How Hospitals/Docs and Magazines/Books on Pregnancy/Motherhood Can (and Should) Increase Public Awareness on a New Mom’s Need for Sleep

Let me start with how I believe OB/GYNs and hospitals–not to mention books and magazines on motherhood and pregnancy– can and should most definitely do more in terms of increasing public awareness of postpartum depression (PPD), which should start with this….the importance of sleep and getting adequate support to help reduce the risk of PPD rearing its ugly head.   OB/GYNs and/or hospitals should put right up at the top of the childbirth education curriculum–short though it usually is (a couple of hours…what a shame!)–the importance for new mothers to get at least 5 hours of uninterrupted sleep as much as possible during the first 6-8 weeks postpartum

What should be included in the education: 

1) the fundamentals of adult sleep, including what is considered “normal” sleep

2) sleep cycles

3) what to expect during late pregnancy and postpartum in terms of their impact on sleep

4) strategies for sleep management during late pregnancy and postpartum

5) effects of sleep deprivation

6) facts about newborn/infant sleep

Granted, for the greater majority of mothers out there a) the husband has to work full-time during the week and it is highly unlikely he could work the same hours and do the late-night feedings all week, and b) they lack the financial ability to hire a baby nurse, postpartum doula or nanny to help with late-night feedings.  What that means is, for most mothers out there, it is highly unlikely the mom can get the 5 hour block of sleep at night that she needs.  That shouldn’t, however, deter the OB/GYN from providing the simple fact that a minimum of 5 hours of uninterrupted sleep is imperative to the healthy functioning of an adult (more so for a woman who has just given birth), and depression is one possible consequence for the brand-new mother–hormones all outta whack and all–who fails to obtain that over the course of weeks following childbirth, a time in which she is at her most vulnerable. 

Awareness + Preparation = Keys to a better postpartum experience and reducing the risk of PPD (Note:  You may not be able to prevent PPD if you are at risk, but it certainly doesn’t hurt to be prepared to have a better postpartum experience):

  • While you are still pregnant, reach out to friends and family members to provide practical support (like help watching the baby, cooking, laundry, housework, errands) and emotional support (someone who can listen to you, provide advice and be empathetic and nonjudgmental) after the baby arrives.  Believe me, after the baby arrives, you will have neither the time nor the energy to search and coordinate.  If family and friends are not options, consider hiring a baby nurse and/or a doula to help during the first couple of months, if you can afford it.    Having a baby nurse to help with nighttime feedings will enable you to get the sleep you need to take care of the baby the whole rest of the day while your husband is at work, and your husband to get the sleep he needs to go to work each day.  
  • Resist temptation to use your baby’s nap time to try to catch up on housework, do laundry, address birth announcements, write thank-you notes, or handle other projects.  I know it’s so much easier said than done. I would suggest you scope out the wording and pick out the birth announcement you want to order (and thank-you cards) before having the baby.  That way, you won’t be stressed out finding the perfect one to send after the baby has already arrived, worry about not getting them out within a month after the baby’s born and hustling to get thank-you cards out within 30 days of receiving a gift.  

What happened to me I wouldn’t want to see happen to you…..

I thought I could handle taking care of the baby, cleaning up, finding announcements, addressing them and mailing them out, etc. since I typically thrive on multi-tasking and I never thought it would be any different after having a baby.  And believe me, the word thrive doesn’t come close to describing how much I try to squeeze in in a day’s time.  Silly me had failed to realize that I had just had a baby, which is a very big deal physically.  And that’s on top of the 7 days of hell I spent at the hospital, not to mention the multiple surgeries, daily blood work, MRIs, loss of 4 units of blood, and constant hunger (see previous post for details of my hellish hospital stay). 

I returned home from the hospital fully expecting to resume my old routine in addition to taking care of the baby.  Every time my mother or mother-in-law suggested I lie down or sit down, put my feet up and relax, I waved them off, saying that I was A-OK and didn’t need to nap.  Now that I’ve actually experienced insomnia and PPD, I know that my mother’s and mother-in-law’s advice was excellent advice.  Relaxing/resting is beneficial, even if you can’t fall asleep.  Problem is, I’m neither a napper nor a rester.  I’ve always considered napping a waste of valuable time that could be spent doing something productive.  For as long as I can remember, at least from the time I was 13 years old, napping was never my thing.  I wasn’t about to nap now. 

