Category Archives: public awareness

Sharing the Journey with Tonya Rosenberg

I’ve been waiting on pins and needles to share this interview! Tonya is the founder of the Online PPD Support Page and has built quite the support system over there. The typical population these days is in the low single digit thousands but that’s vastly more than the 50 women Tonya initially imagined gaining support from the dying site she took over quite some time ago. Now, there’s an amazing team of moderators (hey ladies!) who work very smoothly together to help keep the flow going without deterring the recovery of the women who visit the board. While I haven’t been active there for some time now, I am on the moderator team and am honored to be part of the group.

I am also honored to share Tonya’s interview with you – it’s worth it’s weight in gold, every single word is so intense, transparent, and informative. I read her interview on a rough morning with the kids and boy did it put things into perspective for me. I am always amazed at how that happens!

Enjoy the read and if you or someone you love are in need of some support and there’s nothing nearby or you just need to type some thoughts to get them off your chest, pop on over to the forums at the Online PPD Support Page. It’s like having your own best friend on-line! (Plus, don’t forget that recent study about peer support cutting the PPD risk in HALF – that’s right, HALF!)

Thanks, Tonya, for saving this invaluable resource from an early Internet grave. It’s meant so much to so many families and I know it will continue to do so for years to come. You my friend, ROCK.

Tell us a little about yourself – just who is Tonya as a woman?

Sometimes that’s a very difficult question to answer! I’m a woman who enjoys being 38 years old, as I’ve found some things have gotten better with age. I’m a wife, a mother, a friend, a sister, a daughter, and an individual. I have days in which I feel proud of things I’ve done, and other days when I feel I’ve not done enough – just like everyone probably feels from time to time.

Just like me, you are a two time survivor of Postpartum Mood Disorders. Share with us what your first path down this road looked (and felt) like.

It’s hard to believe that my first child is now 14 years old, and the journey I started on began so long ago!

I was, in hindsight, ripe for developing a postpartum mood disorder. I was a young woman who’d rushed into a marriage with an older man, who himself had a diagnosis of bipolar disorder at the time. My pregnancy was incredibly difficult – I dealt with hyperemesis (and the accompanying weight loss of 40 pounds in the first trimester alone, the multiple ER visits and hospital stays, the visits from home health care providers). I developed gestational diabetes.

During my pregnancy my husband at the time injured himself and was out of work, bringing our usual paycheck-to-paycheck life down to approximately half that income for a couple of months. We racked up a good deal of credit card debt during that time, compounded by the extra medical expenses incurred by my pregnancy and his injury. Near the end of my pregnancy, my paternal grandfather died from prostate cancer.

I was induced, because on top of everything else I started having some blood pressure problems. The birth itself probably wasn’t much different from many birth experiences – I had an epidural and an uneventful vaginal birth.

I remember being alone in the hospital room the first time, exhausted, and thinking that everyone was focused on the new baby – but I felt like the discarded packaging the baby came in. I felt oddly incomplete without the baby still in my now squishy belly, yet also strangely free at the same time.

Breastfeeding didn’t come naturally for me, and neither did motherhood in general. I felt overwhelmed, wrung out, guilty for not feeling the constant glowing love I “should” feel, and irritable. I was grateful when my (wonderful, amazing, fantastic) mother came over to take the baby for a bit so I could rest, yet it also compounded my feeling of being a horrible mother because I seemed to make the baby cry while my mom could calm and sooth and quiet her.

At just a few days old, I was hyper-vigilant about my baby. If she cried, I held her. If she was quiet, I was convinced she’d stopped breathing and would panic. One night in that first week I was sure she was breathing funny, and we wound up at the ER. I still remember the ER doctor laughing at me and chastising me by saying “ALL babies breathe funny.” But then he gave her a closer look and said he’d be back. I found out they were going to take her blood, and I was in charge of holding her steady while they poked her little foot and made her scream. I vividly remember crying along with her, apologizing for letting anyone hurt her. Results came back declaring she’d developed jaundice, and they wanted to keep her in the hospital. (I should mention the hospital I gave birth in was fantastic, but this hospital was the one closest to my house at the time and one I’d never go to again if I had any choice whatsoever!) They wanted to put her in the nursery and send me home, and I remember going into a total angry panic. I insisted they find a room with a bed, because I would not leave her alone in the hospital.

