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ADVANCE Perspective: Nurses

Beyond the Birth

Published June 11, 2009 1:40 PM by Abigail Scott

My son’s birth and first newborn days should have been some of the happiest of my life, but my mind had other plans. It was a long labor and delivery in March 2006, starting with an inducement, progressing through 24-30 sleepless hours of labor and concluding with a 1:30 a.m. C-section. Then my blood pressure went up, and I started to panic. I could not sleep, even when nurses gave me Ambien. I kept thinking I was experiencing a serious medical condition — dizziness, heart palpitations — and the blood pressure medication was causing side effects.

None of the healthcare providers considered a panic attack, which I’m now certain I experienced. Everyone seemed more focused on getting my son to breastfeed and wondering why I still couldn’t void without a catheter. When I finally could urinate and my blood tests were normal, I was discharged with my son. The panic symptoms continued. I was sleepless, but not just because of my newborn son’s demands — I was afraid to fall asleep because I thought I wouldn’t wake up. When I saw my doctor for a blood pressure check 2 days later, she finally admitted my problem might be anxiety and/or depression and prescribed Xanax, which helped immediately. My primary care provider later prescribed Prozac. Over time, my mood stabilized, but I still take an antidepressant.

Studies have shown untreated perinatal mental illness can result in poor infant development, increased injuries to the infant and higher rates of colic, noted Samantha Meltzer-Brody, MD, director of the perinatal psychiatry program of the UNC Center for Women’s Mood Disorders in Chapel Hill, NC. The bond between mother and child also suffers. In severe cases of postpartum psychosis, mother’s have a 5 percent suicide risk and a 4 percent risk of infanticide.

UNC HealthCare believes connecting mental health services with perinatal services would reach more women at risk for postpartum depression and related mental illness. As a result, it created an inpatient perinatal psychiatry program. Housed within the North Carolina Women’s Hospital, the program has an inpatient and outpatient component.

The Perinatal Mood Disorders Inpatient Unit consists of four private and two semi-private beds on a 15-bed, locked unit shared with geriatric psychiatry patients, which postpartum patients prefer because of its “calm and quiet” atmosphere. Mothers can spend extended supervised time with their newborns; rooms are furnished with glider rockers, and the unit has lactation consulting, breast pumps and milk storage. After discharge, women can receive follow-up care through two clinics. In addition to comprehensive assessment and treatment, including medication stabilization, postpartum patients receive specialized group and individual therapy. Spouses also can receive counseling and other support.

Fortunately, my anxiety and depression were minor and responded to medication and plenty of love and support from my family; however other women aren’t so lucky. If more programs such as those at UNC were available, new moms at risk could get the help they — and their babies — desperately need.


My problem wasn't mood disorder, it was exhaustion!  I was in labor for 19 hours (over night) with my first daughter.  Please, please, remember that the reason your new mom doesn't want to hold her new baby isn't because she's not bonding with the baby, its because she's exhausted!!!!  All I wanted to do was sleep.  But I knew I had to hold her, feed her, change her or the social worker would be showing up at my bedside!  Please try to investigate your mom's refusal, maybe she's so exhausted she's afraid she'll drop the baby or fall asleep holding her!!  I know I was!  I've been wanting to speak about this since my daughter was born 13 years ago.  So glad I finally have the opportunity to do so.  I know there have to be other moms out there like I was!!!!  

Susan, Rehabilitation - RN, HealthSouth June 11, 2009 11:34 PM
Arlington TX

The nurse practitioner was correct to point out that a personal history of depression increases the likelihood during the postpartum period. In the OB office in which I work, patients with a history of depression are encouraged to take an antidepressant during pregnancy to decrease the chance of a more severe depressive state following the birth of their child. I have a background in psychiatric/mental health nursing and am often the "go to" nurse for patient education concerning pregnancy and postpartum depression.

Some patients are hesitant to take medication during pregnancy; however, there are antidepressants considered safe for use. It is one of those situations in which the benefits outweigh the small possibility of risk. Numerous research studies indicate that infants fare better on many levels when their mothers are emotionally present to care for them.

I would love to see more units designed to treat women suffering from postpartum depression and/or anxiety. Unfortunately, most insurance companies are not willing to cover in-patient mental health services unless the woman is immediately suicidal or homicidal. Considering the well-documented impact of untreated mental health conditions on the mother, infant, and other family members, this type of treatment should be more readily available and encouraged.

Michele Hackney, Women's Health - Registered Nurse, Renaissance Women's Group June 11, 2009 8:01 PM
Austin TX

Overall, we need more mental health services available.  This is a great plan for so many new moms.  It's scary enough to be a parent, regardless of past medical history.  

When I had my second child, I saw a nurse practitioner.  She  asked about my prior history of depression and told me I was at higher risk for postpartum issues because of it. So, after my daughter was born, I watched myself more carefully, as did my husband.  That nurse practitioner's moment of education allowed me to seek help when I needed it-probably a lot sooner than I would have otherwise.

I really hope this program at UNC can start to take the stigma out of mental health issues.

Lorettajo Kapinos, Emergency - RN June 11, 2009 2:34 PM
Springfield MA

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