Helping hands for new parents

Lauren Harris remembers the moment clearly. Overwhelmed for months following the birth of her second child, she was driving over a mountain in the Berkshires on the way to work when a frightening thought crossed her mind.

“I can swerve my car and go over the side and I wouldn’t have to deal with anything anymore,” she recalls thinking.

It was, she said, the first inkling that she was dealing with something more than the “baby blues.”

Even though Harris had no intention of doing anything drastic, she was so disturbed by that thought, she called her doctor. As a therapist, she knew that hormonal changes and other factors following childbirth often cause mood swings, crying spells, anxiety and sleep difficulties. She also knew those emotional ups and downs, experienced by about 20 percent of all new parents, should only last about two weeks. What she didn’t know was that she was experiencing something much more severe.

“It was terrible, awful,” she says of the anxiety and helplessness she felt for months following the birth of her second and third children. “Some things that were insignificant seemed insurmountable to me. Going to the grocery store required all my energy. I knew I was struggling but I thought I had it under control.”

She didn’t.

Harris’s doctor diagnosed her not only with postpartum depression but also with postpartum anxiety and postpartum obsessive-compulsive disorder. Collectively, her conditions were part of what is known as perinatal mood and anxiety disorders, three of seven associated conditions that include the more serious perinatal bipolar disorder and perinatal psychosis.

To help Harris deal with her condition, her doctor prescribed a low dosage antidepressant, a decision which Harris calls “a game changer.” The drugs lifted her mood and helped her get through the difficult emotional period.

Today, Lauren (seen below with her family) is helping others as a certified perinatal mental health therapist and western Massachusetts coordinator for PostPartum Support International, an organization that works to increase awareness about the emotional changes experienced during and after pregnancy. She also owns and operates a clinical practice that focuses on supporting pregnant parents and parents of newborns, The Center for Perinatal Wellness in Easthampton, Mass.

The importance of awareness

About one in 10 new mothers develop a pregnancy-related mood disorder such as perinatal or postpartum depression, according to new research from the American College of Obstetricians and Gynecologists. A combination of medication and psychotherapy is highly effective treatment for most.

But few actually get treatment, said Dr. Robin Fischer, a reproductive endocrinologist, obstetrician-gynecologist and a physician reviewer for Blue Cross Blue Shield of Massachusetts. That’s primarily because many of the common symptoms — such as excessive worrying, sleeplessness, crying and a decrease in appetite, among other things — are often disregarded as “normal” hormonal changes that develop during and immediately after pregnancy.

“It’s normal to feel out of sorts,” Fischer says, “but when there are extreme symptoms like crying a lot, that’s not normal.”

The American College of Obstetricians and Gynecologists recommends doctors screen new moms for signs of postpartum depression around six weeks after childbirth, using a simple form with questions about a patient’s mental health.

However, studies have found the majority of obstetricians, gynecologists, pediatricians and family practitioners do not screen new moms for severe depression.

The stigma attached to mental health issues and the difficulty new mothers have in admitting they need help can create obstacles to proper treatment, advocates note.

Dr. Monica Ruehli, a Norwood, ., specialist in obstetrics and gynecology, says although it has become more common to screen new parents for depression both before and after they give birth, only one out of four actually get the treatment they need.

“It’s a real health crisis,” Ruehli said of the low treatment rate. New parents with a family history of depression, a difficult or traumatic birth, or those from certain ethnic groups, including black mothers and Native Americans, may be especially susceptible to developing prenatal and postpartum depression.

Effect on babies

A parent's postpartum depression also can affect their newborn.

“It’s become a very difficult issue in public health because it not only affects the well-being of the mother, there is significant research to show that there may also be an impact on a child’s development.” Ruehli said.

Depression and anxiety during or after pregnancy can cause underweight births, bonding problems between parent and baby, and later, may even affect a child’s IQ, language or psychological development, said Dr. Nancy Byatt, a psychiatrist and Massachusetts medical director of the Massachusetts Child Psychiatry Access Program for Moms, which provides training, psychiatric consultation, care coordination, and other support to clinicians who are serving pregnant and postpartum parents and their children up to one year after delivery.

An episode of postpartum depression also can increase the risk for another episode with subsequent pregnancies, so support and planning for treatment are key, postpartum clinicians say.

Ending stigma, improving education

Parentscan find help through hospital-based organizations such The Center for Women’s Mental Health at Massachusetts General Hospitalwhich provides evaluation and treatment of psychiatric disorders associated with reproductive functions. Other organizations, like The Center for Perinatal Wellness and PostPartum Support International, can also provide guidance.

Education is key, says Harris, the founder of The Center for Perinatal Wellness who survived her own bouts with postpartum depression.

“We need to educate new parents-to-be by incorporating this into birth education. We need to educate all care providers, not just OB/GYNs and midwives. We need to address this with general practitioners, pediatricians and maybe take it a step further with intervention workers,” she said.

Equally important, Harris added, is the need to decrease the stigma around postpartum depression so that new parents feel safe to say, “I need help.”

The discussions, Ruehli said, should start during pregnancy because sometimes, those “baby blues” can begin even before the baby arrives.

Connecting parents and physicians to the right resources is key, experts say.

The Postpartum Health Alliance and other similar groups connects parents and clinicians with therapists, said Maria Hester, a marriage and family therapist who volunteers with the alliance.

“The biggest thing is education,” says Fischer. “Women need to talk about this with their partners and physicians. Don’t be afraid. You are not alone.”

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_{PHOTO PROVIDED BY THE HAWKINS FAMILY}