Being in the hospital with her was painful for me on so many levels. I was made to feel that my breast-milk actually caused the jaundice, and was instructed I would have to “pump and dump”, and that she’d be on a bottle of formula until she was well. I couldn’t hold her because she had to spend so much time in the clear plastic bassinet under the Bili-light. When it came time to feed her those bottles, I’d wind up in tears and hand her to a nurse to feed. Holding her with a bottle just made me feel like even MORE of a failure as a mother.

I struggled through, getting her back on breast-milk exclusively a few weeks after her hospitalization. I’m glad of that, because I truly believe (for me) breastfeeding saved my life. I had become more and more miserable to the point of being suicidal. The only things that stayed my hand in those low moments was the realization that she could only be fed by me (she never took a bottle or pacifier), and I couldn’t leave her behind to starve.

One day I got scared enough to call my doctor. She’d been crying and crying for hours, and I was about to lose my mind. I took her into her room and put her (probably not as gently as I could have) into the crib. I walked out, closed the door, and leaned against the wall just outside her door as she screamed. I closed my eyes, and the best way I can describe it is that I saw a movie play out in my mind. In my mind I could vividly see me walking back into her room, grabbing her tiny ankles, and slamming her head against the pristine white walls of her room. The graphic images of her in my hands, of red coating the walls, terrified me. I knew in that moment I couldn’t go another second alone – I was terrified of hurting her and would have very possibly hurt myself if I hadn’t picked up the phone instead.

I called my doctor, who got on the line immediately. I asked her if she could help me, and told her I was terrified of my thoughts. She soothed me and told me she had faith that I wouldn’t hurt my baby, that by knowing those thoughts were WRONG and was reaching out for help, that I wasn’t going to do anything bad. She told me to call my mom over, put the baby in the car-seat, and have my mom drive me to the office. The doctor said she’d make time for me whenever I got there.

Just saying out loud all the things I’d been feeling and thinking and fearing to my supportive and wonderful doctor helped to ease the weight I’d been feeling crushed under. With her help I began a treatment that involved an antidepressant and talk therapy.

It was a turning point in my life as a mother, and as a person.

Did you feel any more prepared the second time around? My second pregnancy was planned but my third was not. I was also still depressed during the second pregnancy which is what I ultimately felt led to my break a month after my daughter came home from the NICU. Was there a difference for you between your two experiences?

There were a lot of differences between my first and second postpartum experience. With my second child I still had challenges, of course. I had a new husband, a five year old daughter to care for, and I had moved across the country (and away from the loving support of my family and my doctor). On the other hand, finances weren’t a constant worry, my second husband is mentally much more healthy, and I only lost 14 pounds in the first trimester.

I knew that breast-milk does not cause jaundice, so I was ready to fight for the right to keep nursing if he developed it. I had educated myself quite a bit about postpartum mood disorders and knew I was at a higher risk, so I talked about that a lot with my new OBGYN. I also knew I was at risk for gestational diabetes again, so I worked harder to care for my health in that regard. (I still developed it, but I think it wasn’t as severe and that I managed it better.)

My second child was a very different baby than my first, too. He was quick to catch on with breastfeeding, he slept easily, and was just a more relaxed and happy baby. (I’ve since learned that my firstborn inherited bipolar disorder and a few other issues from my ex-husband, which actually goes a long way in explaining some of her behaviors even in infancy.) And my new husband was excited to be a new father, and did what he could to ease my burdens which made a huge difference as well.

I still wound up having postpartum depression, some anxiety, and intrusive thoughts, but I’d also opted to start back on antidepressants during the last bit of my pregnancy. I think, for me, it helped act as a bit of a cushion to soften the transitions my hormones went through.

As with any stresses that come towards us in life, one can choose to run or stand and fight. We’re both fighters dedicated to reaching behind us to help other struggling moms finding themselves where we used to be. At what point did you decide to become an advocate and get involved in supporting other moms?

It was rather by accident, truth be told! With my second pregnancy, I was away from all things familiar. So I turned to the Internet to search for resources for postpartum mood disorders. While there were a handful of sites that offered a bit of general information, there wasn’t much “out there” in terms of person-to-person support. I stumbled onto a website that had a very small email group, in which the babies were older and the mothers had left the PPMD world behind. The person who ran the place informed me within a few weeks of finding her that she was going to close the doors, so to speak.

