Shortly before last Mother's Day, 28-year-old Lauren Meehan-Machos broke down in front of her startled husband. "This is more than I can handle," she sobbed.
The typically confident and self-assured Cary, NC, mom -- a former Miss New Hampshire -- had felt overwhelmed and panicky since giving birth to her first child, Luke, two months prior. She'd obsessed so much about getting feedings and naps "right" that she stopped eating and sleeping herself. She cried continuously. She started throwing up.
Her doctor had prescribed medication for postpartum anxiety. But, she told her husband, the day before, she'd found herself at the wheel of her red Chevy Impala, rain falling in sheets from the sky, thinking, If I drive my car off the road, all this will go away.
"I was stunned," recalls Kevin Machos. "She'd done a very good job of hiding what she was feeling."
Immediately, Meehan-Machos's obstetrician referred her to the University of North Carolina at Chapel Hill (UNC). There, doctors had recently debuted a groundbreaking inpatient psychiatric unit, the first in the nation specifically tailored to women suffering perinatal (prenatal and postpartum) mood disorders. Unlike a general psychiatric unit, it offered:
A core group of doctors specializing in perinatal issues
Psychiatrists attuned to medications that wouldn't harm a pregnancy or a nursing newborn
An unusual policy of allowing children, even babies, on the ward during extended visiting hours
Mom-only counseling focused on anxiety and bonding.
And though there were only six beds, one was available for her.
Postpartum depression (PPD) is the most common complication of childbirth, striking approximately 15 percent of new mothers each year. Most of these don't need intensive intervention; standard treatments include counseling and medication. But there are severe cases: women swallowed up by anxiety, who, despite the exhaustion of a newborn, can't sleep. Women who can't stop obsessing over the terrible things that might happen to their babies, or who think about hurting their children -- or themselves.
"Maybe this is one percent or maybe it's five percent of affected moms," says Elizabeth Bullard, M.D., medical director of the new Perinatal Mood Disorders Inpatient Program at UNC. "The number is still larger than the number of women getting inpatient treatment."
There are many possible reasons for this. Experts agree, for example, that PPD is under-reported. But another factor might be that hospitalization can seem like a pretty scary idea. Especially considering that moms requiring or requesting it have had only one option: general psychiatric wards, the same locked units that care for drug addicts, schizophrenics, and patients with bipolar or eating disorders.
It's not that these programs can't help. (Dooce.com blogger Heather Armstrong wrote that committing herself after the birth of her first child was "the best decision I had made as a mother.") It's just that PPD specialists know that their patients could be better served. Afflicted moms often struggle to get sleep, for instance, and a crowded ward can add to the challenge. More important, most psych wards don't allow visits from children under 12, dividing mom and baby just when that relationship is most fraught.
Zachary N. Stowe, M.D., the director of the Women's Mental Health Program at Emory University, remembers his concern committing a mom of twins just six days out of the hospital. "Part of her absolute torture was that she didn't feel she could care for the babies," says Dr. Stowe. "And we reinforce that by separating her from them."
In addition, many women also still feel keenly the stigma against seeking help for mental health issues. After the birth of her third child in October 2008, Carlye Daugird, a former youth pastor from Durham, NC, found herself obsessed with ghoulish improbabilities: What if one of her children stubbed a toe and bled to death? What if the newborn yanked off the crib sheet and suffocated? The night before she was hospitalized, the 33-year-old asked her husband to lay his arm across her body so she couldn't get up and hurt herself. Yet if the UNC program hadn't existed, she says, she might not have sought out the help she needed.
"Your worst fear is that you're going crazy," she explains. "But [at UNC], you don't feel like you're checking yourself into a place for crazy people. It's a place that's just for mothers, so it makes postpartum depression seem like just a part of life, something that can happen to anybody."
