March 29, 2009

Postpartum Depression: Andrea gets help, gets sleep.

I attended a seminar run by psychologists Shoshanna Bennett and Pec Indman through an amazing outfit called Postpartum Support International. The seminar was advertised as for healthcare professionals, and lasted 2 full days. It was crowded and expertly run, in the meeting room of a nice hotel. I think I was the only man there. I was the only physician there. There were no obstetricians, no neonatologists, no psychiatrists. I have to add that I can’t be 100% certain of this, but I looked at a lot of name badges and a list of attendees. There were a lot of midwives and doulas and nurses. Even though there’s a reputation of caring associated with these providers, their involvement with the mother is usually limited in duration. So it seems to me that the natural focus for dealing with postpartum depression was a pediatrician, who would be seeing the mother and baby often in those first weeks and months, and who wasn’t afraid of the extra time it would take to ask the question, “how do you feel?”

A few years ago, when I started my own practice, this would be an important goal. It required a change in scheduling and a change in commitment to the mother-baby unit.

Many of the guidelines for newborn care are a compromise, meant to attempt to optimize the balance between a lot of care, therefore costing more, that catches almost every problem, and little care that misses a lot of problems but costs much less. So the general guideline for pediatricians is a visit within 48 hours of leaving the hospital, then again at 2 weeks, then 2 months, and so on. The interval between visits gradually increases. These dates were arrived at by committee, and are meant to give each baby an acceptable amount of care. The schedule ignored the mother.

The obstetrical follow-up calendar saw the mother at 6 weeks. It ignores the baby.

The seminar at PSI was transformative. I started to ask several questions of all the new mothers. I haven’t kept track over the years, but my sense is that it’s closer to about 50% who have some symptoms.

Not all the symptoms last. Sometimes it really kicks in about day 3 or 4 of the baby’s life. At this crucial time, especially with a first baby, the mother is trying to breastfeed but she’s just not producing a lot yet. The baby has used up the reserve tank with which most newborns come equipped. The baby is much more awake than that first day, crying often to let you know how hungry it is. The mother hasn’t slept much in 3, maybe 4 or 5 days. It’s enough to make anybody reach for a bottle.

Andrea's baby was thriving. I was sorry she had stopped breastfeeding, but I knew that wasn’t yet a lost cause. I recommended a lactation consultant. But the baby was growing well, so this wasn't my first priority. That was sleep. I asked Andrea and her husband to help me make a list of absolutely everyone they could call on for help. Even if it was somebody who could watch the baby for a few minutes while Andrea took a shower, or someone who could join her when she did some shopping. As in many families, there was a grandparent at the top of this list. I used Andrea's cell phone to call her mother to ask if she’d like to watch the baby for a few hours. She was thrilled. I called Andrea’s husband and asked him to take the baby for a few hours, taking over from Andrea’s mother. The baby wasn’t breastfeeding at the moment, and another few hours of formula wasn’t going to make a difference. I suggested she ask her mother to watch the baby in Andrea’s apartment, and suggested that Andrea sleep in her mother’s house. I asked her to return the next day with the baby.

The next day, it should be obvious, was a revelation to both Andrea and me. A single uninterrupted stretch of sleep changed a lot about her view of the baby and her view of her self and her future. For the next 30 days or so, I saw Andrea and her baby or spoke to her on the phone at least once a day. I spoke to her husband, too, and asked him to come to as many baby visits as he could. She was gradually convinced that she wasn’t in this enterprise alone.

Note: Perhaps its no surprise that sleep deprivation has ominous effects for the new parent. It causes: "decreased global emotional intelligence... reduced self-regard, assertiveness, sense of independence... reduced empathy toward others and quality of interpersonal relationships..reduced impulse control... reduced positive thinking and action orientation... and greater reliance on formal superstitions and magical thinking processes." So it worsens interpersonal functioning, self-esteem, and stress management, while increasing your reliance on superstition. Perfect for new parents.

1 comment:

  1. Nice post. It is very educative about the newly born babies and postpartum depression. I believe mothers need a lot of help at that particular period. A helping hand is always needed to fight depression. Her husband can really help out in those situations.


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