I begged her to let it stay up, and asked if I could take up the reins. That was the beginning of my role as an advocate and supporter. None of the old site I took over remains today, but it was an important starting point and one I’m very grateful to have found when I found it.

I’d already been active on other on-line communities – even met my current husband on-line in a community for a couple of our favorite television shows at the time – and had seen how valuable and wonderful it could be to have this worldwide community of people from all sorts of backgrounds and experiences. It seemed a natural thing to take that concept and apply it to the postpartum site.

I started updating information, rebuilding the site bit by bit, adding things here and there, deleting outdated or irrelevant things, and playing with my image program to figure out how I wanted the site to look. I went through a few different designs before I struck on the current theme, but pink always seemed to factor into the mix. What can I say, it’s one of my favorite colors!

In essence, I went looking for people to support me. Somehow it became helpful for me to extend MY help to OTHERS – my support of fellow struggling moms seemed to put my own struggles in perspective, gave me a chance to focus outside of myself, enabled me to gain more education on the subject, and let me redefine who I was and who I wanted to become.

What are some of the things you do to take care of YOU?

I go to therapy at least once a week – except my therapy is called live comedy! Laughter is really good medicine, and I find that I get rather antsy if I miss a week or two of going out to see comedy. It’s also important for me, as a stay-at-home-mom, to get out around other adults. Going to comedy helps in that regard, too.
Reading is something I enjoy, so I often keep my eyes open for books to devour.

It’s been a struggle, but I try to make myself a priority. If I need sleep, I go to bed. If I feel restless, I take the dog for a walk or to the dog park. If I am hurting, I’ll allow myself to spend some time and money for a massage.

The hardest thing – the thing I still struggle with the most – is being gentle with myself. I have had to work on retraining my brain to stop the negative self-talk, to forgive myself if I mess up, and so on. I’m a work in progress. :)

Name three things that made you smile or laugh today.

Watching Nickelodeon with my kids made me laugh.

My dog Blackberry made me smile when she gave me lots of doggie kisses.

The crew of one of my favorite local radio shows were hilarious today.

As you navigate motherhood, what do you find the most challenging? The least?

The things I view as challenging can change from day to day! Some days I feel challenged by things like my kids purposely annoying each other, but then I’ll catch them being sweet and thoughtful. Sometimes my teenager presses my buttons by saying everything AS IF SHE IS YELLING AND ANGRY, but then she’ll say something really funny or profound. Sometimes my son will drive me up the wall because he seems incapable of being quiet for five minutes straight, but when he’s not feeling well he becomes quiet and just wants to curl up at my side.

I guess the biggest challenge I face as a mother is myself, to be honest. I challenge myself when I play the “shoulda, coulda, woulda” game, when I second guess myself, when I take ultimately unimportant things far too seriously. Alternately, I feel least challenged when I am able to adopt an attitude of letting go and having faith that things will be okay even if I’m not micromanaging every second of every day.

How did your husband handle your experiences with Postpartum? What effect did your struggle have on your marriage (if any?)

My first husband had his own issues with mental health, and did not handle things well. He did the best he could, I believe, but his own illness really limited how much he could handle. There were things that happened during and after the pregnancy that I think were harmful to the marriage, things for which I don’t think I ever really forgave. I needed support, and ultimately felt that I had an infant and an adult child to care for instead.

My second husband was a champ overall, but I definitely think it was difficult for him. I think even almost a decade later, there’s a part of him that probably hangs on to some of the things I did and said during the darker moments. I know from my viewpoint it gave me some perspective on the differences of a supportive, helpful partner versus a partner who doesn’t know how to be supportive or helpful – it’s made me appreciate him more, perhaps, that I would have without the postpartum issues.

Tell us a bit about the Online Postpartum Support Page. Has it exceeded even your wildest dreams in terms of sheer number of women who have found support there?

When I started out, I figured I’d consider myself lucky if over an extended period of time there were 50 or so moms who’d used the site and the on-line communication tools. I just wanted to talk to a few other moms who understood what I was going through, and to let them know they weren’t alone in their struggles. I never foresaw the website growing to the extent that it has over the years, and still often feel a little in awe of it. I often feel guilty about the site because I’m not very involved in it and haven’t been for a while, yet I’m also incredibly proud of the fact that I got this ball rolling and incredibly grateful for the women over the years who’ve recovered and decided to “pay it forward” by helping moms.