The doctors at UNC opened the Perinatal Mood Disorders Inpatient Program in the fall of 2008, as an extension of their outpatient clinic, the UNC Center for Women's Mood Disorders. In years prior, doctors there inevitably counseled women they felt needed hospitalization. Wanting a better treatment option, they'd convinced UNC hospital administrators to set up a small postpartum inpatient unit in a space carved out of the geriatric psychiatry wing. They then modeled their program on one in the United Kingdom, where, as in the rest of Europe and Australia, psychiatric mother-baby room-in units are more common.
When Meehan-Machos arrived there this past May, she was greeted by a hospital unit primed for moms. Her room -- one of five, four of them private -- had been painted cream and blue; a photo of white birch trees hung on the wall. There was a glider in the corner, in case she cared to nurse, and a lamp-lit desk for all the journal writing she'd be encouraged to do as part of her treatment. (Previously, says Dr. Bullard, the only decoration on the white walls had been a mounted box meant to hold disposable gloves.)
Ever the overachiever, Meehan-Machos initially assumed she'd pop in briefly, maybe for a couple days, then return home, all better. She was stunned to learn that the average stay at the unit lasts a week. (After discharge, women are followed by outpatient psychiatrists.)
"I don't want to be here on Mother's Day," she protested.
"It's just another day," Dr. Bullard replied. "It's more important that we get you well."
There were three other women hospitalized at the same time as Meehan-Machos. One had spent eight months depressed and another more than a year; the last had lost a baby at 16 weeks' gestation. Every weekday, they'd gather for three to four hours of therapy and education around the causes, symptoms, and toll of maternal depression. Spouses were often involved, and babies were welcome from 7 a.m. to 10 p.m., so doctors could witness mother-infant interaction. Daily readings gave voice to reflections about recovery, shame, and guilt. (One began, "I would never put my baby in the dishwasher. But I've thought about it.")
"It made me realize I wasn't the only one going through this," says Meehan-Machos.
Sitting on the couch in the group room, a Persian rug under her feet, the new mom revealed that just looking at her son made her nervous.
"I know I love him, but I'm afraid of him," she wrote later in her journal.
For Carlye Daugird, a breakthrough came when she shared that she was worried about returning home and having to juggle the demands of her three children. Her therapist responded by giving her a calendar and helping her formulate a plan, working through how she'd get groceries, put dinner on the table, and deal with her husband's late nights. In biofeedback sessions with an occupational therapist, she also learned to be aware of her breathing and heart rate, and how to use that knowledge to try to calm herself.
"When the patients come in, it's like peeling an onion," says Dr. Bullard. "They're so afraid, and then, as they confront their feelings, you see the layers come off."
Frustration. Fear. Guilt.
It wasn't easy; in fact, Meehan-Machos is still equivocal about her eight days at UNC.
"I hated that I had to go to a hospital and I hated that I couldn't get over my problems myself," she says, "but I loved having the doctors and the moms available. I can't imagine what it would've been like to be the only mom in a general ward, trying to get better by myself."
It's taken time for news of UNC's program to spread, but doctors have already discharged more than 200 women. Inquiries have come from as far away as Seattle. Above all, Dr. Bullard hopes to have created a paradigm that other hospitals will mimic. There is some sign of this: Duke University has asked about the process of establishing the program.
Both Daugird and Meehan-Machos have been home for months now. Meehan-Machos says she has good days, when she wakes up free of anxiety, and bad days, when the unease follows her like a shadow. She still can't believe she spent time in a psychiatric hospital. "I joke with my husband that this part doesn't go in the baby book," she says.
Daugird is less ambivalent.
"I won't say it's the best thing that ever happened to me," she says. "But it was certainly life-changing. I don't know what would've happened to me if it hadn't been available."
Up to 80 percent of women get a little blue after giving birth, reports the American College of Obstetricians and Gynecologists. If you develop any of the following, call your doc:
Feelings of sadness, doubt, guilt, or helplessness that interfere with caring for your home, baby, or self
Intense worry about your newborn, or, conversely, no interest at all
Lack of appetite or enjoyment in previously pleasurable things
Negative emotions that increase instead of fade with time, or ones that flare up months after delivery
Bonnie Rochman is a journalist and blogger in Raleigh, NC.