Postpartum screening for depression for new Moms is now being seen as essential by the medical community.

When I brought my second baby home, I felt overwhelmed. I had trouble connecting with him, feeling blank. One day when I ran out of fresh diapers, I felt paralyzed. This was before disposable diapers and clothes dryers and the diapers were clean, but were hanging on the clothesline in the back yard. I laid on my bed,thinking,“This is how people feel when they’re depressed.” I knew I had a choice. I could give up, or go out there- a blustery April day, and pull a diaper off the line. I got the diaper that day, but It wasn’t until two weeks later when I saw a full page picture of a baby’s heart in a Time magazine add, that the numbness melted, and thankfully, it didn’t return.

But for 9% to 10% of pregnant and postpartum Moms, it’s more serious.

The medical industry is now recommending that pregnant women and new moms need special attention in screening for depression, according to the U.S Preventive Services Task Force. This panel was appointed by the Department of Health and Human Services, and now formally supports that advice.This is a first of it’s kind  call for doctors to routinely screen women either pregnant or who have already given birth. There are extra hormones working in women during these times and a lack of sleep can trigger depression. Dr. Eleanor Martinez, M.D., told ABC7 News, “By making this recommendation we are putting it up in the front and saying, ‘Listen, this is a diagnosis. This is a disease. We need to embrace it like anything else.’”

Evidence shows that new mothers can be accurately diagnosed and successfully treated with the help of alert pediatricians, family doctors and OBGYNs. Not taking depression seriously is harmful to both mother and the baby. Research shows that untreated moms have  babies and toddlers, with sleeping problems and take longer to be comforted. Until now, depression in these new mothers  has been under recognized and under treated. A routine test can be given to the mom while she is waiting for her appointment. It will tell the doctor if she needs further screening for depression.

Treatments that work are “talk therapy” or drug therapy, or a combination on them are most successful. However, part of the problem is motivating a depressed mom to keep trying while the right treatment starts working. Plus there is a small risk of miscarriage and preterm birth leaving talk therapy as the best choice, and a nursing mom will be hesitant to take any drug.

Legislation in Congress may authorize Washington to fund screening and treatment for moms with babies one year and under, but as for now, there is none.
If you’re pregnant or a new mom the questions a doctor may ask to determine if you are at risk may be:
“Have you felt down a lot in the last few weeks?
How often have you felt tired or were unable to concentrate?”

Anyone working with a new mother, family members, friends, or a nanny should be aware of symptoms. Mild depression, anxiety and mood swings are common in new mothers and this is called Baby Blues. This is normal in new moms and usually fades away after the second week. The entire process of giving birth is exhausting, hormones are raging, sleep can be sketchy. Most moms go through this.
How is postpartum depression different?  It brings more severe emotions that don’t go away, with thoughts of suicide, or feeling like one is unable to care for the baby. The Edinburgh Postnatal Depression Scale is a set of 10 questions  to determine if  medical help is indicated.

I got a call one Sunday morning from a distraught Dad, who reported that his wife had come out of the bedroom  stating that she had thought of suicide three times that morning. The baby was 5 days old, and we were able to find a Newborn Specialist for this family for a few weeks to get up at night with the baby and do all the night feedings so the parents could get their much needed sleep.

Beth Weise

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SLOGGING through endless nights with a newborn baby has long been a parenting rite of passage. But for some dual-income parents, the arrival of the night nanny is making those 2 a.m. interruptions a thing of the past.
Demand for overnight nannies — also known as newborn specialists — has been growing, especially in the last five years and largely in major metropolitan areas, said Wendy Sachs, the co-president of the International Nanny Association and the founder of the Philadelphia Nanny Network. “People have moved away from the places they grew up, and they don’t have family down the street to help them out,” she said.The trend reflects changing attitudes about child care. Parents no longer see outside child care “as bad for kids or neglectful on their part — child care is seen as a necessity, not a luxury,” said Christine Carter, a sociologist who directs the Greater Good Science Center, an interdisciplinary research center at the University of California, Berkeley. “If it is good during the day, why wouldn’t it also be helpful at night?”Night nannies have evolved from an aristocratic tradition that goes back generations: the baby nurse. These were

