Fetal Surgery May Put Mom At Risk For Postpartum Depression

A recent article describing a pregnant woman’s decision to proceed with surgery to improve the odds of her unborn son prompted this week’s blog post. Because it’s a topic not usually associated with postpartum depression (PPD), I thought it worthy of exploring it further.

In this case, eight weeks prior to delivery, doctors partially removed the unborn boy from the mother’s womb so surgeons could extract a tumor the size of an orange from his left lung. Instead of bringing joy, the occasion of the child’s premature birth — and knowing that he had indeed made it through the surgery and delivery — left the mom depressed and overwhelmed. “I definitely had postpartum depression,” she is quoted as saying. “It was very hard. I was at the lowest point in my life after he was born.”

According to the article, “experts refer to the mother in this experience as the ‘innocent bystander’ because she is subjected to a hip-to-hip wound of her abdomen from two surgeries (the fetal surgery and cesarean delivery), a lifetime of scarring, months of bed rest and lost work — and an expectation that she cope with it all.”

Dr. Julie Moldenhauer, the medical director of the special delivery unit at the Children’s Hospital of Philadelphia, said, “It’s a very fine weighing of the balances between maternal risk and fetal risk, because clearly for the fetus this is a life-or-death situation. And for mom this is a very large commitment.”

Moldenhauer, who is doing research on the incidence of PPD with mothers who carry babies with birth defects, says, “We found that moms with these difficult pregnancies are at higher risk for developing postpartum depression, high anxiety and post traumatic stress disorder. Thankfully, the case study has a happy ending because today, the 2-year-old boy is healthy — and alive.

I think it important to note that many women are at risk for PPD due to hormone sensitivity, relationship issues, and biological vulnerability to depression or anxiety. So, couple that with facing the trauma of fetal surgery and the uncertainty of the outcome. It’s a life and death decision, but there are also the far-reaching implications, such as the developmental struggles of the baby that survives, and how this will impact the mom’s life.

In addition, it can be overwhelming to have a special needs baby to take care of at home, without the assistance of nurses. Other factors, such as the lack of time for self-care and the needs of siblings, exacerbate the mother’s stress.

It seems there a critical piece being overlooked in these fetal surgery situations. Imagine if the specialized physician team that is coordinating fetal surgery also recommending to the mom and couple that they consider the benefits of psychotherapy for support, tools for coping, and interventions for anxiety.
This would also allow the therapist to evaluate the mother for predisposition to postpartum depression and put a timely treatment plan in place.

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~ by ppdsus on January 3, 2015.

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