For moms battling depression, a first-of-its-kind psychiatric unit at the University of North Carolina at Chapel Hill offers intensive, inpatient care.
Jenna Zalk Berendzen gave birth to a son in June. It was a difficult labor, and after Maxwell was born, Berendzen “just felt different.” She was anxious and had trouble sleeping. When she told the nurses, they soothed her, saying, “Oh, it’s just new motherhood.”
But Berendzen, a nurse practitioner herself, suspected it was much more. And she was right. “The night I got home, I started to feel I was going to die,” says Berendzen, from Cedar Falls, Iowa. “I felt maybe I shouldn’t be here so my son could have a better mom. “
Over the next few months, Berendzen, 36, started on antidepressants and antipsychotics. At one point, she had up to 15 bottles lined up in her bathroom. Despite the medications, she still felt overwhelmed. She told her husband she thought she needed to be hospitalized in a psychiatric unit, but being separated from Maxwell — whom she continued to breast-feed and care for — only exacerbated her precarious emotional state. “I knew I wasn’t safe at home, but I also didn’t feel safe there because I was away from my son,” she says. “Being in the hospital perpetuated my feelings that I’m a bad mom because I was away from him.”
It’s a crossroads faced by the sickest mothers who struggle with depression both during and after their pregnancy: a general psychiatric ward that treats drug addicts and schizophrenics doesn’t feel welcoming to moms whose mental health struggles have a very clear cause, the birth of their child. Historically, they’ve had no place to turn.
Then last year, the University of North Carolina at Chapel Hill (UNC) opened the nation’s first stand-alone inpatient psychiatry unit specifically for expectant or new mothers struggling with depression and anxiety. It’s not somewhere moms hope they’ll ever end up, but for those who need round-the-clock care, it’s a place where treatment focuses on the needs of both mother and baby. Perhaps most significantly, a hospitalized mom is able to be with her baby most of the day, which stands in contrast to many general psych wards that don’t allow infants.
There’s weekly therapy from psychologists who practice mother-infant attachment therapy, which works on how mom relates to her baby and reads her baby’s cues, and there’s partner-assisted psychotherapy, which helps dad understand how he can be most effective. Moms learn stress-management skills, practice yoga and participate in biofeedback sessions and mindfulness-based stress reduction groups. They have access to lactation consultants and hospital-grade breast pumps if they want to express milk. Coping skills and medication help get these moms back on track; counselors help connect departing mothers with hometown resources or transition them to outpatient programs.
Outpatient programs serve the majority of mothers who battle postpartum depression. Up to 15% of moms are thought to be affected, but most experience mild to moderate symptoms that don’t require intensive therapy. About 5% of those who become ill are affected so severely that they need to be hospitalized. Think of it like heart disease, says Dr. Samantha Meltzer-Brody, director of the perinatal psychiatry program at UNC and an associate professor of psychiatry. Most of the time, the condition can be successfully managed with outpatient therapy; in the event of a heart attack, however, patients will need state-of-the-art care in a cardiac intensive care unit (ICU). “This is our ICU,” says Meltzer-Brody.
The unit evolved from a pilot program launched in 2008; it was so successful — attracting hundreds of women from across the country — that hospital administrators were persuaded to carve out a separate space for the program. They set aside five patient beds and have treated 61 women since August, when the unit opened.
Decorators have tried to mirror what a lot of labor and delivery units across the country have done in recent years, swapping cold tiles for warm Pergo floors and making rooms pretty and welcoming. Rooms are designed to feel more like a comfy and serene space than an institution. Walls are painted cream and blue; artwork features seascapes and mountains. There are gliders in each room, along with baby bassinets and cuddly blankets.
The real attraction, however, is the camaraderie. “To be there with people who are going through the same thing is hugely important,” says Meltzer-Brody. “You don’t feel alone.” For many women, being surrounded by others experiencing the same struggles is akin to opening the floodgates. “Everyone is in there because things are really not going well,” says Meltzer-Brody. “There is a rawness.”
By the time they check in, women are beyond the point of acting as if everything’s fine. “There is a stigma around postpartum depression, but by the time they are that bad that they need to be in the hospital, they can’t pretend any more,” says Meltzer-Brody. “There’s an enormous relief in being able to be honest with their experience.”
Insurance typically covers the cost of hospitalization as a mental health stay, assuming a woman’s symptoms are severe enough. But still, the average stay of seven to 10 days can be prohibitively expensive, after factoring in travel for mom, dad and baby.
Berendzen was lucky; her sister-in-law lives in Chapel Hill and provided family support for her husband and baby. She was admitted the day after Labor Day and quickly noticed the difference between her hospitalization in Iowa and the specialized focus on moms and babies at UNC. Maxwell was able to visit so she could nurse him. Yoga helped relax her. Meeting other women like her made her feel less alone. “I didn’t feel crazy,” says Berendzen.
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