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Out of the Blue: Creating a Postpartum Depression Support Group
Barbara Maley, RNC, BSN, CLC
DOI: https://doi.org/10.1111/j.1552-6356.2002.tb00020.x

Most expectant parents look forward to the birth of a new baby and the joy it will bring into their lives—typically they’ve planned for the pregnancy and have prepared themselves for the changes that will occur in their lives.

What many women don’t plan for is the emotional changes involved. As recent media reports have depicted, postpartum depression (PPD) affects many women, yet few know about how to recognize the symptoms and get help. That same lack of knowledge holds true for health care professionals as well—in fact, the literature demonstrates that health care, childbirth and social services professional women relate how stunned they were that they could not recognize the symptoms in themselves (Mahar-Sylvestre, 2001).

Western culture infers that each birth will yield a perfect baby, instant emotional bonding, and an early achievement of maternal instincts (Wood, Thomas, Droppleman, & Meighan, 1997)). Beeber (1998)) acknowledged that stressful life events could trigger depression in young women under the age of 30. Most people would recognize the birth of a child as a stressful life event.

Women’s magazines, newspaper articles, news magazines and the World Wide Web have been instrumental in shedding more light on this mental health issue. Unfortunately, it seems to take a tragedy of major proportions to focus attention on this issue. Women who kill their children, and in some cases also kill themselves, make national headlines.

 
RECOGNIZING PPD
Guidelines for Perinatal Care (Hauth & Merenstein, 1997) contains only a brief reference that the physician at the four- to six-week postpartum exam should address the possibility of emotional instability developing into clinical depression. Straub et al. (1998)) reported that many physicians are not assessing for postpartum depression and, additionally, are not informed relative to treatment options and local resources.

Due to the demands and life changes associated with childbirth, the post-delivery time can provide a setting for depression. Biological, psychological, cognitive, situational and anthropological factors comprise many of the multifaceted causes that contribute to the onset of postpartum depression (Beck, 1996; Beck, 1998; Beck, 1999).

It has been estimated that as many as 10 to 20 percent of postpartum women experience postpartum depression (Beck, 1999). Symptoms common to any depression include feeling sad, anxious, worthless or guilty, sleeping more than usual or being unable to sleep at all, poor concentration, confusion, loss of appetite or voracious hunger. Symptoms unique to postpartum depression include quick mood swings, fear of hurting the baby, gastrointestinal disorders and menstrual irregularities.

These symptoms can occur anytime from two weeks to several months after delivery (Beck, 1999; Straub et al., 1998). Unfortunately, many women continue to be undiagnosed or misdiagnosed. As recently as 1998 it was reported that the misdiagnosis of postpartum depressive illness remains strikingly common (Nonacs & Cohen, 1998).

It has also been well established that other family members feel the effects of postpartum depression. Because the depressed mother is focused on her own quest for mental wellness, she has little energy left with which to interact with her infant, husband (significant other) or other children. Even if a woman receives successful treatment for PPD, family members may not escape unharmed. Meighan, Davis, Thomas, and Droppleman (1999)) reported that fathers might also experience symptoms of depression while being supportive of their partner’s search for mental wellness.

Nurses who practice in the field of maternal and child medicine have been encouraged to initiate, nurture and lead such support groups within their communities (Haggerty & Williams, 1999; Leonard, 1998). Cook and Matheson (1997)) proposed that attendance at organized support group meetings might be more beneficial to ease the feelings of isolation and loneliness common in depression. None of the proponents of support groups claims that they are the only solution to postpartum depression, but rather one of many interventions from which a woman could choose.
 
STARTING A SUPPORT GROUP
The process of planning and starting a mutual self-help support group at The Carol Jo Vecchie Women and Children’s Center at St. John’s Hospital occurred over a period of several months. Initially, an exploratory meeting was held between the planning coordinators and the nursing manager of the hospital’s psychiatric unit. The purpose of that meeting was twofold: to determine if any type of services were currently available for women with symptoms of postpartum depression and to begin the process of a collaborative effort to form the support group.

Planning sessions were held over the next few months with various individuals from within the hospital, the birth center and the community who had expressed an interest in being involved with this program. Integral to our planning was the assistance of a member from the community who had experienced PPD. Members of a volunteer parent-help organization agreed to refer individuals to the support group as well as to provide financial and material support.

Nurses from the birth center and home health volunteered to facilitate the group meetings in coordination with social workers from the psychi atric and maternal/child divisions. It was agreed that no more than two facilitators would be present for each support group meeting.

In the process of planning, the postpartum depression support group was born and given the name “Out of the Blue.” The mission statement and goals for the support group were developed.

Meetings were held to clarify the goals, identify those women potentially in need of such a group, explore possible publicity efforts, plan brochure contents and develop an assessment tool to be used by the volunteers of the parent-help group when screening phone calls. The participating staff nurses were instructed on group process and the role of a group facilitator.

The nurses added their own insights into the problem of PPD and reiterated their commitment to the group. With the assistance of the volunteer parent-help group, a bookmark was developed as a quick and simple avenue with which to get information to newly delivered women. The bookmark includes a list of symptoms for PPD, advice on when to call the doctor, emphasis on the importance of seeking help early and the phone number for the support group.

