Postpartum screening for depression for new Moms is now being seen as essential by the medical community.
When I brought my second baby home, I felt overwhelmed. I had trouble connecting with him, feeling blank. One day when I ran out of fresh diapers, I felt paralyzed. This was before disposable diapers and clothes dryers and the diapers were clean, but were hanging on the clothesline in the back yard. I laid on my bed,thinking,“This is how people feel when they’re depressed.” I knew I had a choice. I could give up, or go out there- a blustery April day, and pull a diaper off the line. I got the diaper that day, but It wasn’t until two weeks later when I saw a full page picture of a baby’s heart in a Time magazine add, that the numbness melted, and thankfully, it didn’t return.
But for 9% to 10% of pregnant and postpartum Moms, it’s more serious.
The medical industry is now recommending that pregnant women and new moms need special attention in screening for depression, according to the U.S Preventive Services Task Force. This panel was appointed by the Department of Health and Human Services, and now formally supports that advice.This is a first of it’s kind call for doctors to routinely screen women either pregnant or who have already given birth. There are extra hormones working in women during these times and a lack of sleep can trigger depression. Dr. Eleanor Martinez, M.D., told ABC7 News, “By making this recommendation we are putting it up in the front and saying, ‘Listen, this is a diagnosis. This is a disease. We need to embrace it like anything else.'”
Evidence shows that new mothers can be accurately diagnosed and successfully treated with the help of alert pediatricians, family doctors and OBGYNs. Not taking depression seriously is harmful to both mother and the baby. Research shows that untreated moms have babies and toddlers, with sleeping problems and take longer to be comforted. Until now, depression in these new mothers has been under recognized and under treated. A routine test can be given to the mom while she is waiting for her appointment. It will tell the doctor if she needs further screening for depression.
Treatments that work are “talk therapy” or drug therapy, or a combination on them are most successful. However, part of the problem is motivating a depressed mom to keep trying while the right treatment starts working. Plus there is a small risk of miscarriage and preterm birth leaving talk therapy as the best choice, and a nursing mom will be hesitant to take any drug.
Legislation in Congress may authorize Washington to fund screening and treatment for moms with babies one year and under, but as for now, there is none.
Anyone working with a new mother, family members, friends, or a nanny should be aware of symptoms. Mild depression, anxiety and mood swings are common in new mothers and this is called Baby Blues. This is normal in new moms and usually fades away after the second week. The entire process of giving birth is exhausting, hormones are raging, sleep can be sketchy. Most moms go through this.
I got a call one Sunday morning from a distraught Dad, who reported that his wife had come out of the bedroom stating that she had thought of suicide three times that morning. The baby was 5 days old, and we were able to find a Newborn Specialist for this family for a few weeks to get up at night with the baby and do all the night feedings so the parents could get their much needed sleep.
Demand for overnight nannies — also known as newborn specialists — has been growing, especially in the last five years and largely in major metropolitan areas, said Wendy Sachs, the co-president of the International Nanny Association and the founder of the Philadelphia Nanny Network. “People have moved away from the places they grew up, and they don’t have family down the street to help them out,” she said.The trend reflects changing attitudes about child care. Parents no longer see outside child care “as bad for kids or neglectful on their part — child care is seen as a necessity, not a luxury,” said Christine Carter, a sociologist who directs the Greater Good Science Center, an interdisciplinary research center at the University of California, Berkeley. “If it is good during the day, why wouldn’t it also be helpful at night?”Night nannies have evolved from an aristocratic tradition that goes back generations: the baby nurse. These were nurses hired by wealthy families to provide round-the-clock care of infants.The more recent demand for night nannies began with care of twins and triplets, but in the last several years parents of single babies have also been seeking overnight help.
Beth Weise, founder of Caring Nannies in Scottsdale, Ariz., said her business, which opened in 1983, once served only families with multiple births or babies with health problems. Now the clients are split 50/50 between multiple and single births. The same is true for the work of Tracy Seveney, a night nanny and founder of Nocturnal Nannies in Ashland, Mass.
Agencies like hers and Ms. Weise’s have recently begun expanding the night nanny’s role to meet their clients’ needs — offering infant sleep training and parent counseling. The bulk of Nocturnal Nannies’ clients are dual-career, professional families, Ms. Seveney said, and revenue has been increasing 25 percent a year.
Anie Roche of Los Altos, Calif., hired a night nanny through Craigslist last November after she had her second child. Both Ms. Roche and her husband have high-pressure jobs: he is an executive at a semiconductor company in Silicon Valley and she is a partner at a law firm in Palo Alto.
Their nanny works from 10 p.m. until 6 a.m. six nights a week. “She swaddles the baby and sings to him and that’s the whole point for us — she has a lot more energy and patience at that point in the day than my husband or I do,” Ms. Roche said. “We are wiped out.”
Night nannies are often treated like heroes, said Barbara Kline, president of White House Nannies in Bethesda, Md. “Suddenly you have a six-pound bundle of chaos, an incredible amount of upheaval in the household, and in swoops this person who can calm the baby and get them to eat and sleep,” she said.
As might be expected, help doesn’t come cheap. A week’s worth of night-nanny services can cost well over a thousand dollars, with nannies earning about $15 to $40 an hour, depending on their experience, the number of babies and the babies’ health. Ms. Seveney says overnight nannies usually spend 6 to 10 weeks with a family with one newborn, and anywhere from two to four months for twins.
Night nannies either work on their own — like Ms. Roche’s — or through agencies that find assignments for them. The bulk of agencies charge clients a one-time placement fee, but some charge a flat rate for each night. Agencies generally require nannies to have several years of experience with newborns that are not their own children, and most require training in infant and child cardiopulmonary resuscitation.
Jena Riley, a night nanny and owner of Night Nannies for Newborns in Denver, said most of her nannies are “moms in their 30s and 40s whose husbands were home at night.” That works well for her clients, often in their 30s and 40s, too, who have lots of questions, she said, but may not feel comfortable taking advice from a 20-year-old.
WHAT can make the job tough isn’t the baby but the parents, said Jessica Muzio, 30, a night nanny with Nocturnal Nannies. Ms. Muzio has a degree in psychology and once worked with autistic children. She is pursuing a nursing degree during the day.
“Babies are babies and I’m at the point now where I can almost always soothe them,” she said. “What makes the job good or bad is the rest of the family.” Parents are usually asked to keep track of their baby’s daytime routine in order to help the nanny troubleshoot at night, but many parents don’t.
And the atmosphere in a home is potentially uncomfortable, Ms. Riley said, if the new baby is causing friction between parents trying to adjust to the change.
It can also be isolating to work alone from 9:30 at night until 6:30 in the morning. “That’s the worst thing about the job,” Ms. Muzio said.
Making a steady living is sometimes a challenge because an assignment is generally short term, and there may be a gap before the next one.
Still, Ms. Muzio relishes the work. “It’s a great job for me,” she said, “because I love babies.”
This article ran in the New York Times April 7, 2007