Postpartum Depression

You’d think that by now I’d be good at this whole advocating for women/ advocating for myself thing, but I’m not. It takes practice, and it’s really depressing when I’m unable to find the personal power, the chutzpah, the whatever it takes, to actually say what needs to be said. A case in point:

A few months ago, during the summer, when I was working in postpartum one night, I was taking care of a woman who’s partner seemed to be completely checked-out of their relationship. He refused to respond to the woman’s repeated attempts at engaging him and getting him to help participate in baby care, or even pay attention to her and the baby in the first place. Often as a nurse I get the privilege of teaching both parents so much about their amazing newborn, and about breastfeeding and baby care, and often the fathers are just as eager to learn and help as the mothers. Not so in this case. And it was almost pathetic, the way she kept calling his name over and over, trying to get him to look, to pay attention, to help, to see, while instead he watched TV, and then eventually rolled over, turned his back on his wife and baby, and went to sleep. I was rather shocked by it, and went out of my way to help the mother take care of her newborn that night, while the husband slept on. I think I was hoping he’d see my efforts and realize that a) his wife needed help and b) he was doing absolutely nothing, and then begin to help, out of embarassment if nothing else. This didn’t work, obviously. The husband didn’t stir throughout the night, didn’t help his wife with the 3rd degree laceration walk to the bathroom, didn’t get up to check on the baby when it was screaming through the night (and in fact, how in the world do you SLEEP with a screaming baby in the same room??). The mother was very needy, wanting to breastfeed, lacking confidence in herself and her abilities, and desperate for praise and attention. I spent a lot of time in that room, and she stayed up for most of the night, while her husband slept. I could imagine how exhausted she’d be in the morning, and was worried about how little help and support she’d receive from him, and it turned out that I wasn’t the only one who was concerned! The nurse who’d taken care of the couple the night before confirmed that the husband’s behaviour had been just as unsupportive during her shift as well, and that there was definitely something “not quite right” about the way they related to one another (or failed to relate). Couple this with the fact that this woman had a history of depression, and it was almost like we were staring at a major case of postpartum depression just waiting to happen.

So, what did I do about it? I mentioned my concerns to woman’s attending doctor the next morning, and was flatly dismissed as being ridiculous and out of line. The doctor told me he knew the husband well, and had seen him at many prenatal visits, and was sure that not only was the husband supportive, but that the woman would be fine. When I suggested that we call social work, he told me absolutely not. When I mentioned her history of depression, he again stated that he was sure she would be fine, and that obviously what I had seen and observed was not what was really going on. He defended the husband again, said that maybe he was just tired and worn out from supporting his wife through labor, and that was that. No consults were made. No referrals were given. I felt absolutely helpless, but the way consults work in my hospital, only a doctor can order them, not a nurse, and what could I do? And frankly, I’m not so sure this woman needed a social work consult anyway—she didn’t need WIC or public assistance or anything like that, she just needed support!

I turned my patient over to the day nurse at the shift change, telling her about what I and the other nurse had observed, and then I went home, feeling shamed and belittled by the doctor, and feeling hurt and angry and pissed off and frightened, and alternately wanting to scream at the doctor, but also somewhat wishing I hadn’t opened my mouth, so thoroughly had I been shot down.

And where is that woman now? How is she doing? Who’s checking up on her? Has her partner become any more supportive, or is she feeling like she’s all alone in the world, with a new baby, absolutely no help at all, and ready to climb the walls? Did we let her down? Did I fail her by not taking a firmer stance with Dr. Belittle?

We had a very moving lecture on Postpartum Depression a few weeks ago, and of course this incident with Dr. Belittle and the scary unsupportive husband immediately came to mind. I wish I had had this lecture before above said incident, instead of 3 months after the fact. It was really driven home to me just how poor our country is at recognizing this disorder, let alone offering the appropriate resources and treamtent to the women who so desperately need support during such a terrible, vulnerable time. And as a nurse who occassionaly works on a postpartum unit, I’m amazed that I, personally, in the role of the nurse (i.e. someone who is supposedly trained to recognize signs of this, and to intervene with the appropriate support and treatment when necessary)…I had NO idea where to send a woman like this. No idea how to get in touch with support groups or hotlines. No resources to give this woman. No idea of who to call. No idea what referrals needed to be made (and as a nurse, my ability to refer is limited, since nurses can’t make referrals, but as a midwife, it’s a whole different story). Neither did the other nurse. We both felt something should be done, but we didn’t know what to do. Hello?? Shouldn’t the hospital have provided us with info and resources for this very situation? Where are nurses supposed to get this information from if it’s not part of their training? Why aren’t these resources more readily available? While the idea of routinely screening women for PPD as part of a nurse’s training/ job (let alone a doctor’s!) is given lip service, in practice, it isn’t really that routine. Isn’t that more than just a little scary??

