Aspects of the full scope of the obstetric team’s potential to detect and treat postnatal depression were possibly neglected in the otherwise useful review of Pearlstein and colleagues. That this neglect is perhaps commonplace in obstetric practice might be reflected in the high number of maternal deaths because of psychiatric illness.

In the latest triannual review from the United Kingdom confidential enquiry into maternal and child health, deaths from psychiatric causes were the second most common cause of mortality in mothers after cardiac disease. Recent US surveys found only a third of patients with a diagnosis of major depression while experiencing obstetric care are actually receiving treatment for that depression, whereas others suggest the detection rate for depression among pregnant women is less than a quarter.

The key role of the rest of the obstetric team, perhaps particularly the midwife and health visitor, whose role in northern Europe is at the core of maternity and postnatal care, seemed to be somewhat glossed over in this review. Midwives are frequently the key health workers who provide most continuity of care during a mother’s stay in the maternity unit and therefore have a vital role to play in detection in significant change during that time.

A recent study found that early detection of major depressive episodes increased by 37.7% following a specific psychologic training package administered to midwives alone.

Women offered postnatal counseling sessions by health visitors are more likely to recover from postnatal depression. As a result, listening visits have now been widely implemented throughout the United Kingdom. Other interventions that could treat or prevent perinatal depression include counseling, massage, doulas or companionship, and hormonal treatments.

Heightened awareness for common psychologic problems frequently comorbid for depression would probably be very helpful. For example, patients who are infertile because of an eating disorder may nevertheless seek a fertility workup from obstetricians and gynecologists.

It is therefore useful to be aware of screening questions (eg, convictions of being overweight while in fact being a low weight), along with the characteristic abnormal physical investigations commonly linked with eating disorders. These women may get pregnant, and signs of abnormal preoccupation with food include knowing in excessive detail the fat content of baby food.

Obstetricians, as well as the rest of the obstetric team, have a special responsibility to develop mental health awareness built in at a foundational level, just as general practice or family practice medicine now accepts its key role in the detection and management of mental health difficulties in the population.