Postpartum depression: Look for clues of the blues
Postpartum depression: Look for clues of the blues
Dispel notion that depressed women are bad moms
A man phoned the 24-hour hotline at Mount Carmel Medical Center in Columbus, OH, concerned about his wife, who had given birth there a month before. Against a backdrop of crashing sounds, he told the nurse who answered the phone that his wife was smashing baby bottles against the wall. He wondered, was that normal?
Upon further evaluation, the woman was admitted to the hospital and treated briefly for postpartum depression (PPD), a disorder that usually begins two to six weeks after birth. Although such hospitalization is a rare outcome for the disorder, experts say many new mothers suffer in silence from mild to moderate depression because they fear the stigma of being inadequate as well as unhappy during what should be a joyous time. These experts suggest careful screening of all new mothers to identify those who might need psychosocial and medical intervention, and they recommend short-term treatment with antidepressants. (See story on symptoms of PPD, p. 46.)
Linda Sebastian, MSN, director of the women’s program at the Meninger Clinic in Topeka, KS, says mood disorders are more common than most other postpartum complications: The incidence of postpartum mood disorders is about 15 to 20%, whereas the incidence of postpartum infection is 3%. However, OB/GYNs usually don’t discuss mood disorders with women before birth or when they come for their six-week follow-up exam, Sebastian asserts. Some women will hide emotional distress from their health care provider because they feel guilty, she says.
Women’s health centers get involved
Sebastian treats depressed women one-on-one, but she often refers less serious cases to the Jane C. Stormont Women’s Health Center, also in Topeka. There new moms can attend the Ready, Set, Grow program for mothers and their babies. The classes, in which both mother and baby participate, are free.
Although many different topics come up during the weekly, one-hour sessions, the conversation is "steered toward depression pretty frequently," says Karen Rowinsky, director of the Family Center at the Stormont-Vail Regional Hospital and a consultant to the women’s center. The topic often arises during childbirth classes, as well, Rowinsky says.
The Women’s Health Center at Mount Carmel, part of the Mount Carmel Medical Center in Columbus, OH, took a different approach. To determine the best way to inform women about postpartum mood disorders, the center organized a 20-member task force of psychiatrists, psychologists, OB/GYNs, nurses, and lactation consultants, says center manager Terry Yost Allton, LSW.
The task force decided to create a postpartum depression referral network, a list of more than 100 professionals who can help new mothers experiencing depression. The list is kept on hand by all providers who might come in contact with patients needing referrals. Yost Allton says 450 women were referred for help last year using this network, and their families also were given resources for support.
Here’s how the referral list is organized:
• Immediate help.This section includes the hospital’s 24-hour hotline and a toll-free number for Ohio State University Medical Center.
• Centers. This section includes names and phone numbers of counseling and behavioral health centers in the community, as well as of a social worker at the women’s center.
• Individuals. This section includes names and phone numbers of local psychiatrists, psychologists, Christian counselors, and social workers.
• Resources for Medicaid patients. This section includes the names and phone numbers of community mental health centers.
Women feel dropped’ after delivery
Yost Allton became interested in creating a network when members of a self-help group for women with PPD came to the hospital saying that no one had explained what could happen after delivery. The group is a local chapter of Depression After Delivery, a nonprofit organization based in Morrisville, PA.
"I was surprised that there was such a focus on inpatient care but so little focus on outpatient care after birth," she says. "Before birth, the women feel a connection to the hospital, but many of them feel dropped after they deliver their baby."
If you would like to set up your own referral network, here is some advice from Yost Allton:
• Find out if there is a local chapter of Depression After Delivery in your area.
• Investigate the continuity of care in your area. What kind of follow-up exists, and what is needed? Are there physicians who specialize in PPD or have an interest in doing so?
• In addition to physicians, involve other health care professionals who have regular contact with women, such as labor and delivery nurses, lactation consultants, and social workers.
• Initiate a 24-hour hotline at your center so women and their families can get help any time. If that’s impossible, check with your local mental health center; it may have one already.
Whether you start a special support group for postpartum women or simply compile a list of local resources, the most important thing is to educate women not to be ashamed of their emotions.
"There’s a stigma [associated with PPD] about being a bad parent," Rowinsky notes. "Parents are supposed to be so happy it’s supposed to be the best time of their life and they are so guilty if they aren’t feeling that way. The more people who bring up the topic of postpartum depression, the better. Women need to know that other people experience it, too."
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