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.