Don’t feel guilty for napping instead of doing something productive.  Now is not the time to feel compelled to try to impress others or try to fit the mold of what in your mind is how a perfect mother should be like.  After all, no one is going to expect that your house be spotless with a new baby to take care of.   Don’t worry if your house isn’t spotless and neat for visitors.  I know that’s easier said than done.  My house is messy on a normal day sans baby in the picture, let alone with baby (and exhaustion) in the picture.  It didn’t help that I resisted the idea of hiring a cleaning lady because I was brought up to clean my parents’–and now my own–house, so why pay someone else for the work I can do myself, even if it is for the sake of convenience?   I have issues with privacy and trust in hiring a stranger to come into the house (same reason I couldn’t hire a nanny).   

Don’t be like me, letting yourself get caught up in one hell of a vicious cycle:  If you don’t clean, you are less willing to have visitors, so you will feel more lonely and isolated than ever, which makes your PPD worse….

Current Dilemmas, Barriers to Progress When it Comes to Diagnosis and Treatment of PPD

Continuing from previous post titled “Recent News on Screening Expectant and Postpartum Moms,” the following scenarios are the current dilemmas/barriers to progress when it comes to detection, diagnosis and treatment of postpartum depression (PPD).

One of the contributing factors to the numbers of undiagnosed and untreated cases of PPD is that the responsibility for detection, diagnosis and treatment falls between two specialties—obstetrics and psychiatry—that are currently not set up to cooperate with each other in the treatment of PPD.  Unfortunately, the “norm” in the United States—which has created a disjointed system that leaves perinatal families at a tremendous disadvantage—consists of:

  • Lack of training on perinatal mood disorders (recognition of symptoms and treatment)
  • Lack of cooperation between the segments of professional care

The problem with the healthcare industry when it comes to treating women postnatally is that, once a woman has given birth—with the exception of the standard, six-week follow-up visit—it’s almost like the OB/GYN is washing his hands of her.  Aside from the doula who fills this gap in care for the new mother, there is no medical professional who fulfills such a need.  This is why the role of the doula has evolved and become more commonplace in this country.  She is there to provide the family with support for as long as she is needed.  It is not uncommon that she stays with a family for six weeks or longer.  She can work any schedule that you require.  She could work a typical 9 to 5 day, or she can do mornings, afternoons or overnight.

One thing I’ve personally witnessed through the years at my company is the unfortunate tendency for groups to work in silos, which is seldom associated with achieving good results.  Similarly, health professionals ranging from OB/GYNs to pediatricians, general practitioners, psychiatrists to social workers work in silos too.  They do not work as a team.  Not enough doctors out there care enough to cross their areas of expertise and perform the extra step to show that they truly care for their patients–e.g., following up even when not asked to, making sure the mom gets treatment, etc.   Ideally, there would be a collaboration between medical healthcare providers (GP, OB/GYN, pediatricians), mental healthcare providers (psychiatrists, psychologists), and others who come in contact with the new mother (lactation consultants, midwives) to proactively coordinate care of the new mother and communicate with each other about her status, treatment and progress.  In most cases, the woman cannot muster energy and/or willpower to do this herself.

It’s time for women to stop falling through the cracks once and for all!  OB/GYNs, pediatricians, lactation consultants and primary care providers–basically, everyone who would come into contact with a new mother after she has a baby–should know the basics about PPD and be sensitive enough to at least inquire about the well-being of the mom in the first 3 postpartum months.  In fact, hospital nursing staff should proactively call each and every mother 1-2 weeks postpartum to see how they are doing.  As the new mother checks out of the hospital, the OB/GYN (or hospital staff) should talk to her about the mood changes (i.e, baby blues) that are considered normal and experienced by most new mothers, and why this happens.  They should provide a pamphlet about PPD that says right up front (like the Postpartum Support International poster) that the #1 complication of childbirth is PPD, with an occurrence rate of about one out of eight new mothers.  That would be more likely to catch attention, as most new moms are likely to wave it off, thinking they would never let themselves fall victim to such a thing as PPD (like me).  The OB/GYN should also explain how PPD is different from the blues and offer the patient to call whenever they need to, particularly if their mood changes last longer than 2-3 weeks and seem to be getting worse.  Knowing that a professional is just a phone call away can make a big difference. 

