7 women giving birth; increased if family or past history of affective disorder, lack of support, childhood abuse, and multiple stresses of any type.

Mood and anxiety symptoms that are there for most of the day, most days, for two weeks. More likely to be anxious than other depressive disorders. But...women are good at denying/covering up so anyone frequently presenting especially with baby symptoms, and if its sleep related, having a night off doesn't help. Sleep disruption and breastfeeding changes physiology so physical symptoms need to be carefully elucidated.

Be sure not to miss postpartum psychosis - behaviour usually changes significantly and anxiety or mood symptoms quite prominent.

I don't see the baby blues because they are further down the track by the time I get them. But 80% have the blues to some degree...and unsurprisingly, most women with PND started with the blues. Only postpartum psychosis, which often starts at the same time, can be readily differentiated (more marked anxiety, mood and behaviour change, but beware, some women can hide it so always good to listen to those who know the woman best).

The EPDS is really the only one that is useful but only as a mass screening tool. I don't use any in clinical practice - I take a detailed history which is the only real way to get a diagnosis. In research - it depends what I want to measure. I do however use the Adult Attachment Interview and the Strange Situation Procedure in my parenting assessments (and the Maternal Q sort is also useful for this).

The number one differential diagnosis! If possible have their mother or partner care for the baby overnight (and provide sleeping tabs). It doesn't however cause a disorder (though it an be one of many factors); sleep deprivation is quite often caused by the disorder, especially anxiety. These mothers have been noted to get up more often and wake their baby (fear of SIDS) as much as the other way around (babies can sense tension and may have disturbed sleep in response). These mothers often have babies who sleep amazingly well - but the mother still can't sleep.

Probably all the same things you would do for anyone. Flexible times to see them, seeing them more often when needed. Women need to feel heard, and evidence suggests just a supportive nonjudgmental ear can help many. The difference is to remember they are battling the anxiety not just of having a mental illness, but also fear being seen as a bad mother (and some will fear their child might be removed). Be sensitive to them and their particular issues. They won't all be the same, but be aware of the common themes: fear of being seen as a bad mother if they aren't perfect not feeling supported or understood (nb by partner) everything being about the child not them resentment of the child but guilt about this awakening of their own unmet emotional needs/childhood trauma

Some are going to need practical anxiety management skills and don''t rush in too early with trauma/attachment work about their own childhood until they are well enough to manage it (and many then won't need it). The child on the other hand can't wait and their attachment is happening, so don't forget them - the Circle of Security is very good at helping mothers not feeling blamed but at seeing their child's cues more clearly (without their own issues getting in the way), and therapists can work on this too.

Treating Postnatal Depression by Jeannette Milgrom Look at COPE with Nicole Highett - I think she does practical education sessions. The Circle of Security Intervention by Bert Powell et al (but its rather dry and attending training much more interesting and very useful!) Good Enough Parenting by Andrew Wake - designed for parents but useful to understand attachment and the message for parents and where things go wrong

I mostly think it is my role to give the risks and likelyhood but never actually advise one way or another. Two people given exactly the same advice can make opposite decisions! Mostly there are ways to help improve outcomes, but needs a serious discussion with both parents. If someone is on very high/multiple medications and can't get off them then given this is an added risk, I might be stronger re the risks but ultimately there is no zero risk. If they decide not to go ahead then its helping support the grief/what that means for them.

Yes - though current evidence suggests that antenatal depression and anxiety has the biggest impact because of biological changes (ie increased cortisol) that the infant is exposed to, altering their stress response and possibly making them more vulnerable to depression/anxiety alter in life). Postnatally emotional neglect/ attachment issues can impact if the woman isn't treated, and there are her own attachment issues to her own primary carer. These can occur in nondepressed mothers but a higher rate in those with depression (probably because attachment issues/chlidhood trauma is a risk factor).

Certainly you are at increased risk of postpartum depression if there is a family history of depression (any depression, and either side of the family) and especially high risk of postpartum psychosis if there is a family history of bipolar disorder. This suggests a genetic component. There is also an additional risk through attachment style, especially if your parenting experience as a child was traumtic.

There is certainly evidence fathers get PND, though at a lower rate than mothers - but most of the studies are not of dads who are primary carers. Much less looked at, but the simple answer is yes if the risk factors are in play - change of role can be positive but also stressful, and for men there may be additional issues eg mothers groups support. well, mothers more often than not--finding men in similar circumstances for support is likely to be harder. All other risk issues - past and family history of depression, financial stresses, a traumatic childhood will also increase risk.

Education about PND is recommended in all antenatal classes as is at least one antenatal screening with information about services. Unfortunately this doesn't always happen. Women are very open to it but often don't hear because "it won't happen to me" attitude. Training and the comfort midwives (&O&Gs) have with PND varies too. There is more awareness than there was, but doesn't mean we're there yet!

Perhaps looked at more holistically. The problem with the medical model is it tends to be simplistic and there is nothing about these cases that are simple. Ideally we'd have a system which these families are offered supports well before this happens - certainly in pregnancy and maybe even earlier. In schools for instance looking at role models in pregnancy/gender stereotypes. PND in these families is merely the tip of the iceberg and needs a multi pronged approach that all too few get and often too late

Not all studies say this is a risk factor, and it may depend what you mean; delayed by choice or delayed because multiple unsuccessful attempts? In the first case, older first mothers may find the lack of control, lack of peer support they had at work ( and mundaneness) of being a mother a stress; the beyondblue study showed "perfectionism" was a risk factor for PND. They want to be perfect mothers and there is a mismatch between expectations and reality. Multiple unsuccessful attempts (and then success) can be associated with depression because there is the unresolved grief of the previous losses, (and sometimes guilt of success when others haven't)

Having had one postpartum disorder, you are at higher risk of having it again postpartum, but also unrelated. Mostly the disorder will look much like the last, sometimes a little worse. The one I would caution on is high anxiety with obsessional symptoms; mild ones can be managed first time with antidepressants/ CBT but later ones the öbsessions can become psychotic. This was probably a misdiagnosis of the first rather than a real change of disorder.

Cognitive Behavioural Therapy Interpersonal therapy Antidepressants (better with one of the above)

Supportive therapy helpful for mild cases. No strong evidence for anything else (though things like exercise/pram walking/support groups/yoga can help some women).

For parenting/attachment trauma Circle of Security is very popular (and I'm a fan) but long term data is lacking, at least in part because there are so many covariables in child outcomes

Anxiety. Or rather they see it and down play it. Postpartum psychosis can present as marked anxiety, often about the child. Other than that, the biggest issue is not asking - and keeping asking (especially if your intuition says things aren't quite right). Women are afraid and ashamed and cover their symptoms for fear of baby being removed or being seen as a bad mother.