Thursday, September 25, 2014

More Than the Baby Blues

I have had the good fortune of working in the health care industry for almost 3 years now. Not as a clinician (lucky for the patients where I work) but as a trainer and now coordinator of the training for the users of our inpatient and outpatient electronic health records. I honestly love what I do. I get to work with some amazing caregivers and learn many things about the medical profession without having to surrpress my gag reflux at the sight of blood, vomit, or worse. I'm not a doctor (or a nurse) but I do play one on TV. 

I found myself on the other side of the computer when my daughter was born. Instead of training users to document on their patients, I was one of their patients. It was a different world, being in the hospital bed, my care up to the same people that I've trained on multiple occasions. It was a very good reality check for me, and it's something that had never left me. 

Today, while in a meeting with a workgroup of users of our outpatient medical record, someone handed me a piece of paper that stopped me dead in my tracks.  The top of the paper read "Edinburgh Postnatal Depression Screening".  Wait, what is this?!  How is it that I, someone who has worked in healthcare and patient documentation for 3 years and who herself has struggled with postpartum depression, did not know that this screening tool existed?  

I did my best to turn my attention back to the meeting, but as I left the room, my mind was reeling. I read the questions, all 10 of them, and I realized that my answers to each in the days after Sabrina was born would have definitely raised a red flag. Why had no one asked me those questions?  

But whose responsibility is it?  The nurses on the maternity floor?  My Obstetrician?  Someone else, perhaps a nurse following up on me via phone?  I couldn't come up with a clear answer. And therein lies the problem. It is up to everyone and no one to screen for postpartum depression. And so many times, as was the case with me, it gets overlooked. 

They talk to us about breastfeeding. They talk about jaundice. They make you sign forms and watch videos from the 1990s about Shaken Baby Syndrome. They bring you into the office to do an exam 6 weeks postnatal. They remove your stitches or in my case, your staples. They tend to your physical needs, but what about our emotional needs?  Who is tending to those?

Timing is a huge issue with screening for postpartum depression. I myself began to feel the effects of postpartum depression the day I went home from the hospital, when Sabrina was 3 days old. Is this the case for everyone?  Probably not. In my case, if the nurses on the maternity unit had given me this screening test, I likely would have passed. It hadn't hit me yet. For many women, you leave the hospital when your baby is just a few days old, and you aren't seen again for 6 or 8 weeks. By that point, you are already deep in the bowels of postpartum depression if you are symptomatic. I won't go as far as to say that it's too late, but early intervention and education is obviously a better course of treatment.

I was lucky enough to have a husband and family who intervened and forced me to see my OB about my depression issues. Let me start by saying that my OB is a fantastic doctor. The best. I had the absolute best care during my pregnancy and my c-section was quick and easy to recover from. But that day, in his office, all he could offer me was to either medicate or wait it out. In my current, stable frame of mind, I understand why he said that. Clinically those are your options. There's no magic pill that will "cure" you. But that day, in the middle of one of the darkest periods of my life, I felt hopeless. Was there nothing else that he, or any other doctor or medical care provider, could have offered me?  Resources for educating yourself on postpartum depression,  the number to call for a local therapist, even an alternative therapy such as a supplement or herb?  Nothing more than medicate or wait?

For me, that's not good enough. There is too much information available in today's connected world.  We have tablets and iPhones and watches that do far more than tell time. Yet all we can offer to new mothers in peril is medicine?  Nope, sorry. Give them names of books, reputable websites, support groups, moms groups, anything. Give them tools to handle their feelings so that there are no more Paula Yates's. Give them something, anything, because what you are really offering them is hope. Hope that this horrible dark cloud will pass over them soon. To hang in there, just a little longer. That this feeling isn't forever. 

It is time to expect more, to educate, to spread awareness. It is time to not be ashamed.  

Edinburgh Depression Screening- 

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  1. This is such an important issue and I think it's really great your bringing it up. Literally NO ONE talked to me about it. Thankfully it wasn't something I suffered from, but the fact that I didn't even really know about it until recently is worrisome. Thanks for shedding some light.

  2. Great article and you are right, so often--too often over looked.