Analysis of data from a full-scale clinical trail in the UK has shown that postpartum depression can be prevented with help from properly trained health visitors. In the UK, health visitors are registered nurses who have been specially trained to give support and advice to new mothers.
Mothers seen by health visitors with additional mental health training were 30% less likely to become depressed six months postpartum than those women receiving the standard care.
There has been a lot of research looking at a lack of support as a trigger of postpartum depression. But mothers in the US don’t regularly receive postpartum care—let alone home visits. There are some programs for military families and low-income mothers, but most of us don’t see someone at home. You can hire a baby nurse or postpartum doula, but that’s considered a luxury rather than a basic medical service. It’s almost always an out-of-pocket expense.
In fact, women in the US can feel hung out to dry after the baby is born. There is so much prenatal care and then “see you at the six week check-up!” If a woman has breastfeeding problems who does she turn to? Her OB/GYN is out of the picture while her pediatrician may not have enough breastfeeding knowledge to help her. Mom has to seek out and sometimes pay for help. Psychological care can be similarly lost somewhere between prenatal weigh-ins and baby vaccinations.
Of course some OB/GYNs and midwives are excellent at discussing, identifying and following up on psychological issues–and breastfeeding for that matter–but not all.
When I had a mysterious fever postpartum I dragged myself and my days-old baby to the OB/GYN. I was absolutely exhausted and sick. My doctor took one look at me and said, “you look awful. You need to take some vitamins.” Another doctor visibly winced when she examined me. I felt crushed and left in tears. No one identified my mastitis– I had to self-diagnose via the internet.
After my experience, the the idea of a home visit from a nurse sounds pretty good. But if she’s poorly trained, it can backfire. My mother– whose four children were born in England in the 60s and 70s–recalls visits from “awful health visitors” sent ostensibly to help with feeding difficulties. These stern government nurses would show up, peer around her messy house and over her shoulder, and judge her. The message was, you’re not getting this right and you’re not coping very well. After the health visitor left her mood would plummet.
Given that it’s unlikely all American women will be getting home visits anytime soon– good or bad– I always urge new mothers to seek out local support and/or feeding groups. These can be an invaluable resource. Mothers learn from other mothers and see that they are not alone.
Still, this new research may lead to better training of health visitors in the UK and maybe even some new forms of support in the US. The University of Leicester were so impressed with the results, they are “now considering undertaking further research on prevention of postnatal depression in other parts of the world.” To which I say, New York is lovely in the fall!