Significant changes would need to be made at the legislative level first—which is why I believe the passing of the long overdue Melanie Blocker Stokes MOTHERS Act is so important—to drive the changes needed to ensure healthcare professionals are trained in screening and treating PPD, to require healthcare professionals to screen and treat PPD, and to ensure medical insurance covers screening and treatment.  More realistically, and in the nearer-term, the ideal approach to treating PPD would be via an extensive referral network or multidisciplinary team of professionals consisting of:

  • Obstetricians, pediatricians, family physicians/general practitioners
  • Nurses, physicians assistants
  • Midwives, doulas, social workers, lactation consultants
  • Psychologists, psychiatrists

Why pediatricians, you wonder?  Well, pediatricians are the ones who typically see the mother first, and it’s their office that would get the phone calls from the mother with concerns about the baby.  It’s the pediatrician’s office that would come into contact with the mother the most, not the OB/GYN’s office.  High anxiety can result in an increase in frequency in phone calls—with many even being mundane in nature—to the doctor, nurses or other staff members, particularly if reassurance from anyone on the staff doesn’t do anything to help the mother’s concerns.  It’s a shame pediatricians don’t work together with the OB/GYN.  If they did, pediatricians can give the woman’s OB/GYN a heads up about the possibility that she could have PPD.  Rather than the pediatrician telling the mom that she should be assessed for PPD, which can be taken the wrong way by the mother who thinks it’s the baby that’s their business, not her.  Fear of bringing up the topic would merely open up a can of worms, resulting in spending a lot of time—which they lack in the first place—talking about something that is not their specialty.

The pediatrician would normally see both infant and mother right after childbirth and regularly for a period thereafter.  However, they do not have en established relationship with the mother.  To complicate matters, the mother may feel too embarrassed to admit what she’s going through to a doctor because the focus is the well-being of the baby.  It’s only natural for the mother to avoid wanting to be perceived by the doctor as being a failure at properly caring for her own baby.  People must realize that the well-being of the baby is dependent on the well-being of the mother.  The pediatrician (whose patient is the baby) and even the lactation consultant (whose goal is to ensure the baby can successfully access his/her mother’s breast milk) should be concerned about the postpartum mom because it’s her mental health that has a huge impact on the baby’s development.  The least they can do is provide a pamphlet to all new moms, regardless of their current state.  In the ideal situation, the pediatrician’s standard protocol should be to ask the new mother during each visit how she is doing, especially if she is a first-time mother and/or a mother who had complications during childbirth. 

Actually, I will give my daughter’s first pediatrician credit.  Knowing the complications I experienced during childbirth and our extended hospital stay, the first question she always asked me—while looking straight into my eyes—whenever I brought my daughter in during the first few months was “How’s mom doing?”  Realizing it was “out of her jurisdiction” to help me, I never went into any details of how I was really feeling.

Doctors, ignorance about PPD and lack of sensitivity are a bad combo

I just wanted to share with you the letters I wrote to my GP and OB/GYN once I was on the road to recovery and able to peek out from the dark cloud of PPD.  Boy, did it feel good to express my feelings!  

If you are currently suffering from PPD, it’s to your advantage that the doctor you see has been your doctor for a while (so he/she knows your personal history).   But if you’re like me, don’t have a doctor nearby and had to find a new one to treat your PPD, these are signs that you should move on to a new one:

1.  He/she does not spend enough time listening to you, discussing your symptoms with you, answering your questions, and addressing your concerns

2.  He/she does not treat you in a sympathetic and caring fashion

3.  He/she does not perform a thorough evaluation (including bloodwork) to rule out other possible causes for your symptoms, like thyroiditis

4.  He/she minimizes your experiences by indicating that what you’re going through is normal (i.e., “most moms get the blues”) and part of the adjustment to motherhood

If you find yourself needing to find a doctor, see if a relative, friend or neighbor can recommend their doctor to you.   I know in New Jersey, NJ Monthly has an annual Top Doctors list by specialization.  In the past few months, I discovered how reliable and helpful that list really is. 

