Mountain View, CA - May 25, 2009 - A new mother recently confided to the intake therapist at El Camino Hospital's Maternal Outreach Mood Services program, "We had wanted a baby for so long, this was a dream come true. But I am exhausted all the time. . . It's as though the color has drained out of everything. How can I feel like this when I have a beautiful, healthy baby?"
A year ago, this mother might have had difficulty finding help. Although one in eight mothers in the U.S. will experience postpartum depression--the most common complication of childbirth--a survey of local physicians revealed a real shortage of therapists and programs to which to refer new moms. But El Camino Hospital's innovative program addressing perinatal mood disorders has provided much-needed new resources and treatment for hundreds of women since it opened a year ago.
It's the first comprehensive, therapy-based treatment program for prenatal and postpartum depression in the Bay Area--and only the second of its kind nationwide. Maternal Outreach offers a day treatment program comprised of group, individual and couples counseling and medication evaluation and management by the program's medical director, Nirmaljit Dhami, MD. Unlike other programs, women can come in at least two to three times a week because, as one mom said, "Right now a day feels like a week and a week seems like an eternity, so I'm glad I don't have to wait a whole week between counseling appointments."
Regardless of the treatment option women choose, early intervention is critical. According to a number of studies, untreated postpartum depression can have serious consequences not only for the mother, but for her child, including cognitive and language delays and attachment difficulties.
"Some women might refrain from seeking help because they feel they can tough it out on their own," Kris Peterson, MFT said. "In some cultures, there's a lack of understanding of the disorder, which can lead to shame and reluctance to seek treatment. But without proper treatment, postpartum depression has the risk of becoming more chronic and recurrent, and can become increasingly difficult to treat."
The irony is that for many women, a maternal mood disorder may be their first and only experience with a mental health problem. But it also is one reason why the treatment outlook is so hopeful, according to Peterson. It's also why El Camino Hospital decided to provide a separate home for the program, rather than treating them in the same setting with other behavioral health patients as other hospitals do. In fact, El Camino Hospital's program has moved to a new building, apart from other mental health programs.
"For many women, this is the first time they have experienced any significant feelings of depression or anxiety," Peterson said. "Because of hormonal fluctuations, sleep deprivation and the demands of pregnancy or a newborn, the experience of depression and anxiety during pregnancy and postpartum is unique. These moms simply don't fit neatly into the rest of our patient base, and treating them together with other patients isn't a good solution. So we recognized the need to tailor a program specifically for them."
The diversity of the first year participants has been stunning; 15 different nationalities from six different continents. Although there are important differences in how they--and their families--react to postpartum depression or other perinatal mood disorders, they also have something in common; talking about it with others provides a tremendous sense of relief and support. Group and individual therapy has been the "secret weapon" of the program. Moms bond over sharing similar experiences and knowing they are not alone. Outpatient moms and infants spend an average of three hours a day in intensive individual and group therapy, working through issues ranging from feeling overwhelmed and exhausted to difficulty bonding with their babies.
Peterson emphasized that it is also important to provide culturally sensitive services for postpartum depression. Mothers from various ethnic backgrounds may present with different symptoms, such as experiencing more physical complaints than emotional difficulties--and their extended families can have a significant psychological impact. One Chinese American mother shared this comment: "My mother, mother-in-law, husband and doctor all have different opinions on how to take care of this baby. I am torn in so many directions."
With nearly two-thirds of its maternity patients coming from cultures outside the U.S. (with South Asian and Chinese leading the list), medical director Dr. Dhami, who attended medical college in her native India, has made it her personal mission to identify local therapists and groups that can work effectively with a wide array of ethnic and cultural backgrounds. "We must remove every possible barrier to women getting the treatment they need" she said.
Though a survey of the hospital's own data revealed that as many as one in five women delivering there are at risk of postpartum depression, not everyone needs the comprehensive treatment program offered at El Camino Hospital. That's why the hospital offers free, confidential assessment to anyone in Northern California, and keeps an updated list of community resources ranging from therapists experienced in working with maternal mood disorders to online and drop-in mom's support groups.
"We are proud of our achievements in our first year, but we know there is so much more to be achieved, said Dr. Dhami. "Despite the prevalence of perinatal mood disorders, primary care physicians and obstetricians lack information and resources to assess and help their patients. So last month we teamed with Postpartum Support International to hold the first of many training courses to educate local health care professionals about the problem."
The Maternal Outreach Mood Services Program was started with seed money from a "Hope to Health" (H2H) Grant H2H is a committee of concerned women in the El Camino Hospital community who care about women's health and believe in the power of philanthropy to make a difference. By pooling their resources and focusing their goals, the group has made significant contributions to programs, equipment and initiatives that have significantly improved women's lives and health.