A decision was made to provide the home health nurses with a supply of these bookmarks to distribute as appropriate in the course of making their postpartum home visits. Plans were also made for the parent-help group volunteers to begin using a simple assessment for depression tool during phone calls in which they felt a woman was expressing PPD symptoms and refer her to her physician or the support group as appropriate.

While in the process of formulating the PPD support group, a psychiatrist with Southern Illinois University School of medicine who specializes in women’s mental health had been contacted and agreed to be a referral for potential patients. In addition, a plan was developed for the birth center to send out a letter at three to four months postpartum to further inquire as to the mother’s well-being. This letter was based on research that has shown that some women develop symptoms of depression later in their postpartum period.

 At the final planning session, a date was set for the inaugural meeting of the support group. Plans for publicity, distribution of brochures and flyers, and the role of the facilitators were final-ized. Long-range plans were made to evaluate the support group sessions approximately every other month and eventually on a quarterly basis. In-service presentations for the perinatal home health nurses and the parent-help group volunteers were also planned.

A formal presentation was made to the physicians at their monthly OB Department meeting. The purpose of the support group was explained, and they were provided with information on how they could refer their patients to the group as appropriate. They were made aware of the availability of the physician interested in treating PPD. The doctors did offer that they had experienced difficulty in being able to refer patients for immediate counseling in Springfield and were pleased to hear of this additional resource.
 
MOVING FORWARD
With great anticipation, the first meeting was held. Attendance was sparse, but the women were appreciative that such an opportunity was available for them. They reported that they had learned about the group from newspaper publicity and word of mouth. They concurred that monthly meetings should be adequate and were very positive about the support group. The facilitators were prepared for a light turnout initially and were eager to commit to continued participation.

As the months went on and more women came to meetings, it became apparent that most were coming as a result of encouragement from family, newspaper notices and word of mouth. Very few were given information about the support group by their physicians. A list of suggested books that discuss PPD and current Web sites dealing with this subject were also provided for attendees.

As the size of the group changed, educational presentations were incorporated into the agenda. As the group evolved, it became apparent that a printed agenda would be helpful to keep the discussion moving in order to avoid any one person monopolizing the session. The mothers spontaneously began staying in contact with each other between meetings and maintained an informal support system. Some came to only one session. Others would come to several, not necessarily sequential. In some cases, a close friend or relative drove them to the meeting and waited for them to take them home.

Attendees were encouraged to continue coming if they felt comfortable with the group, but were also advised that their need for the group may decrease. In other words, they were informed that the support group was there for them if and when they felt they needed the meeting.
 
GETTING THE WORD OUT
The biggest obstacle continues to be creating awareness among postpartum women and their families about the group. Information has been delivered to physicians’ offices. Notices are published in the local newspaper prior to each monthly meeting. Local magazine and television interviews with one of the facilitators, as well as with local women who have experienced PPD, have been done, but a dramatic increase in attendance has not resulted.

Women who attend meetings continue to report that it was a friend or relative who encouraged them to come or that the pediatrician prescribed medication for their anxiety or depression. In many cases, they recount that they were faced with having to continue to ask for help from numerous professionals until one finally heard their plea for help. Many offered that the state of their emotional health is not seriously addressed at the postpartum checkup.

Women attending the meetings also reported that the postpartum home health visit was very beneficial in making them aware of symptoms and as an avenue to ask for help. Postpartum home health nurses report similarly. They tell of new mothers in tears waiting at the door for them to arrive, anxious that they are not coping with a newborn as well as they think they should be, and fearful that there is something terribly wrong if they are feeling this way.

It appears that most of the women who do attend support group meetings have support from their spouse, significant other or other family members. They report that they would not have been able to cope without this help. They also recount that they were completely amazed at the feelings they were experiencing and felt that they must be alone in those feelings. Like Corrine Mahar-Sylvestre (2001)), professional women who have come to “Out of the Blue” meetings shared that they were fearful their professional life would be over if they reported their symptoms or sought help.
 
FINDING SOLUTIONS
Even though there has been more publicity about PPD, the realization that it can happen “to me” continues to be denied by most women. Whether or not a woman has the benefit of extended family does not seem to make a difference in whether or not she will experience PPD. However, having that extended family does give her more options for support while she is dealing with her feelings, seeking help and hopefully regaining emotional health.

Continued education regarding PPD for health care professionals is just part of the solution. Support groups are just part of the solution. Education of the public about the real problem of PPD is part of the solution. Acceptance by society that women can be “blue” after bringing home a perfectly healthy baby let alone an infant with problems is part of the solution. Recognition that some women may even become depressed and need medical attention is part of the solution. Realization that the infant, any other children and the other parent are also impacted by PPD is part of the solution.

One answer will not fit every circumstance, but PPD is a real problem and early intervention will result in early resolution and the well-being of the entire family dynamic. Our goal is to continue to go forward with “Out of the Blue,” continue to educate the public as well as the professionals about the importance of this issue and continue to support women who are experiencing PPD for as long as they need our support.