And last but not least, what advice would you give to an expectant mother (new or experienced) about Postpartum Mood Disorders?

I’d like all new and expectant mothers to be educated on all the facets of postpartum mood disorders (and all doctors, for that matter!) – awareness of potential vulnerabilities, the various ways a PPMD can express itself, knowledge that having a PPMD does NOT mean you are a bad mother, and so on.
I’d like these women to know that media lies to us! Babies don’t come out with perfectly shaped heads and evenly toned skin. Mothers don’t always instantly have a magical moment as soon as the baby is born where they are madly, deeply in love. Birth plans don’t always go as planned, and that’s okay.
I’d like moms to know, ultimately, that no matter what thought they have or what feeling they experience (positive and negative), they are not alone. There’s been another mother, many other mothers, who’ve thought or felt the same thing. There’s a certain power in the knowledge that you are not alone, I think.

Prenatal Depression restricts fetal growth

In a new study published today at ScienceDirect, researchers concluded that Prenatal Depression restricts fetal growth. They also state that up to 18% of all pregnant women experience depression but when focusing specifically on lower socio-economic status and minority moms, the risk more than doubles to 40%. Babies born to depressed moms are more likely to have a smaller head circumference, low birthweight, arrive prematurely, and experience a certain level of growth retardation within their first year of life.

Many mothers, doctors, and family members will buy into the myth that all pregnant mothers are happy. Obviously the numbers beg to differ as do the mothers who experience depression during pregnancy. Moreso than mothers with Postnatal Mood Disorders, pregnant mothers struggling with depression or other mental illness face quite the quandary in seeking treatment. Many find themselves dismissed by their doctors or faced with taking anti-depressants which will affect their fetus as all medications do cross the placenta.

As with any decision, we must always remember to make an educated decision with the support of your physician and other professional advice. There are also risks v. benefits to consider. Yes, there are risks associated with taking medicine during pregnancy but most studies out there do not put this risk at a much higher rate than mothers who do not take anti-depressants.

There are resources for mothers and professionals alike to refer to when faced with this situation:

Mother Risk: A project of the Toronto Hospital for Sick Children, they are staffed and well informed regarding medications, herbs, etc, in pregnancy and the postpartum breastfeeding period.

University of Illinois @ Chicago Women’s Mental Health Program is designed to meet the unique needs of women with psychiatric disorders and life problems including during pregnancy and postpartum.

The Emory Women’s Mental Health Program, established in 1991, primarily focuses on the evaluation and treatment of emotional disorders during pregnancy and the postpartum period. The clinical program is complemented by both clinical and laboratory research into the causes of these conditions and their treatment.

I also want to take this opportunity to promote an upcoming teleclass over at Pampered Pregger and Beyond with Tiffani Lawton and Shoshana Bennett. The class starts tomorrow at 11am EST and will be taking an in depth look at her new book, Pregnant on Prozac. I would highly recommend participating if this topic is near and dear to your heart. Registration at the site is not required but the call is a long distance one. Callers will be muted during discussion and unmuted for Q&A so if you have little ones running around, don’t worry – they won’t be interrupting the flow. For more information, click here.

The Misnomer of Postpartum Depression

Not terribly long ago, Katherine Stone wrote a beautiful diatribe directed at the media regarding the misuse of the term Postpartum Depression.

Just like Katherine, I too have Google Alerts set to scour the web for anything Postpartum or Perinatal related and blessedly I get about 10-15 emails every day. (I LOVE Google!) I must admit that I found myself highly irritated when people misuse the term Postpartum Depression. One particular post used the term Postpartum Depression to describe how the author felt after seeing his car driven into a car wash. Really? REALLY? Then there’s the CNN story Katherine mentions in her post, What do you do about post-election blues? What DO you do when a reputable agency such as CNN misuses the term? Are you glad the term is on their radar at least? Or do you get frustrated about the application and trivial way in which our experience with hell has now been marginalized? Or do you settle on somewhere in between? I had done the latter until yesterday.

What happened to change my mind?

I received an email as a result of my Community Leader position for the Postpartum Depression board over at iVillage. Hidden away in my Spam folder, it went unnoticed for a couple days but finally got read last night.