I think in general people are so uncomfortable with diagnosing and treating and accepting psychiatric illness that we’d rather look the other way and pretend it doesn’t exist, rather than confront it. And I think a lot of this also stems from the fact that so often as providers, we really don’t know where to send women so that they can get the help they need, aside from the truly drastic measures like psych consults and social work consults (a route which Dr. Belittle clearly didn’t want to take). Maybe the new postpartum depression bill that’s recently been proposed in Congress will help with recognition and treatment of PPD, because any help at all in this depeartment is sorely needed!

Anyway, to make a long story short, the lecture was fabulous. The presenter was an RN who had personally experienced PPD herself, and was incredibly passionate about the subject. She had references and resources coming out the wazzoo, and I’m now very pleased to be able to pass all of this information on to you, my loyal readers, as well as to know that next time I see something like this (as a nurse or midwife), I will know exactly where to send the at-risk woman. And I’ve started incorporating signs and symptoms of the Baby Blues and PPD into the teaching and educating I do when I’m working on postpartum. And, I’m kinda hoping I get another opportunity to bring an at-risk patient to the attention of Dr. Belittle, because not only will I now be prepared to tell him exactly where to go if he starts to belittle me again, but I also feel like have the tools I need to actually educate him. He wasn’t the one staying up all night with that woman. He should put more faith in a nurse’s judgement, because after all, we spend a hell of a lot more time with the patient than he does. Doctors of the world: ignore nurses and their insights at your own peril, because they see things you’ll never see during your 15 minute antepartum visit or your 10 minute rounding!

Every time I’m forced to stand up for myself, I get a little bit better at it: a little calmer, a little more grace under fire, and a little more articulate.

Postpartum resources:

1-800-PPD-MOMS

1-800-944-4PPD (4773)

Postpartum Support International

National Association of Mothers’ Centers

The Postpartum Resource Center of New York

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4 Comments

  1. Posted November 13, 2006 at 10:54 am | Permalink

    Good for you!

  2. Posted November 15, 2006 at 9:59 am | Permalink

    I’m so glad that you advocated for that woman even before you were given the resources to help women who might have post partum depression. I’m a psychiatric social worker and have seen the suffering women go through when it is not diagnosed. I had a client who was not diagnosed at the time and went without treatment for over ten years while her life fell apart and everyone told her she should just perk up.

  3. The Student
    Posted November 30, 2006 at 1:11 pm | Permalink

    That’s just it: people don’t take psych disorders seriously in this country, when really they can absolutely *destroy* a person’s life. I rarely speak about this, but PPD has affected my own life, and the life of my mother, in very very profound ways, and I think PPD is so much more prevalent than people like to admit. This is something I’m working hard to become much more aware of, and to incorporate PPD screening into my daily practice. If *everyone* who works with women begins to do this, we might actually have a chance when it comes to screening, identifying and helping women with PPD, which is why a federal law might be just the thing we need.

  4. arcem
    Posted May 2, 2007 at 3:47 pm | Permalink

    What an interesting story and one that I have seen being played out many times myself. As a nurse you DO spend so much more time with patients than their actual doctors. I totally agree, this health care system is not structured to help women like this patient and many others suffering silently, all alone. Providers don’t want to open the can of worms because they don’t know what resources there are for them. Insurance companies coverage for psych care is limited, and diagnosing someone with a mental condition comes with consequences that can affect their eligibility for many things later on. This is very, very complicated….

    I think one lesson to bring out from this story is how important it is for us student nurse-midwives to hear from our nurse’s concerns when we are actually the midwives, doing postpartum rounds very quickly on the six patients we have to discharge, while labor and delivery is waiting for the beds to open up… oi… the pressure.

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