The Star-Ledger (Newark,
December 9, 2007 Sunday
Promised lifeline for new moms
Postpartum depression law called
a disappointment so far
BYLINE: SUSAN K. LIVIO,
Jon Corzine signed
the landmark postpartum depression law 20 months ago,
the state has spent $9 million on the program: half on
TV and radio ads and brochures encouraging women to ask
for help, and half on training more than 6,000 medical
professionals in how to identify the illness.
But health experts and women using the hotline say the
law has fallen short: Women are seeking help, but when
they do, state and medical professionals often are not
prepared to assist them.
Many women found a state hotline staffed by people who
were inexperienced at helping those in a mental health
crisis. Obstetricians, gynecologists and other doctors
often are afraid to get involved, they say, because of
their lack of psychiatric knowledge. And there is a
shortage of mental health professionals skilled in
treating the illness.
``The people who did speak up were greatly
disappointed," said Joyce Venis, a
Princeton psychiatric nurse who treats women with
perinatal mood disorders and served on the state
advisory group that assembled the public awareness
campaign. ``How could this happen? I believed this was
going to be a good program."
Venis, who sees about 40 patients a week at her
Princeton practice and runs a postpartum support
group that meets in Somerset County, said the majority
of her patients have expressed frustration and
disappointment with either the hotline, the lack of
experienced doctors and mental health professionals, or
both. It's a sentiment echoed throughout the state,
women's advocates and health experts say.
Gail Schuetz, 35, of Edison and a member of Venis'
group, says she became depressed after her second child
was born. Her son, sleepless and inconsolable, needed
her, but she couldn't muster the energy to leave her bed
and soothe him.
She suspected she had postpartum depression, a mental
illness in which women experience severe depression and
relentless anxiety, and even contemplate hurting
themselves or their children. One of the prime movers in
getting the law passed was Mary Jo Codey, wife of Senate
President and former Gov. Richard Codey.
One part of the state's advertising campaign urges women
to "Speak Up When You're Down."
But when Schuetz tried to speak up, she said she was let
She said a therapist referred to her by the hotline
turned out to be a drug counselor whose advice consisted
of telling her "don't obsess." Her own obstetrician
refused to see her and advised her to go to the
emergency room. It took five calls to find a support
"The state postpartum depression advertising program and
the law made it seem like I would just call the 800
number and would have everything I need - therapists,
doctors, support groups," she said. "It had nothing."
Assistant Health and Senior Services Commissioner
Celeste Andriot Wood said she's heard the "horror
stories" but said, "we have to err on the side of being
conservative" with an illness in which a small
percentage of women have killed their children.
"If women are truly in crisis, we have to tell them to
go to a crisis center," Wood said. "You don't want to
miss somebody, especially when the woman is calling and
she doesn't have a support system or extended family."
Wood conceded the hotline - an existing "Family Health
Line" with information on a variety of topics - has its
problems. She said women complain it is staffed by
operators short on suggestions of where to go for help.
Many who complain can't find a therapist, or are
frustrated they've been referred to inexperienced
"When you suddenly have a large influx of women who are
indeed seeking out treatment, we need to be able to
identify appropriate resources," Wood said. "It's been a
About 2,400 women have called the postpartum depression
hotline since its inception in July 2005, and nearly 300
uninsured women got treatment at state expense.
Wood said the health department plans to hire
experienced social workers to handle some hotline calls
in the coming year, and compile lists of skilled mental
health and medical professionals.
A `HORRIBLE' RESPONSE
Maxine Garcia of Sayreville says that when she asked for
help she got a response that left her stunned. Police
officers and rescue squad workers arrived unannounced at
her home last year, an hour after she called the hotline
to say she was six months pregnant and "depressed out of
my mind." According to the police report, Garcia
threatened to hurt herself, but she denies it. She and
her two children were forced to go to the emergency
room. "I felt like I had no rights," Garcia said. "I
really just needed someone to talk to."
