May 2007

Changing Views on Postpartum Depression

Quincy Patriot-Ledger

Actress Brooke Shields made headlines last year with her public battle against postpartum depression, a crippling form of depression that affects mothers – and sometimes fathers – after childbirth. She was back in the news last week, holding a press conference on Capitol Hill to support legislation that would direct federal research dollars toward postpartum depression.

While the disorder is not an officially recognized form of depression by the American Psychiatric Association, the APA has devoted time to the disorder, most recently presenting a study noting postpartum depression symptoms are routinely under-diagnosed and often go untreated. Healthcare workers in the Quincy area say they are now seeing postings for conferences on treatment and early diagnosis of postpartum depression popping up on bulletin boards all across hospital walls. And now a small group of nurses, doctors, midwives and social workers south of Boston is trying to bring home the message that postpartum depression is real – and treatable.

As part of that effort, a series of forums directed at families and healthcare workers has already begun in areas around the cape, with more planned in cities like Worcester and Rockland.

Rosemary Chrétien is Program Coordinator for the North River Collaborative Family Network. She said she was really impressed by the forums she attended and is looking to establish one in Rockland in early 2008.

“I liked it because people got up and shared their stories,” she said, referring to a March forum on the Cape. “Particularly, because I’m a mom and I remember having more than just the ‘baby blues.’”

“That’s a big distinction people need to make,” said Dr. Deborah Issokson, a licensed psychologist in Pembroke who has taken part in the series of forums.

“If you have the baby blues, you might cry, but you still socialize,” she said. “Your moods go up and down and your emotions are all over the map, but they are only ‘moments’ of mood.” Postpartum depression, she says, is much more serious. The mother is not sleeping, not eating, refusing to get out of bed, and simply not able to feel better.

“A woman suffering from postpartum depression is inconsolable,” she said. “There’s a big difference between that and the ‘baby blues,’ and we in the healthcare field need to do a better job of recognizing that difference.”

Issokson has spoken at two forums, most recently at a May 11 forum sponsored by Greater New Bedford COAST, which stands for community, opportunity, access, safety and trust. Judith Coykendall is the chairperson of COAST’s health access committee. She said the response to the forums has been positive.

“It’s important for us to increase awareness, and increase the ability to recognize and refer new mothers to the proper channels,” she said.

Issokson says 15-20 percent of women can have a diagnosable mental health disorder after birth, and that women need to know that if they have feelings of anxiety and uncontrollable depression, they are not alone.

“It’s important to get people to understand that this happens and, you know what? It’s OK. Nobody’s going to take your baby away,” Issokson said.

Postpartum depression can generally be characterized as a severe anxiety. Not so much feelings of “I’m going to hurt the baby,” but “something is going to hurt the baby.” It is not simple fret, Issokson says, it is obsessive fret.

“Babies bring about huge change. People need to realize that,” she said. “We need to expect it, prepare for it, and most of all, don’t be ashamed of it.”

New mothers are often surrounded by people telling her how wonderful she should be feeling, that this is the most beautiful time of her life. A lot of the time, Issokson says, that’s just not the case.

“A new mother can have feelings of sadness, of doubt, feelings that go against what everyone is saying,” she says. “She doesn’t want to tell anyone about these negative feelings so she internalizes it all, which only serves to compound the problem.”

Issokson says part of the reason for this surge in postpartum awareness could be attributed to the fact that more and more women are having children later in life, creating a new kind of mom.

“Often times we’ll see a mom who was pulling down $100,000 in the city, interacting with and often supervising other adults,” Issokson says. “Suddenly they’re transported into the middle of this new world of dirty diapers and sweatpants covered in spit-up. They’re alone in a new world, and if there’s nothing in the way of a support system, it can be quite a shock.”

Kathy Jones-McWilliams has been a midwife in the Quincy area for over 16 years.

“Having the proper support system around you is one of the most important things,” Jones-McWilliams said. “These women are going through a life-changing event. Sometimes they can feel like they’re all alone in the world. We’d like to see if we can change that.”

She also says one of the main obstacles in finding women who may be at risk for postpartum depression is the current structure of our healthcare system.

“Doctors and nurses are told to see more patients, which means less one-on-one time,” Jones-McWilliams said. “You’re lucky to get 15 minutes during a post-natal visit; it can be hard to determine who might be a candidate for postpartum depression.”

She says her years of practice have helped her to learn to recognize signs, but it is not something that is covered by basic medical schooling.

“We’re not saying OB-GYNs or midwives are to blame for not catching this,” Issokson said. “It’s simply not part of their training.”

New mothers have one, maybe two post-natal medical appointments and that’s it. After that, the OB-GYN is essentially out of the picture and pediatricians come in. Issokson says that’s why pediatricians are crucial to the success of these forums.

“That’s what these forums are all about,” Coykendall says. “They have been open to the public, but the main focus is toward healthcare workers, the people who surround mothers throughout this process.”

Attendees are told what they should watch for, how to tell the difference between the baby blues and actual depression.

“There are big gaping holes in the system. It’s easy for a woman who is experiencing postpartum depression to feel alone,” Issokson said.

Issokson says there are groups – though not many – for dealing with these issues, but often times moms and doctors don’t know where the groups are. These groups are there for women to meet with other women who had these same experiences.

Jones-McWilliams sees the growing awareness of postpartum depression and the new forums and conferences as a good thing.

“It’s good to see all the attention being paid to this disorder right now,” she said. “We need to be asking these questions and paying attention to the mother as a whole person. That’s really what healthcare is all about.”