Healthcare workers learn of depression in new moms
If you are a new mother with a newborn baby in your arms, and by late afternoon you have not gotten out of pajamas or found time or energy to brush your teeth, you may be among the 10 to 20 percent of new moms suffering from post-partum depression (PPD).
That was the consensus of experts who discussed their experiences and their professional understanding at the Martha's Vineyard Post-Partum Depression Outreach Forum Saturday.
The Martha's Vineyard Hospital and Martha's Vineyard Community Services (MVCS) organized the forum, the first of its kind here. Both organizations are members of the Cape Cod and Islands Maternal Depression Task Force. The event was an effort to coordinate services, provide helpful information for service providers, and educate young mothers and families. The gathering in the Tisbury Senior Center attracted about 25 healthcare professionals seeking the latest information on PPD.
The guest speaker was Deborah Issokson, a licensed psychologist who heads the Counseling for Reproductive Health and Healing center in Wellesley.
In additional to providing firsthand accounts of the PPD experience, the forum provided professionals with new research findings. Dr. Issokson summarized the typical PPD symptoms including tearfulness, irritability, sadness, feelings of inadequacy, and irrational fears. The onset of PPD may occur anytime during the first year postpartum and last two weeks or longer.
"Depression in new moms looks and feels different than depression in women without children," Dr. Issokson said.
The mood disorder, a form of depression, may be caused by a severe drop in hormone levels following birth or may be psycho-social in origin. Regardless of the root cause, the symptoms include extreme anxiety, a sense of isolation, and neediness. "The way I was feeling was exactly like grief. There was a longing for the way my life was before," according to one PPD sufferer who joined the panel of professionals.
According to one young mother who offered a personal perspective, "I did not want people to know what I was feeling. I was totally overwhelmed by fear and I felt trapped."
There are four diagnosed levels of PPD. The mildest form, the "blues," affects as many as 84 percent of new moms, lasts a few days, and is self-correcting. Postpartum anxiety includes intense preoccupation with the safety and health of the baby and may include panic attacks. Post-traumatic stress disorder may occur in up to six percent of new moms. Postpartum psychosis is rare, usually is seen two to four weeks after birth, and may include hallucinations, delirium, and confusion.
"There is a 'chain of secrecy' that goes along with PPD," according to Dr. Issokson. "Women come into my office with such shame. We have come a long way in helping to educate moms and families, but there is still a lot of stigma."
Dr. Issokson described several cultural and psychological factors that also contribute to the occurrence or severity of PPD, including cultural isolation. "We don't have a lot of retreats to bring adults across the threshold to parenting, and I think that is a real problem," she said adding that new moms too often do not have a realistic picture of what parenting entails. Patients in her practice have told her, "I thought I would be like the Hollywood stars with their babies."
"A lot of what we professionals have to do is intervene with reality," said Dr. Issokson. "I tell patients it is okay to shower every other day, or brush your teeth at three in the afternoon."
Dr. Issokson recommended that nurses seeing pregnant women initiate a screening process to identify potential problems before the woman gives birth. "If we did a really good screening pre-natal we would keep women out of the emergency room," she said. She also recommended that nurses begin to educate women about community support services before they give birth.
According to the most recent research, Dr. Issokson told the audience that "there is no excuse for any physician to tell women they have to go off drugs if they are breast feeding." Most anti-depressant drugs are now considered "pretty safe" for babies and work well on relieving anxiety and depression, she said.
And dads should be included in a pre-natal process that educates them about PPD and provides them with "tender loving care," because they will also experience the postpartum process, Dr. Issokson suggested.
On Martha's Vineyard, there needs to be better coordination among professional care providers, so that the services mothers and families need get to them, according to Joyce Capobianco, RN, the manager of the Martha's Vineyard Hospital maternity services.
Nancy Leport, a certified nurse midwife with the Center for Women's Health at the hospital, also expressed concern for a lack of services. "On this Island, if we can get a new mom emergency care, she might not be able to see a counselor for three months," she said. "I should have a list of referral names, but it is not easy to get an appointment, and insurance may not cover the cost."
Martha's Vineyard Community Services offers a "baby's first year" support program, with meetings for new mothers held twice a week (Monday, at 3 pm, and Thursday, at 10:30 am) where new moms are welcome "even in their pajamas," according to registered nurse Marney Toole.
Motherhood is a "normal life transition, but it is a transition, and then it is a matter of context and degree. If it takes over their life, it is a problem; if it doesn't rule them, it's life," Ms. Toole concluded. For information about the support program, call 508-693-7900, ext. 283.
