Examining beyond the ‘baby blues’
When I went to see Lauren, who came into the emergency room with several complaints, I noticed that she didn’t make good eye contact with me and had dark circles around her eyes. She also looked exhausted and sad.
I asked what brought her in and Lauren said she was having abdominal pain and was extremely fatigued. This had been going on for several weeks and she couldn’t take it any longer.
I went through my usual questions for females with abdominal pain, including asking about any pain or discomfort with urination and when she had her last menstrual period. She told she had been bleeding intermittently the past six weeks and didn’t have any nausea, vomiting or diarrhea but had been constipated at times.
Lauren said she was having trouble sleeping and felt fatigued all the time. She also was having trouble mustering up the energy to work around the house or do fun things with her family. She hadn’t traveled anywhere because of the pandemic and didn’t have any known exposure to COVID-19.
When I asked more about her vaginal bleeding, Lauren told me that she had a 2-month-old baby and had been intermittently bleeding since he was born. I thought it was a little strange that she didn’t mention her baby right off the bat, and when I asked more about the delivery and birth, she admitted that she just hadn’t felt well since his birth.
She told me that her pregnancy was uncomplicated. She had a straightforward delivery and a healthy baby boy. Lauren said she initially had some issues with breastfeeding, but it has been going well since meeting with a lactation specialist. She went home from the hospital two days after giving birth.
This was Lauren’s first baby and she said she felt overwhelmed. She had always wanted to be a mother and was thrilled about getting pregnant. She had lots of support from her husband and parents, who lived nearby. She was excited when she came home from the hospital but become increasingly anxious over the next several days. She found herself crying frequently, for no apparent reason. She was having trouble sleeping, even when her baby was sleeping. She also found herself snacking and eating junk food even when she wasn’t hungry.
Lauren was ashamed about having these feelings. She tried to pull herself together but things got worse when her husband went back to work and she was left at home with the baby by herself during the day. She couldn’t believe she was feeling this way when his was supposed to be an amazing time in her life.
Many new moms experience the “baby blues” after childbirth, which can include anxiety, crying spells, difficulty sleeping, appetite problems and changes in mood. The baby blues typically appear within a few days of delivery and can last up to a few weeks. Some moms, however, experience a more severe and longer lasting form of depression called postpartum depression.
Symptoms of postpartum depression can include difficulty bonding with the baby, inability to sleep or sleeping too much, withdrawing from family and friends, reduced interest and pleasure in activities that used to bring enjoy, loss of appetite or eating too much and fear of not being a good mother. It can interfere with the mother’s ability to care for her baby and her ability to function. In severe cases, the mother may have thoughts of harming herself or her baby.
After examining Lauren’s abdomen, I ordered blood and urine tests. I reassured her that we would make sure there weren’t any serious problems go
ing on with her abdomen. I then asked our emergency room social worker to talk with Lauren as I was concerned that her symptoms were due to postpartum depression.
About an hour later, I saw that Lauren’s tests had all come back normal. I spoke with the social worker who was also very concerned about Lauren’s depressive symptoms. While she wasn’t having any thoughts of harming herself or her baby, she was not sleeping well and had stopped doing the things she liked to do.
The social worker arranged for Lauren to meet with a psychiatrist a few days later to consider starting antidepressant medications. She also set up Lauren with a counselor for psychotherapy.
I went back in to talk with Lauren and she seemed more hopeful than when I had first met her. We discussed the importance of eating regular, healthy meals and ensuring that she got enough rest. She was also planning to start exercising again and felt hopeful about seeing a therapist and psychiatrist. She assured me that she would return immediately if she had any thoughts of harming herself or anyone else.
I smiled at Lauren through my facemask as I left the room and reminded her to be kind to herself and remain hopeful as things would get better.
Dr. Erika Kube is an emergency physician who works for Mid-ohio Emergency Services and Ohiohealth.
drerikakubemd@gmail.com