more than baby blues: unmasking postpartum depression

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ore Than Baby Blues: Unmasking Postpartum Depressioneaturing Ruta Nonacs, MD, PhD, and Lauri Klein, LICSW. Producedy Paraclete Video Productions, 2003. VHS, color, 30 minutes.79.95.

eviewed by: Ruth Johnson, CNM, CS, MSN, MPA, nurse-midwife andsychiatric clinical specialist in private practice, Massachusetts.

ostpartum depression is the most common medical compli-ation following childbirth, affecting 15% of mothers and theiramilies, yet it remains underdiagnosed and undertreated. Thisideo presents information about depression and other psychi-tric disorders that can appear in the postpartum period, usingformat that is appropriate for consumer education as well as

n introduction for professionals.

he video is narrated by Nurse Jas Gabbidon and featureswo clinicians. Dr. Ruta Nonacs is a nationally knownlinician and researcher at the Perinatal and Reproductivesychiatry Clinical Research Program of the Massachusettseneral Hospital. Lauri Klein is a clinical social workerho specializes in treating postpartum psychiatric disor-ers. Video segments alternate information presented byhese experts with the stories of 2 women who sufferedrom postpartum depression, providing interplay betweencientific knowledge and subjective experience.

r. Nonacs emphasizes that postpartum anxiety and depres-ion are not different from anxiety and depression thatppear at any other time in a woman’s life and describes theost severe and dangerous illness: psychosis, which affectsor 2 women in every 1000 deliveries, with symptoms that

sually begin in the first week postpartum. Psychoticymptoms include a detachment from reality, often withrrational thoughts about the baby, and require emergencyreatment to prevent the mother from harming herself or theaby.

s. Klein describes risk factors for postpartum mental illness:as the woman ever been depressed before? Has she experi-

nced PMS? Has anyone in the extended family committeduicide or suffered from a mental illness? These are powerful

ournal of Midwifery & Women’s Health • www.jmwh.org2004 by the American College of Nurse-Midwives

ssued by Elsevier Inc.

linicians discuss these risks with their patients and “expecthe worst” by following women closely and marshalingupport and resources during pregnancy.

nfortunately for the 2 mothers featured in this video, theirisk factors were not identified during pregnancy. Oneoman had a history of prior depression, and her motherad experienced postpartum depression. The other womanraced the onset of her postpartum depression to the firstrimester of her pregnancy; her symptoms went unnoticednd untreated by her obstetric caregivers. The woman clungo the common—and mistaken—belief that her depressionould lift after the baby was born. Instead, she became

cutely ill immediately after the birth, requiring emergencysychiatric care and medication. Both mothers’ descrip-ions of their illness and the impact on their families areloquent and heartbreaking, the most powerful segments ofhe video.

nfortunately, the experience of the 2 patients in thisideo—and of thousands of other women—illustrates thenadequacy of obstetricians and primary care providers inelping women with mental illness.

oth Dr. Nonacs and Ms. Klein recommend that newothers seek out mental health providers who specialize in

reating postpartum illness, such as psychiatrists, psychol-gists, and social workers. They do not mention psychiatriclinical specialists who, as advanced practice nurses, are thenly nonphysicians who are trained to prescribe psychiatricedication as well as to practice psychotherapy. They also

o not include nurses or other nonphysician cliniciansmong those who might be helpful to pregnant women orew mothers.

his video is an eloquent portrayal of postpartum mentalllness and its impact on women’s families. It may be usedy clinicians, childbirth educators, and community supporteaders to stimulate discussion among their clients. Profes-ionals will find it a useful introduction with much food forhought about how to improve access to mental health care

e31526-9523/04/$30.00