Here are the letters that I had mailed to my GP and my OB/GYN.  Read them and hopefully you will gain some wisdom from them.

LETTER TO GP (dated Feb 9, 2006):

“I am writing this letter to inform you that I have decided not to retain you as my physician. I am returning to my previous physician who, though he is much farther away, is far better in terms of communication skills. I’ve wanted to stop seeing you since my very first appointment with you last February. However, at the time, I was in such bad shape that I thought your close proximity to my home was priority and I did not have the strength to look for another doctor.

Fortunately, the Paxil you prescribed worked for me, as I understand that it can be hit or miss with SSRIs and other anti-depressants used to treat post-partum depression (PPD). However, your refusal to talk to me while I was in the deepest, darkest stage of my PPD (complete with panic attacks) exacerbated my terribly painful experience. I will never forget your reaction to my apology for calling your emergency # one morning…..instead of telling me “That’s OK, just please don’t do it again…the number is for medical emergencies only,” not even acknowledging my apology, you shook your head with disgust and said “That’s not good.” I didn’t know I was having a panic attack and didn’t know what else to do. Additionally, your previous assistant claimed that I could only talk to you via appointment, as you will not answer questions over the phone or call me back. Finally, referring me to the psychiatrist who happens to be in your building and does NOT specialize in PPD was absolutely of no help.

 I never spent much time waiting for you (in fact, you seldom had other patients waiting for you), which is no surprise since you spend so little time examining and talking to your patients. I never even had a chance to warm up my seat before I found myself walking out to my car. My reaction each time was “Did I really see the doctor, or was it my imagination?” Case in point, when I came to see you about possible conjunctivitis, you asked me if I had a cold, you looked at my throat and proceeded to prescribe me eye drops without so much as looking at my eyes. When I tried to ask you a question, you tried to shrug it off, in usual fashion. You spent less than 2 minutes with me.

It’s as if your main objective is quantity of patients rather than quality of care. A good doctor provides quality care, which includes talking to your patients about their questions and concerns, not rushing through each patient as if trying to win a race.

One final note – with so many women experiencing PPD (1 in 8 new moms), it’s amazing to me how you could know/care so little about PPD. You didn’t even know enough to refer me to someone who specializes in its treatment. At minimum all GPs should 1) recognize that the symptoms of PPD include insomnia and panic attacks and 2) be able to refer these patients to PPD specialists.”

Letter to OB/GYN (dated Feb 6, 2006-names and locations have been replaced):

“It took me until now to decide to write this letter to you.  I am finally winding down on the Paxil that I’ve been taking for nearly a year for postpartum depression (PPD).  I have a lot to thank you for….. helping me to bring [my daughter]into this world and helping me leave [the hospital] alive and in one piece (or shall I say, minus one piece).  I can see how so many women in [town] have chosen you as their OB/GYN. 

However, I am truly disappointed in the way my PPD was handled by you.  Once I told you the fact that I had insomnia, it should’ve alerted you that I might have PPD.  You successfully made me feel like I was all alone with this problem and losing my mind. 

 You should’ve asked me if I had other PPD symptoms and, if so, referred me to someone who specializes in PPD care.  It could’ve prevented me from going through one of the most horrific experiences of my life without professional support and thinking I was nuts forever.

 I still can’t get over the fact that, as soon as I called your emergency number suffering from a God-awful panic attack, you didn’t hesitate to express your frustration for being bothered by me, and then passed me off – saying that you “couldn’t help me any more” – like a hot potato to [your doctor] who, incidentally, has the WORST communication skills of any doctor I have seen in my entire life!!!

 It would be way too awkward for me to continue on as your patient.  When I identify another OB/GYN, you will be notified.”