nurses hired by wealthy families to provide round-the-clock care of infants.The more recent demand for night nannies began with care of twins and triplets, but in the last several years parents of single babies have also been seeking overnight help.
Beth Weise, founder of Caring Nannies in Scottsdale, Ariz., said her business, which opened in 1983, once served only families with multiple births or babies with health problems. Now the clients are split 50/50 between multiple and single births. The same is true for the work of Tracy Seveney, a night nanny and founder of Nocturnal Nannies in Ashland, Mass.
Agencies like hers and Ms. Weise’s have recently begun expanding the night nanny’s role to meet their clients’ needs — offering infant sleep training and parent counseling. The bulk of Nocturnal Nannies’ clients are dual-career, professional families, Ms. Seveney said, and revenue has been increasing 25 percent a year.
Anie Roche of Los Altos, Calif., hired a night nanny through Craigslist last November after she had her second child. Both Ms. Roche and her husband have high-pressure jobs: he is an executive at a semiconductor company in Silicon Valley and she is a partner at a law firm in Palo Alto.
Their nanny works from 10 p.m. until 6 a.m. six nights a week. “She swaddles the baby and sings to him and that’s the whole point for us — she has a lot more energy and patience at that point in the day than my husband or I do,” Ms. Roche said. “We are wiped out.”
Night nannies are often treated like heroes, said Barbara Kline, president of White House Nannies in Bethesda, Md. “Suddenly you have a six-pound bundle of chaos, an incredible amount of upheaval in the household, and in swoops this person who can calm the baby and get them to eat and sleep,” she said.
As might be expected, help doesn’t come cheap. A week’s worth of night-nanny services can cost well over a thousand dollars, with nannies earning about $15 to $40 an hour, depending on their experience, the number of babies and the babies’ health. Ms. Seveney says overnight nannies usually spend 6 to 10 weeks with a family with one newborn, and anywhere from two to four months for twins.
Night nannies either work on their own — like Ms. Roche’s — or through agencies that find assignments for them. The bulk of agencies charge clients a one-time placement fee, but some charge a flat rate for each night. Agencies generally require nannies to have several years of experience with newborns that are not their own children, and most require training in infant and child cardiopulmonary resuscitation.
Jena Riley, a night nanny and owner of Night Nannies for Newborns in Denver, said most of her nannies are “moms in their 30s and 40s whose husbands were home at night.” That works well for her clients, often in their 30s and 40s, too, who have lots of questions, she said, but may not feel comfortable taking advice from a 20-year-old.
WHAT can make the job tough isn’t the baby but the parents, said Jessica Muzio, 30, a night nanny with Nocturnal Nannies. Ms. Muzio has a degree in psychology and once worked with autistic children. She is pursuing a nursing degree during the day.
“Babies are babies and I’m at the point now where I can almost always soothe them,” she said. “What makes the job good or bad is the rest of the family.” Parents are usually asked to keep track of their baby’s daytime routine in order to help the nanny troubleshoot at night, but many parents don’t.
And the atmosphere in a home is potentially uncomfortable, Ms. Riley said, if the new baby is causing friction between parents trying to adjust to the change.
It can also be isolating to work alone from 9:30 at night until 6:30 in the morning. “That’s the worst thing about the job,” Ms. Muzio said.
Making a steady living is sometimes a challenge because an assignment is generally short term, and there may be a gap before the next one.
Still, Ms. Muzio relishes the work. “It’s a great job for me,” she said, “because I love babies.”

This article ran in the New York Times  April 7, 2007

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Why is it that babies of Mexican immigrants in the US have lower infant mortality in the first few weeks of life than average American women? In rural Mexico, Hispanic mothers also avoid postpartum depression, compared to 15 percent of US mothers. What are they doing differently? They don’t have insurance or top notch medical care or education. One reason is the “cuarentena” — 40 days of completely compulsory nurturing for the new Mom. For the first six weeks, family and neighbors come together to ensure the mother eats, sleeps and bonds with the new baby. There’s no cleaning, cooking, or errands. The outcome? A happy mother and a happy baby.
New mothers we see using our agency are typically sucessful professionals between 30 to 40, independent, with successful careers, used to being in control of their lives and overcoming challenges. But bringing home a new baby is overwhelming, and nothing can prepare her for that first one. Hospitals are not designed for sleeping, so by the time she arrives home with baby, she’s utterly spent. Not used to asking for help, her whole identity has radically morphed into how successful she feels she is at mothering. When I had my firstborn, I’d never changed a

diaper! How did that happen? In our culture, we live far from parents and extended family, and we think we should be able to do it all.

When my second son was born, I had the blues. I wasn’t feeling any emotion towards my baby, and I’d run out of diapers. I stared out the window at the clean ones fluttering on the line. This was 1968 and dryers had yet to be invented. I was so emotionally spent, I couldn’t go get one. I finally got up to get a diaper, and a few months later, my emotions returned, but that experience has given me an inkling of understanding of what others go through.
Three causes of postpartum depression are a lack of sleep, poor diet, and clutter or disorganization. How can we nurture new mothers so they can successfully nurture their newborns?

  1. Sleep is crucial now, but hard to get. Be sure the new mom naps during the baby’s nap. Get someone to take the baby at least a couple of hours a day so she can rest. The tiredness is intense. If the Mom is nursing, she can pump for one feeding so that she gets five to six hours of sleep at night.
  2. Get some help. Being a new mom can be lonely and isolating if dad is back to work and family isn’t close by. A friend who can fold laundry or spend time with the new baby so Mom can get a nap or a shower is invaluable. This isn’t as crucial for new moms, because they can sleep when the baby sleeps day and night, but after a second child, it’s helpful for a friend to come and take the older child on an outing. It’s pretty rough being dethroned, and the older child needs some special attention.
  3. Supplying meals for a new mom is so helpful. New moms need lots of veggies, foods rich in Omega 3 fatty acids and B vitamins such as Riboflavin to bolster her against postpartun depression. Friends can send a gift certificate for your favorite resturant, or bring a home cooked meal that can be warmed up or frozen for later. MealBaby.com is the perfect way to organize meals! It’s free and easy!
  4. If Grandma can’t help or if you need space from family, hire a mother’s helper, a newborn specialist  or baby nurse, or a doula. A newborn specialist can be 24 hours 7 days per week, or just nights. A doula is there more for the mom, preparing meals, taking over baby care for a few hours, preparing meals, doing housework, or a full night shift. Both are helpful for answering questions, hands on education, and reassuring the new mom that she’s doing a great job.
  5. If there’s someone doing housework, mom will feel free to rest, since naps are her only time to get caught up.
  6. Listen. Care. Validate her feelings. She may break down and cry, feeling inadequate. What she needs now is understanding, listening, caring. Let her vent. Ask questions. Be curious. Don’t try to solve the immediate problem but ask more about how she’s feeling, giving her your time, and letting her know you care. Most of all, she needs to know  she’s doing a wonderful job with her newborn.
  7. Help her connect with a mom’s group or friends she can go on play dates with.

Offer to run errands for her or with her or babysit so she can get out of the house by herself. Go with her for her six week check-up. Offer to babysit so she she can go out with her husband for a few hours.
So let’s learn from our neighborns south of the border and do a better job of taking care of our mothers by making sure that they get

  • plenty of sleep
  • nutritious food
  • rest
Beth
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