April 3, 2009

Postpartum Depression: A father's comment--observed

A father’s Comment, observed.

In my last post was the comment of a new father. This story has many elements in common with a lot of the cases of postpartum depression that I have seen. The mother isn't overtly depressed, and wouldn't identify herself as depressed. Dad says that he is, but is quick to say how happy he is. But when I read this, I don't get a happy feeling. I think most readers will hear the tone of sadness throughout the comment. Professionally speaking, I don't think things are going all that great for these parents and I don't fully believe that either one of them are really happy with the situation.

Can I relieve some of this suffering? Does it have to be this way?

Her Mood:
When I received this comment, I called the family and asked them to come in to the office. The baby was doing fine, which enabled me to focus on the parents. Just as hinted at in the father's comment, mother was at the same time territorial about the baby's care and yet feeling overwhelmingly pressured to do everything herself. I started with the usual, ‘How are things going?’ She said everything was going fine, and she felt good. But every time I asked about something specific, it was a different story. Mom used a lot of tissues during the visit.

For this mother, as she saw it, nothing was going the way it should. Breastfeeding was very painful, and she had been told it wouldn’t be. She was very afraid that the baby wasn’t getting enough, even though his weight gain was good. To her, he always seemed hungry after nursing because he continued to want to suck. She couldn’t stand his screams. The baby was telling the world that what she was producing, what she was doing, just wasn’t good enough.

Dad’s Mood:
She didn't think the father could do a lot of the tasks she did, but never asked him for help or showed him what she wanted. She never let him help, and was angry at him for not helping. He felt like an outsider looking in, saddened by his isolation and by his own helplessness.

The Wrist:
The mother felt bad enough without the excruciating pain in her wrists. Every time she went to pick up the baby, she felt that she was destined to wince in pain. She didn't know who to tell about this problem, but I'm glad the father told me. She had something called nursemaid's wrist. (Important note: this has nothing whatever to do with nursemaid's elbow.) It's an overuse injury that you get from picking up babies all the time. The fix is rest. What I told her to get was a wrist splint with a metal bar in it for stiffness. All the wraps and elastic things won't help. The wrist has to be immobilized for the inflamed tendons to heal.

It’s tough enough to keep your spirits up when you’re in pain. But she told me that her wrist pain made her feel bad. She explained that every time the baby cried, she dreaded having to pick him up, as if he were causing her pain. She felt terribly guilty about these feelings and knew it wasn’t the baby’s fault—it was her fault.

As an aside, this brings up once again a philosophical problem with medical care. I'm the baby's doctor and the baby was doing OK. Should I mind my own business about everything else? Hint: what do you think?

Next Post: A strategy

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Please let me know what you think. Do you know a child or situation like this?