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Harris Methodist Springwood Develops Outpatient Postpartum Depression Clinic

Monday December 8, 2008
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Becoming a mother is supposed to be one of the happiest times in life, but Laura Burnett, RN, BSN, IBCLC, often saw women in distress at the breastfeeding support clinic where she works.

"I would see women just falling apart," says Burnett, a nursing supervisor for the clinic at Harris Methodist HEB Hospital in Bedford. "Once or twice a year I was afraid they would even hurt their baby or themselves."

Burnett says a large percentage of the 10,000 mothers the clinic sees each year were experiencing the "baby blues" or postpartum blues.

The condition can occur in up to 80% of all births, Burnett says.

Its more severe version, called postpartum depression or PPD, can happen to new moms in as many as one in four births, or some 800,000 women, she said.

PPD is the No. 1 complication of child birth, according to Post-Partum Support Group International, an educational advocacy group based in Santa Barbara, Calif. PPD is a mental disorder that can occur shortly after childbirth, or several months later. Like most types of depression, it can manifest through a range of physical and emotional symptoms that can vary in severity and intensity.

Burnett says the Family Resource Center, where her breastfeeding support clinic is located, had few options for women suffering from PPD.

"These women would come in with PPD and not have any resources at all," Burnett says. "We would walk some of the more severe cases over to our ER, but we came to realize that this was a bigger problem."

While the clinic could refer patients to a few local psychiatrists, or back to their obstetrician, Burnett says she wanted more for her patients. So she met with the unit nurse manager at Harris Methodist Springwood Hospital, a psychiatric in-patient and out-patient hospital licensed in 1998.

From that meeting sprang Texas' first hospital-based intensive outpatient depression treatment program for women coping with infant loss (including miscarriage), prenatal and postpartum depression, and depression stemming from infertility, peri-menopause and menopause.

Just a handful of hospitals in the United States offer such day programs for women for PPD, much less the wider range of women's depressions related to fertility and childbirth issues that Springwood has developed. In October, the University of North Carolina Center for Women's Mood Disorders opened the first unit where women with PPD can stay overnight.

The Springwood outpatient program began in August with 30 patients, says Ramona Osburn, director of the facility. A similar program was opened at the same time at Arlington Memorial Hospital. And a satellite Harris Methodist clinic in southwest Fort Worth began offering the women's depression program in October.

In the program, women work with a licensed clinical social worker in group therapy three hours a day, three days a week, for four or five weeks, Osburn says. There are no more than 10 women in one group.

"The program is life-skills based," she says. "We work with them on anger and stress management, coping skills, dealing with a loss."

The women are referred to psychiatrists for follow-up treatment and can be part of a monthly support group after they finish the initial program. The program also includes an educational element for family members.

Women are responding positively to the therapy, Osburn says.

"We see a huge difference in them," she says. "Women have such a deep sense of empathy for each other. They offer each other so much support."

The exact causes of PPD are not clear, but it is likely related to hormonal changes from pregnancy and childbirth, as well as the stresses of having a new baby, Osburn says.

"It does not linger on like people clinically depressed," she says.

At least 10%, but maybe as many as one in four new mothers develop symptoms severe enough to be diagnosed with PPD. Signs and symptoms include: increased crying, irritability and impatience; hopelessness and sadness; uncontrollable mood swings; feeling overwhelmed or unable to cope; fear of harming the baby or herself; fatigue and inability to sleep or sleeping more than usual; loss of appetite; lack of interest in the baby or over concern about the baby; withdrawal; inability to think clearly or make decisions; unexplained weight loss or gain.

Most are not prepared for PPD. As with all mental illnesses, the stigma involved makes it more difficult to ask for help, but more women are aware of the illness and starting to ask to reach out, Osburn says.

"Women are seeking help," she says. "They don't want to be the one on the news after they have done something to their child."

Osborn says insurance plans often pay for PPD treatment, making it easier on the family to seek out such resources as the Harris program.

"As many as 80% to 90% of insurers will cover treatment under the plan's mental health benefit," she says.

Treatment for PPD, like for most depressions, can include antidepressant medication, hormone therapy, psychotherapy and support. If untreated, PPD can lead to maternal disability, poor mother-infant attachment, and can affect an infant's development.

Teresa McUsic is a freelance writer.To comment on this article e-mail editorSC@nurseweek.com.