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]