I posted this article to Facebook over the weekend and it got me thinking about the few women I've seen over the past year who presented to the ER with postpartum depression.
I can't remember if I hospitalized any of them, but I don't think I did.
I was really close once--it was a woman from South America. She was with her husband and so depressed you could feel it when you walked in the room. She had no support other than her well-meaning spouse of one year. Her mother and sister tried to get visas to leave their country to come and help her, we'll say it was Bolivia, but Bolivia wouldn't grant them permission. Not for a short-term visit. Not for the birth of a grandbaby/nephew. Please try again in six months, kthanksbye.
As an aside, what the hell? In the states, all you do is apply for a passport, pay a fee, and a few weeks later it's in the mail. I honestly never gave thought that other countries might not let their citizens leave so readily. Obviously, I'm naive in this realm.
In the end, I sent her home because her husband managed to get the next few weeks off work to stay with her and take care of the baby. She wasn't sleeping, so the doc gave her an injection to induce sleep and a prescription for a sleep aid. Additionally, the husban was able to get his mother to help some, although she also had a sick husband at home. And I referred her to a Latina agency in town that provided home-based services to new moms for up to one year. But I don't know if she followed through and my hunch is that she didn't. But I made the referral and spoke to her husband about the importance of her (or him) calling the agency.
Herein lies the conundrum: The hopital calls you in to assess and you do the best you can, but do you really want to separate an infant from his mother and vice versa? I know postpartum depression can be excruciating--thank God I never had it--but professionally and ethically, hospitalization should be the last resort. What I know for sure is that none of the women I've seen have been actively psychotic.
As the article notes, Ms. Sanchez was. If she was hearing voices, I think the hospital should have forced inpatient treatment. But. That's easy for me to say when hindsight is 20/20. It could be that she simply didn't tell them the extent of her condition when she was there. It could be jaded medical professionals didn't believe her. It could be overworked physicians and nurses simply missed it. It could be a social worker, like myself, evaluated her and put what she felt was a valid safety plan in place based on the information she had. At this point, it's all conjecture.
Years ago when I was a case manager at a local mental health center, I worked with a schizophrenic woman who killed her child. Her child was young--five, six, seven?--and she, too, had drowned her child, albeit through different means. The mom was delusional (I don't remember many details) and geniunely believed one day that her child was possessed by the devil. Mom made her her son drink water. Again and again and again. Her sons's electrolytes got all whacked out and he died.
Murder? No, I don't think so. She was convicted, of course, and served her time, but it was under a decade. Thankfully, some judge and/or jury was able to get past the horror and see the situation for what it was: an accident. A mother's mental illness gone horribly, horribly astray. I worked with her after she got out of jail and was blissfully unaware of her history for about the first month or so of our relationship. She was a nice lady, really, with a tragic back story.
What I do know is this: In the future, I'll take postpartum cases a bit more seriously. God forbid something like this come back and haunt me. Although to put it all in perspective, the overwhelming majority of mothers with postpartum depression don't eat their children. ->
Read the complete post at http://feedproxy.google.com/~r/blogspot/tXCM/~3/LF7cXCsL7gc/baby-blues.html
Posted
3 Aug 2009 4:12 PM
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Trench Warfare
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