Friday, June 22, 2001

Anxiety normal
after birth,
therapist says

Severe depression occurs in
20 percent of new mothers

Attorney named in Texas case

By Helen Altonn

A spectrum of reactions may occur after a woman gives birth, from "baby blues" to anxiety, more severe depression or even psychosis, says a clinical psychologist at the Kapiolani Medical Center for Women and Children.

About 50 percent to 80 percent of new mothers may experience blues because so much is involved after having a baby, said Trudy Guo, who works with many women referred to the Kapiolani Counseling Center with such problems.

The blues -- described as "normal crazy" by the Postpartum Survival Guide -- are common and disappear within a few days or weeks.

Depression, with severe and prolonged symptoms, occurs in 20 percent of new mothers, Guo said.

The Houston case of a woman who allegedly drowned her five children has stirred nationwide interest in postpartum depression.

It isn't known if the woman was psychotic, a rare post-birth reaction occurring in one in 1,000 new mothers, Guo said.

Postpartum psychosis can involve "life-threatening confusion, hallucinations or delusions that might impede normal functioning," according to the Postpartum Survival Guide.

"They believe that what they are experiencing is real rather than illusory; as such, they can pose a great danger to themselves and their baby. Women with these symptoms need immediate medical attention," the guide said.

The 36-year-old Houston woman, charged with multiple counts of capital murder, had been on medication for depression since the birth of their fourth child two years ago, her husband, a NASA computer specialist, told police.

She also attempted suicide two years ago, Houston social services officials said.

The suicide of a Chicago woman suffering from postpartum psychosis was reported there last week. The 41-year-old woman was undergoing electric shock treatments to prevent hallucinations that told her to kill herself or her 3-month-old daughter when she jumped from a hotel window.

Guo said women often suffer from anxiety along with depression after giving birth "just because of all the stress and changes." Some anxiety is normal, and some women even have panic attacks she said.

Many times they "think they're failing or doubt themselves, their ability to be a wife and mother, all the roles they have to adjust to. ... This is not something you have a manual for," she pointed out.

A depressed mother may exhibit a number of symptoms, Guo said, including a lot of crying spells, problems sleeping, fatigue, irritability and appetite changes. Women with persistent and severe symptoms should seek professional help, she said, "especially if there are any thoughts of suicide or hurting the baby."

A new mother may have such thoughts but acting on them isn't common, Guo said, urging any mother in distress and afraid to seek help and talk to somebody.

New mothers also should take care of themselves, eating well and making sure they're "getting as much rest as they can, with breaks from all the stuff they have to do taking care of the baby," she said.

They should accept offers of help from people to give them a break, she said.

She also advises keeping expectations realistic. "Certain things have to go on the back burner," she said. "You don't have to feel you have to maintain everything at the standards you're used to while going through this transition."

Guo, expecting her first baby in three weeks, added, "I'm wondering which of these symptoms I may end up having."

Since some anxiety is normal, she said, "I may have to apply what I preach."

She said new mothers who have concerns or want help may call the Kapiolani Counseling Center at 983-8368.

Q&A: Postpartum depression

What is postpartum depression?

While "blues" is a mild depression that is common to many women after the birth of a baby, post-partum depression is a more severe, incapacitating depression that requires active intervention and support by family members and a physician.

What are the symptoms?

Persistent sad, anxious or "empty" mood; loss of interest or pleasure in life; loss of appetite; loss of motivation to do things; restlessness, irritability or excessive crying; feelings of guilt, worthlessness, helplessness; sleeping too much or too little; thoughts of death or suicide.

Who gets it?

It is more likely if you have had previous postpartum depression or depression not related to pregnancy, severe premenstrual syndrome, a difficult marriage, few family members or friends to talk to or depend on, stressful life events during the pregnancy or after the childbirth.

Why do women get it?

The exact cause isn't known. The hormonal and physical changes after the birth of a baby, and the added responsibility of a new life, can be factors that lead to it in some women.

What is the treatment?

The most common treatments are antidepressant medication, psychotherapy or a combination of both, depending on the severity of the depression.

Sources: Mayo Clinic; U.S. Department of Health and Human Services; American Academy of Family Physicians; National Institute of Mental Health

Andrea Yates, pregnant with daughter Mary, sat for this November
2000 portrait with husband Russell and their sons, from left, John,
Luke, Paul and Noah. Yates is charged with drowning her five
children in the family bathtub.

Court appoints attorney
for mother accused of
drowning children

By Pam Easton
Associated Press Writer

HOUSTON (AP) - Without uncrossing her folded arms, a mother accused of drowning her five children told a judge Friday she was indigent and needed a court-appointed attorney.

During a brief hearing, the judge said she would arrange for an attorney for Andrea Yates, 36, whose children died Wednesday. Bob Scott, who was assigned to the case, did not immediately return telephone messages.

The hearing was held in a makeshift courtroom after floods devastated downtown Houston earlier this month. A speaker in the small, glass room where reporters watched the proceedings picked up only the judge's voice.

"She took the lives of her five children by drowning them," prosecutor Kaylynn Williford explained after the hearing. "I did not go into any specifics, because I do not have any evidence. ... I am still waiting on everything from the officers."

According to an account in Friday's Houston Chronicle, an officer who heard an audiotaped interview with Yates said she gave this account of the events on Wednesday:

She drowned her sons, ages 2, 3 and 5, and placed each boy on the bed in a back bedroom. She then began drowning her 6-month-old daughter, Mary. After her 7-year-old son walked in and asked "What's wrong with Mary?" she chased him through the house and dragged him back to the bathroom, where she drowned him next to the infant.

Police spokesman Robert Hurst confirmed the interview, but would not comment on the content.

Yates is charged with capital murder in the deaths of Noah, 7, and John, 5. Harris County Assistant District Attorney Joe Owmby said other charges may follow.

"It's not an everyday occurrence anywhere. It's not an everyday occurrence in the world. I've been here 15 years. I've not seen the cases others have seen, but this is the most horrendous thing that I've ever seen," Owmby said.

Yates' husband, Russell, said she was taking medication for postpartum depression and the death of her father this year also was a blow.

"I think that she obviously wasn't herself and that will come out," he said. "Everyone who knows her knew she loved the kids."

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