The email started out innocently enough and asked for casual conversation off-board, something I do quite often for the ladies there because I am all too familar with the stigma and the possibility that there may be some things they don’t want to lay out in public. The sender went on to describe a pretty difficult situation and as I read I kept waiting for the baby to pop into the equation. When I got to the end of the email, there was no baby and now I was expected to share some advice. I re-read the email a few times to make sure I hadn’t missed anything and became confused as to why I had been chosen as a recipient.

I emailed her back with instruction to speak with her mental health caregivers and some general advice. I apologized that I didn’t quite understand why she had emailed me in the first place.

This morning I had a response.

The response made me drop my jaw in awe.

The sender legitimately thought Postpartum Depression was the term for what one feels after experiencing any big event. To steal a line from Hannah Montana, “Mama Say What?”

How could I be upset with her about this? I emailed her back with a brief description of Post-Traumatic vs. Postpartum Depression and promptly came here to blog about the experience.

Let me make this CLEAR.

  • Something traumatic happens to you that DOES NOT INVOLVE BIRTH and you have issues afterwards. This is Post-Traumatic.
  • YOU GIVE BIRTH and feel sad, anxious, panicked, etc, at any time during the first year after giving birth and that is POSTPARTUM DEPRESSION.
  • Your car is driven into a car wash and you feel a tug at your heart. This is just SAD or wistful. It is NOT depressed – not plain depressed, not depressed with a dose of postpartum on top, not depressed with other co-existing conditions. It is just SAD.
  • The campaign is over and you don’t know what to do because you have to unplug from CNN. Time to find a new hobby, not time to claim you have Postpartum Depression.

Media, general public, bloggers, medical professionals, nurses, and whomever else I have missed, please take note of this. Don’t marginalize the hell those of us who have suffered from Postpartum Depression have been through and have miraculously managed to claw our way into the light. My hands are still dirty from that journey and I don’t think they’ll ever get really clean. And no, I’m not ashamed of my “dirt.” I just don’t want anyone else playing with it.

(Addendum here – I’ve started a feature called PPD Misnomer Sightings. The link is over to your right under the Pages section. If you come across any misuse of the term, please email it to me to have it posted there. I’ve already had one sighting today. Infuriating, isn’t it?)

Blogs as Peer Support for PPD

With the recent release of the study regarding how helpful peer support is for women with Postpartum Depression, I thought it would be interesting to take a look at blogging as a form of peer support. The source of inspiration for this piece? An article by Kristin Schorsch over at the South Town Star about blogging and PPD in which yours truly is featured along with Natalie Dombrowski.

Many of the women I know who have blogs and have recovered from Postpartum Depression have found their blogging habit to be a powerful source of support. Those who read them undoubtedly feel the same way, finding strength and hope in the words that part ways with those of us who have been through the very dark in which they now find themselves enrobed.

For me, there was relief in knowing I had my blog to lean on and that through my blog I was potentially helping other families survive the very same thing I struggled against. I credit my blogging as a tremendous part of not experiencing PPD the third time around. After all, I had numerous risk factors according to several different studies and statistics.

My first risk factor lied within being a two time survivor. A third episode lies in a nearly 100% risk range. Studies have also shown that women who give birth to boys are more likely to experience Postpartum Depression than mothers who give birth to girls. My third child? A boy. I also had extenuating stressors – a marriage that was dashed onto the rocks at just 3 months postpartum after giving birth to Cameron and financial stressors to boot. Last but not least, women who experience severe pelvic pain during pregnancy are also more likely to suffer from Postpartum Depression. And guess what? I had severe pelvic pain with all three but it was the worst with Cameron. Relying solely on numbers, I should have suffered from Postpartum Depression with Cameron. Yet I didn’t.

Why?

I had peer support, social support, medication, education, blogging, meetings, advocacy, and preparation on my side.

But hey, I had all that too you say. And I still ended up suffering. Unfortunately this is where it gets tricky. What works for one woman in one situation may not work for another woman in her situation.

Why? We don’t necessarily know. What we do know is that communication with other women and TRAINED medical professionals is key to recovery. This is where I get on my soapbox.

The MOTHER’S Act would allow for research funding so we might be able to find these things out. It would also allow funding for additional social and community support programs to be implemented across the country so that no family would have to suffer silently. It would allow for women to speak up without fear about their intrusive thoughts, to admit they are not happy at a time when they feel they should be. It would educate caregivers so no more women would have to be fear being dismissed when they do speak up, as I was. It would decrease potentially lethal cases of untreated Postpartum Depression and catch episodes of Postpartum Psychosis before they reached the breaking point.

