In the first days after her son was born, says Antioch mom Diana Ferranti, "I recognized there was something wrong." She felt anxious, hopeless. "I was struggling. Everything felt difficult." She requested a home visit from a breastfeeding counselor. "Your son is feeding fine," said the visitor, "but I want you to read this brochure." It was on postpartum depression (PPD), and it described the way Ferranti was feeling.

She called the number on the brochure and reached the Postpartum Health Alliance, which helped her find therapy and support. Now, eight years later, Ferranti says, '"A lot of good came out of it. I learned to take care of myself and that it's important to let dads have a major role-I realized I don't need to be Wonder Woman."

Another new mom, Teena Abu Hamdeh, went through "two weeks of hell" until the Kaiser "Welcome Home Baby lady" visited after her son was born. Abu Hamdeh was terrified to hold her baby because of frightening "intrusive thoughts" -visions that she might harm him.

The Kaiser visitor explained that such thoughts are another type of postpartum mood disorder. Abu Hamdeh immediately started counseling and medication and after a couple of months began to enjoy and bond with her son.

Suffering alone

Ferranti and Abu Hamdeh were lucky-knowledgeable and supportive home visitors connected them with help. Although postpartum depression is very common, affecting 10 percent to 20 percent of new moms, experts say most women suffer through it alone.

But treatment is important, says Dr. Ronald Soderquist, whose Westlake practice specializes in PPD. Of moms who experience PPD, "forty percent will still be depressed a year later if they don't get treatment." That's a problem, not just for the mothers, but for their children.

Effect on children

"Often parents' depression makes them unable to respond to the child's most basic cues-crying, hunger," explains Kadija Johnston of the UCSF Infant/Parent Program. The child can start to feel "helpless as to having an effect on their world." Some babies stop expressing their needs, others become very demanding.

"The longer a mom is depressed, the more significant the impact on the child," says Pec Indman, coauthor of Beyond the Blues, a book on PPD. A mother's depression can affect a baby's language development and brain development, says Indman, if the mom is too depressed to play with the baby or respond to his babbling. When mothers are depressed, children of any age are more likely to have behavioral or learning problems.

Stigma and shame

If PPD is so common and treatment so important, why do most mothers struggle with it alone? "Our culture is not attuned to the struggles that mothers go through," says Soderquist. "People think, 'if your children are healthy, just be thankful.' Mothers get blamed if they're not happy."

Often "mothers do not realize [they are depressed] until they come out of it," says Sue Jensen, RN, of the Child Care Health Line. And a mother may fear a "stigma" in admitting an emotional problem, says Johnston.

Treatment

Treatment for postpartum depression, says Soderquist, can be "a combination of antidepressants and counseling. Sometimes [PPD is] a combination of hormonal and relational problems. A new baby can put a stress on a couple's relationship. Depression is so common with mothers of young children. Mothers working outside the home are often happier because they get a break. Being home with young children can be lonely, boring, and stressful."

"Doctors shouldn't assume it's only biochemical," he adds. "Sometimes antidepressants aren't needed."

Who can help?

Home visitors

Like many First Five (Prop. 10) commissions, Alameda County First Five offers new moms up to three home visits from a public health nurse. In the four participating hospitals, says Deborah Bremond, director of Family Support Services, 97 percent of new mothers accept.

If the visiting nurse sees signs of depression, she brings a mental health specialist along on the next visit. The specialist watches the mother-child interaction-the parent's sensitivity and responsiveness to the baby-and recommends treatment if it's needed.

For now, Bremond says, First Five funding can pay for home visits, but she's concerned about the effect of budget cuts on this kind of pro-active prevention and on resources for treatment.

Pediatricians

"A pediatrician's role goes beyond the care of just the child," says San Diego pediatrician Richard Walls. "An advocate for the child is also the advocate for the parent." Pediatricians should "check in with the mental health of the primary caretaker-the mom is a major part of the baby's environment," says Shoshana Bennett, psychologist and president of the California chapter of Postpartum Health Alliance.

Pediatricians may feel it's not their role, but "doctors need to know that women are relieved and thankful if the doctor cares about how they feel," says Dr. Ronald Soderquist, who treats women with PPD. He suggests that pediatricians use a short questionnaire to screen all new moms for depression. Walls, on the other hand, says doctors should gear questions to the particular family-the key is creating an atmosphere where the mother feels comfortable enough to be open.

Pediatricians' offices can also help by displaying information about PPD, especially about available counseling and other resources.

Child care providers

Child care providers are "most likely to be in the best position to identify with the parents and offer referrals," says Kadija Johnston, who directs the Day Care Consultants project of the UCSF Infant/Parent Program. But providers should be careful not to make a mom feel her parenting is being attacked, Bennett warns.

Because a parent's depression is difficult for children, "lots of depressed parents take criticism from child care providers and the community at large," says Sue Jensen, RN, of the Child Care Health Line. A child care provider is much more likely to be able to help if she "feels empathy instead of criticism and anger," Johnston says.

Bennett recommends neutral questions like, "Are you able to sleep at night when the baby is sleeping?" or even simply, "How have you been feeling?" One of the most important things a provider can do, says Jensen, is to put out literature that describes depression and offers information on where to get help.

Resources:

• Beyond the Blues: www.beyondtheblues.com: links to PPD sites, and PPD book ordering information
  
  
• Child Care Health Line: 800-333-3212
  
  
• Center for Postpartum Health, 818-887-1312, www.postpartumhealth.com, information and links to many other sites