There have been several posts recently on tragic situations involving
suicides of mothers of multiple babies. I urge those who work with moms of
multiples to read the article, "Depression and Anxiety Disorders During
Multiple Pregnancy and Parenthood," by Linda Leonard, RN, MSN in JOGNN
1998;27(3):329-337. It's the May/June 1998 issue. The author says that
"depression or anxiety disorders may affect more than 25% of multiple birth
parents during the perinatal period. Such parents are often uninformed,
suffer in silence and fear, and are reticent to seek help..."
I find that mothers expecting multiples, frequently in their 30's, very
competent career women who are used to managing everything perfectly, can't
really conceive of the idea of needing help. They believe they can handle
it all themselves. They are not used to accepting help from others. The
loss of control they face in the pregnancy, birth, and newborn period is
very threatening to their sense of self. (Remeber, they also may have
faced years of infertility, premature birth, C-section and other
complications as well.) At home, the feeling of everything in their life
being out of control with new babies - no schedule, sleep deprivation, the
realization that it is 4 pm and they haven't gotten dressed yet and
everyone is crying and they have to go to the bathroom but there is no time
- is especially difficult for these mothers to deal with. They feel
totally incompetent. And if most of their friendships are through their
work, they suffer a loss of their usual support systems as well.
They will not ask for help. Or even if they realize they need to now, they
are so over their heads that they can't go to the phone and look up a
number.
What to do?
It does help if they can build a support system that meets their needs
ahead of time. Other mothers in a similar situation are better than books
or lectures at convincing them about what it will be like, what to do to
prepare, what things make it survivable, and that getting help is normal
and not a poor reflection on their skills.
I find that breastfeeding support group meetings that get these multiples
mothers together are very supportive. Especially helpful is the chance to
see that a mother with babies just one month older has survived the
overwhelming period a mother of young babies is currently in. And talking
about feelings with others actually in the same situation seems to be more
acceptable. We have had some meetings where several mothers cry as they
describe their feelings of inadequacy (often around trying to meet the
needs of the 2 or 3 year old sibling of new multiples), but then seem to
feel better and re-energized to go home and make it through another day.
They keep coming back, so it must help. And in a couple of months they are
proudly displaying their smiling 5 month olds and encouraging another new
mother to hang in there just a little longer.
All of us need to know good resources for referral in our local areas when
severe depression and even psychosis is a risk for a mother and her family.
Multiple births, and also postpartum depression are on the rise. In
Wisconsin, a series of workshops on postpartum depression titled, "More
Than Just the Blues" was given around the state this fall so that
professionals will be alert for, recognize, and refer mothers with signs of
postpartum depression for help. We were given a Center for Epidemiologic
Studies - Depression (CES-D) Scale to screen new mothers for depression.
(It is based on original work by Radloff LW. A self-report depression scale
for research in the general population. Applied Psychological Measurement,
1977;1(3):385-401. It has 20 questions about how the mother felt during
the past week.)
Some of the other resources that were shared:
Wood AF et al. The downward spiral of postpartum depression.MCN,
November/December 1997;22:308-316.
A "Patient and Family Fact Sheet" from an article by Suri R and Burt VK.
The handout is titled, "Coping with Postpartum Depression." It says it may
be duplicated for patients and families. It's in the Jrnl. Prac. Psych.
and Behav. Hlth. March 1997. I don't have the title of the complete
article, or a volume or page number.
Depression After Delivery, P.O. Box 1282, Morrisville, PA 19067
1-800-944-4773
Postpartum Support International, 927 North Kellogg Ave, Santa Barbara, CA 93111
(805)967-7636 e-mail [log in to unmask]
(I have no personal experience with these last two resources, but they were
given to us at the seminar.)
If others would like to conduct similar seminars on postpartum depression,
you could contact Mardelle Wuerger for advice at the Maternal and Child
Health Education and Training Institute, 610 Walnut Street, 707 WARF
Building, Madison, WI 53705
Phone (608)265-3730 FAX (608)263-6394.
Anne Altshuler, RN, MS, IBCLC and LLL leader in Madison, Wisconsin
mailto:[log in to unmask]
|