The MOTHER’S Act would finally allow for the recognition of Postpartum Mood Disorders as a true illness, allowing for the flow of ideas and treatment options between patients and clinicians to open up. It would allow us to finally create treatment networks between Pediatricians, OB’s, Therapist, Psychologists, and Psychiatrists, keeping women from slipping through the cracks and confused about which medical professional to talk with regarding their emotions.

The passage of the MOTHER’S Act would allow those of us who have survived and those of us who are still struggling to finally begin to live over the rainbow, where we deserve to live. Where there is finally acceptance, happiness, and true hope instead of disapproval, sadness, and despair that permeates the lives of so many women and families fighting to rid themselves of the beast of Postpartum Depression.

Off the soapbox now.

I blog to provide the land over the rainbow for myself and for others. We’ve fought hard enough against the rain on our own. Nothing more, nothing less. Providing hope to those who struggle behind me, those deserving of a helping hand as they claw furiously against the muddy wall of the hole they now find themselves lost inside.

We all deserve the rainbow.

Postpartum depression: Studies show peer support, trained nurses can help

This is AWESOME news! (Although I could have told you this long ago – tis nice to have an official study to refer to now!)

TORONTO – Postpartum depression affects about 13 per cent of women in the first year after childbirth, but two new studies – one in Canada, one in the United Kingdom – have found that early identification and intervention can help new mothers who are at risk.

The result was fewer depressive symptoms in the months that followed childbirth, according to results published Friday in BMJ Online.

The Canadian study was led by Cindy-Lee Dennis, an associate professor at the University of Toronto, who had previously found that mothers receiving peer support over the telephone were significantly more likely to continue to breastfeed.

“Women just loved this telephone-based support, and I thought, well, what other conditions might this type of support be beneficial for? And so I then related this model to postpartum depression.”

The study involved 701 women in the first two weeks after giving birth who were identified as being at high risk for postnatal depression, scoring greater than nine using a measure known as the Edinburgh postnatal depression scale.

Volunteers to provide them with peer support over the telephone were recruited by putting up flyers in places like community centres and daycare centres and by putting ads in local newspapers in seven Ontario health regions.

To be a peer volunteer, women had to have experienced postpartum depression and recovered. They also took a four-hour training session, for which Dennis developed a training manual.

“What I had the peer volunteers do was let the mother lead the discussion and the conversation and I had the peer volunteers provide useful suggestions,” said Dennis, who holds a Canada research chair in perinatal community health.

The volunteers provided emotional support, validated the new mother’s experience, told the mother about strategies to make her feel better, or where she could seek help if needed.

“We found that mothers who received this telephone-based peer support were at half the risk of developing postpartum depression,” Dennis said.

Postnatal depression was defined as a score of greater than 12 on the Edinburgh postnatal depression scale. At 12 weeks, 14 per cent of women in the intervention group had postnatal depression, compared to 25 per cent in the control group that didn’t have a volunteer telephone partner.

In the other study, Jane Morrell, a health services researcher at the University of Huddersfield, trained “health visitors” – community nurses – to assess a mother’s mood and identify depressive symptoms at six to eight weeks postnatally using the Edinburgh scale. They were also taught specialized skills so they could offer “talking therapy.”

More than 4,000 new mothers took part in the trial, and those who had visits from the specially trained health visitors saw them for an hour a week for eight weeks.

“Irrespective of the kind of therapies or interventions that were offered to the women, the health visitors’ skills in the intervention group were associated with greater improvement in the intervention group than in the control group at six months postnatally,” Morrell said in an interview.

“This improvement was maintained at 12 months postnatally.”

Morrell said that in general, people don’t know enough about postnatal depression.

“Women and their partners need to be better educated about this, ideally during pregnancy,” she said.

“The moms need to be not afraid to ask for help when they’re suffering with symptoms postnatally. And there needs to be much more thorough training for health-care professionals.”

Dennis, meanwhile, said that several health regions that took part in the study plan to maintain their volunteers to continue the postnatal peer support work.

And Dennis is completing work on an economic evaluation of the trial so that health regions will know more about the costs of developing such a program and screening mothers for postpartum depression.

(source: http://www.canadaeast.com/wellness/article/542159)