From a painful distance, we witness a family’s tragedy - The Boston Globe

I suffered from postpartum depression. There was a day I will never forget.

I've been reading the coverage of the Duxbury mother who has been accused of killing her three children and who jumped from a second-story window.

My story is not original or unique. As a new mother at 35, I experienced significant postpartum depression. My case did not progress to postpartum psychosis. I was a family nurse practitioner at the time. I had worked as a pediatric registered nurse for 15 years before that.

I suffered from postpartum depression immediately after my son was born. I was terrified of hurting him. I was afraid to let him out of my sight or let anyone else care for him. I thought he would sense my sadness and think I didn't love him. There was a day I will never forget where I was overwhelmed with anxiety and sadness. I held him in a carrier and paced the apartment. I was afraid to be near a kitchen knife, that I might hurt him. Even 27 years later this statement fills me with shame. Thank God I did not.

The difference between postpartum depression and postpartum psychosis is that I knew I would not hurt my son despite my fear. Psychosis involves a break with reality, unrelenting voices that tell the patient to inflict self harm or to harm others, an obsessive, constant noise.

Mothers are supposed to be ever protective of their children. The guilt and shame of postpartum depression can prevent a mother from asking for help. Like so many, I am heartbroken for all involved in this tragedy.

Karen M. Gregory

Billerica

After childbirth, focus is more on baby's well-being than mother's

As the mother of three (now young adult) children, I know firsthand that after childbirth, the focus is more on the baby's well-being than the mother's. Are pediatricians sufficiently trained to identify any warning signs that a mother is suffering, whether from fatigue, depression, or some other undisclosed issue? A depression checklist form is not enough. There needs to be open and honest communication with the mother to determine whether she needs assistance.

Insurance companies place a heavy burden on the medical community to see as many patients as possible in the shortest amount of time. Physicians must be permitted to build more time in their appointment schedules to address both babies and their mothers to help avoid more tragedies like the one in Duxbury.

Ann Doyle

Scituate

We need to shine light on systemic challenges in all communities

The recent tragedies in Duxbury and Cohasset and coverage of these families in crisis raise important questions about child and family well-being, mental health, lessons learned, and policy implications. Unfortunately, I worry that the media once again raise these issues primarily because of the shock they seem to elicit since they are happening to white families in communities of means. Every day, a disproportionately high number of children of color enter the child welfare system for these same reasons — mental health struggles, domestic violence — and for even more basic issues such as poverty, homelessness, and food insecurity. Massachusetts needs to shine more light on the needs in all communities for better access to health and human services programs and basic resources that keep children and their families safe, healthy, and thriving.

Rachel Gwaltney

Executive director

Children's League of Massachusetts

Boston

Screening is vital, and for fathers too

I read the excellent article that discusses in great detail maternal postpartum depression ("More help sought for post-birth depression," Page A1, Jan. 29). The impact on the mom, subsequently on the newborn, and ultimately on the dad and the rest of the family cannot be underestimated. The rate of postpartum depression varies, but screening is always important. It should be done by the ob-gyn and other health care providers who have contact with the family. This includes the pediatrician who interacts with the baby and family as well as an internist.

Unbeknown to many, dads develop postpartum depression at about half the rate of moms. With so many stresses on working parents today, and parents in new roles, families often need more support. Dads exhibiting postpartum depression may work longer hours, use alcohol, or even become abusive and leave the family.

It is time for the medical community to step forward and begin screening both parents. Ideally this can occur at the ob-gyn visits or the child's pediatric visits. These are often the only times there is an interaction with a health care provider, and that opportunity should be taken seriously. If needed, making a referral for parents may avoid long-lasting negative consequences.

State and health insurers should compensate providers for spending the time necessary to be effective screeners. While the return on this investment may take years to become obvious, it is well worth the expense.

Dr. Mark Friedman

Belmont

The writer is a retired pediatrician.