Yolanda Iyube of Franklin in
Somerset County says she confided to her
gynecologist two years ago she was consumed with scary
thoughts about her baby dying violently. Before she left
the office, a police-escorted social worker took her to
the emergency room. "They brought me in a police car to
the hospital. It was horrible - everyone was looking at
me like I had committed a crime."
Venis said such responses can discourage women with
postpartum depression from seeking help.
"When they have intrusive thoughts, they need to know
their fears are safe with whom they are talking," Venis
said. "If a person has intent and talks about a plan to
hurt herself or someone else, there's a difference.
Sometimes (doctors or hotline workers) don't know, and
maybe it's a sense of covering themselves."
Experts say improving the hotline won't be enough if the
medical community does not gear up to handle the demand.
One in eight mothers - about 16,000 women in
New Jersey - suffers from a perinatal mood
disorder, mental health experts estimate.
"Amazingly, there is not a lot out there for women,"
said Robin D'Oria, executive director of the Central New
Jersey Maternal and Child Health Consortium, one of six
groups hired by the state to provide training and create
lists of specialists. "We made some phone calls, and
some practitioners don't choose to treat postpartum
depression. It's hard for women to see someone right
Codey, who revealed her personal struggle with the
illness and launched an awareness campaign in 2005, says
she knows this firsthand. She said after a psychiatrist
she used moved out of state, her gynecologist told her
he doesn't know where to send his patients.
"He said the people who are out there - the
psychiatrists - they don't get it," she said. "He sees a
lack of experience in what to do with these women."
Codey believes the law is having an impact, saying
"society is accepting" postpartum depression. But she
said "we have a long way to go" and is lobbying for
national legislation for research, screening and
treatment of the illness.
When the law took effect, there was an initial
reluctance from physicians treating new mothers - a fear
that "we won't be able to discharge anyone from the
hospital," said Edward Wolf, vice chairman of the
Department of Obstetrics and Gynecology at Saint
Barnabas Medical Center in Livingston.
Wolf said the law added responsibilities for
obstetricians already vulnerable to malpractice
lawsuits. He said there was a fear of "I am going to get
this thrown on my lap without help."
Saint Barnabas, which delivers the most babies in the
state - 7,000 annually - has hired two psychologists
well-versed in prenatal mood disorders to be on call
when a patient needs them. "It makes all the difference
in the world," Wolf said.
THE ROAD AHEAD
Since September, hospitals across
New Jersey have screened 18,000 mothers for the
illness following delivery, with 13.5 percent indicating
they were at risk.
Susan Stone, a clinical social worker from Englewood
Cliffs and president of Postpartum Support
International, said doctors treating women and children
must be assured there will be mental health services
available when they identify a patient who may be at
"We've come a long way in the last two years, thanks to
Mary Jo Codey, in raising awareness," Stone said. "But
we have a long way to go to catch up the mental health
community, which needs to develop specialized services."
Ricardo Fernandez of
Princeton, a psychologist who has treated
postpartum illnesses for nearly 25 years, said the
mental health field will eventually respond. "It's
happening, but these things take time," he said. "The
New Jersey has accelerated it."
But Venis, who has treated women with the illness for 30
years and suffered from it 40 years ago, said many in
her field shy away from it. "You need to be okay with
the illness and I don't believe they are," she said.
Venis' group meets in a tidy conference room at the
Rocky Hill Library.
At one recent meeting, one woman said her doctor told
her postpartum depression "was a made-up illness." Two
said their husbands doubted how sick they really were.
One got this bit of advice from her mother-in-law: "Snap
out of it."
"You forget who you used to be. You can't trust your
brain," Margarita Turkish, 35, of
Old Bridge said at the October meeting.
Venis nodded as each woman spoke, saying she's heard too
many stories about how hard it was for them to get help.
"To be told to `just get over PPD' is like telling
someone to not have cancer, or telling someone with two
broken legs to shovel the sidewalk," Venis said. "You
can't think your way out of it."