Visits from public health nurse, midwife may prevent baby blues: study

TORONTO (CP) - Providing professional support specifically tailored to a woman after she brings home her new baby may be the best way to prevent postpartum depression, research suggests.

An analysis of 15 international studies by the University of Toronto shows strategies initiated before birth, including pre-natal classes targeting postpartum depression, appear to be ineffective in preventing the disorder.

"Mothers are busy and they often do not attend these pre-natal classes, so they weren't receiving a sufficient dosage of the intervention," researcher Cindy-Lee Dennis of the faculty of nursing said Wednesday.

What she did find is that support provided by a health professional - for instance, a public health nurse or midwife - may be able to prevent postpartum depression if it is geared to the individual woman and based on her specific needs.

That could mean a mom who is having marital difficulties after the birth of her baby being referred for family counselling or a low-income mother getting steered towards financial assistance, Dennis said.

More than one in 10 women experience depression after giving birth, ranging from mild baby blues to a severe form of the illness that in rare cases can include psychosis.

But most women are reluctant to seek help or even talk about it to friends and family, Dennis said.

"There's a stigma attached to being depressed in the postpartum period because it's supposed to be a happy time."

The reason pre-natal measures don't seem to work is because it's virtually impossible to predict which women will develop postpartum depression, although those at greatest risk are women of low socioeconomic status, those with relationship difficulties, a past history of psychiatric problems or pre-natal depression and anxiety.

Dennis analysed 15 research projects that involved almost 7,700 women, going back to the 1990s. The studies investigated various methods to see if they could prevent postpartum depression.

"Individual, flexible postpartum care provided by a health professional and based on maternal need may have a preventive effect," concluded Dennis, who advises that new moms be assessed by a health professional during the first four weeks after birth and referred for treatment if needed.

"For mild depression, interventions that might be beneficial would be, say, support groups or talking to another mother about their experience and home visits by public health nurses. When you have severe depression, that's when you really need expert assistance from mental health experts."

Antidepressants are one form of treatment, although many women don't want to take drugs while they are breastfeeding, said Dennis, noting that psychotherapy can be as effective in alleviating postpartum depression.

The drugs have been the subject of a public spat between actor Brooke Shields, who says they helped her after she gave birth to her first child, and actor Tom Cruise, who calls antidepressants unnecessary. (Cruise is a follower of Scientology, a religion that teaches that psychiatry is a destructive pseudo-science.)

Saying she hadn't been following the controversy, Dennis would only offer that "Antidepressant medication isn't for everyone, but if a woman feels comfortable to take it and it's beneficial for her, then that's more than appropriate."

Caring for a new child is a tough job, she said.

"Many women who are sleep-deprived because they're caring for their children 24-7, they are going to have challenging days.

"And I think it's important for them to recognize that . . . and if they're feeling as if they're really struggling - having these feelings of sadness, loss of appetite, not able to sleep properly, feeling like they're incompetent as a mom - if these feelings persist for more than two weeks, then I think the mother really needs to go and seek treatment."

Dennis, whose study appears in the latest issue of the British Medical Journal, has received a $1-million grant from the Canadian Institutes of Health Research to investigate whether having new moms talk to women who have recovered from postpartum depression would help them dodge the disorder.

© The Canadian Press, 2005

Back to News