UNC Health Care offers help for pregnancy-related anxiety and depression

Friday, May 8, 2009 — In November, UNC Health Care opened what might be the only inpatient perinatal psychiatry program in the country.

UNC Health Care offers help for pregnancy-related anxiety and depression click to enlarge Clarke May and her son, Max.

Written by Margot Carmichael Lester for UNC Health Care

Pregnancy and new motherhood are tough enough, with certain expectations, many of them unrealistic, coming from the mom as well as well-meaning family and friends, says Christina Lomax, a Greensboro mother.

For 10 percent to 15 percent of women, the expectations, anxieties and stress of motherhood lead to debilitating mental health problems during or immediately after pregnancy, and for most, there is no place to turn.

“Women who need help with mood disorders should have it from providers who are experienced, knowledgeable and able to provide the most appropriate care,” Lomax says.

In November, UNC Health Care opened what might be the only inpatient perinatal psychiatry program in the country. A break from traditional postpartum mental health programs – if they even exist – the UNC program, at the North Carolina Women’s Hospital, is separate from the psychiatry unit, so women, their babies and their families feel more comfortable having their acute needs met.

“Many studies show that maternal depression has a negative effect on infant development, and has been associated with higher rates of colic and increased injuries resulting from the mother’s failure to follow routine safety practices like using a car seat,” explains Samantha Meltzer-Brody, M.D.,  assistant professor in the Department of Psychiatry in UNC’s School of Medicine and director of the Perinatal Psychiatry Program of the UNC Center for Women’s Mood Disorders. “It’s also related to impaired mother-child bonding, which can have many long-term consequences.”

More alarming: The most serious cases – women suffering from post-partum psychosis – have a 5 percent risk of suicide and 4 percent risk of infanticide. But many women simply slip through cracks, either because they don’t seek care or their physicians don’t recognize the problem – or know how to treat it if they were to find it. There is no national standard for screening women for depression, Meltzer-Brody says.

“It’s critical to provide a supervised setting where we can ensure the safety of mother and baby,” says Meltzer-Brody, to created the new inpatient unit. The unit is baby-friendly, offering extended, supervised time for mother and baby to be together.

Clarke May, a new mom who lives in Durham, started to feel anxiety and depression when her son, Max, was 3 months old. “It got to the point where I just couldn’t handle it,” she says. She stayed in the UNC unit for two weeks, enough time to overcome depression and feel more comfortable caring for Max.

Letting moms visit with their families is part of what makes the inpatient service unique, and successful. During her recovery as an inpatient, Max visited his mom often, which helped nurture the bonding experience while helping May overcome depression.

Cognitive behavior therapy helps women like May cope with anxiety, stress, insomnia, lack of confidence and sadness. They also participate in family therapy and learn biofeedback and proper medication management. Comfort measures include gliders in patient rooms, a dedicated pumping room and pumping equipment and milk storage for nursing mothers. Additionally, staff provide lactation consulting and post-partum and obstetric care.

After discharge, care continues through one of two clinics, at UNC or at Rex Hospital in Raleigh. Services are usually covered by most insurance policies.

But the clinics can only help women who request assistance. “The stigma attached to mental illness can double itself in the mind of an expectant or new mother and she may shy away from seeking help,” says Lomax, who received outpatient services from UNC. “I've met so many other mothers who have experienced mood disorders during and after pregnancy that didn't receive help because they thought they needed to just ‘get through it’.”

Meltzer-Brody agrees. “Many women would rather die than go to a psychiatry clinic,” she says. “That’s why we align ourselves with comprehensive perinatal services and have integrated some of our perinatal outpatient mental health providers into the ob-gyn clinics.”

Referrals are not required to receive treatment. Women can request an appointment in the perinatal outpatient program by calling (919) 966-5217. Direct admission to the inpatient perinatal unit can be secured through a mental health provider.

“I encourage women to look at it this way: you’d seek treatment if you were bleeding or had pregnancy-related diabetes, right? Depression and anxiety are just other complications,” Meltzer-Brody says. ”We can help you. The sooner you call, the sooner you’ll get well.”

Warning signs of pregnancy-related anxiety and depression

Even a labor and delivery nurse like Tara Willis of Wilmington initially missed the signs of her own post-partum depression after the birth of her daughter. “It manifests itself in so many different ways that even me – an OB nurse -- thought, ‘What is going on?’ I didn’t even associate with post-partum depression.”

That’s why she says it’s important for women – and their family members – to know the warning signs:

  • Unusual changes in mood, such as feeling more anxious or worried
  • Lack of fulfillment from usual activities
  • Significant changes in appetite or sleep, especially not sleeping when the opportunity is available
  • Inability to function normally, particularly the inability to concentrate
  • Feelings of guilt or low self-esteem
  • Thoughts of hurting self or baby
  • Panic attacks

“It can be hard to separate what’s ‘normal’ for pregnancy and what’s not,” admits Meltzer-Brody. “But if you’re worried about yourself or your family member, talk to your OB doctor and get the help you need.”


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