MONTREAL - A group of Canadian clinicians say they think the incidence of postpartum depression could be reduced by a simple remedy -- sleep.
A few years ago, Dr. Meir Steiner noticed that mothers who had previously battled the mood disorder were telling him they feared another bout due to the fatigue they were experiencing during their subsequent pregnancy.
The Ontario doctor already knew that fatigue is practically universal among women in the first days after giving birth. Since sleep is also known to play a role in mood disorders, he had a eureka moment.
"What these women were describing was jet lag. We called them the jet-lagged moms," said the founding director of the Women's Health Concerns Clinic in Hamilton, Ont.
They were exhausted even before labour because they were nervous, uncomfortable and rarely slept through the night.
"The whole system -- particularly the hormonal system -- is totally desynchronized," Steiner said. "(The mother) needs to resynchronize. Her rhythms are all off."
He thought it might help if he could reset her circadian clock.
"The idea is to try and prevent sleep deprivation, which seems to be the biggest enemy for those at risk," Steiner said.
With the help of his colleagues, Steiner launched an informal program that allowed women at high risk for postpartum depression -- those with personal or family history of depression or who showed symptoms during pregnancy -- to stay in the hospital for up to five days after giving birth.
They were given a private hospital room at no extra cost and the infant was kept in the nursery overnight. Women who choose to breastfeed were encouraged to pump milk or use formula for nighttime feedings or ask to be woken only when necessary to feed.
Steiner also encouraged new mothers to continue the restful regimen at home as much as possible.
"The feedback was overwhelming," Steiner said, adding while he knew it was working, he needed statistics to back up his theory.
In 2005, his team applied for a study grant from the Ontario Mental Health Foundation to begin gathering empirical evidence. The program has since been picked up by six other hospitals in Ontario.
Canadian statistics show 10 to 20 per cent of women experience postpartum depression.
The sense of malaise will generally hit within two weeks to six months after birth. Symptoms include excessive crying, feelings of guilt and inadequacy, anorexia, insomnia and social withdrawal.
Children of mothers with untreated postpartum depression are also more likely to suffer from behavioural problems and their emotional and social development is thought to be delayed.
Recent studies are lending credence to Steiner's theory that there's a link between sleep and postpartum depression.
Research published in the journal "Sleep" suggests the babies of women who suffered from depression during and after pregnancy also had disturbed sleep patterns.
Another study published in the "Journal of Obstetric, Gynecologic and Neonatal Nursing" links the quality of a mother's sleep to postpartum depression.
Still, critics have some concerns with Steiner's work. Among the most serious are fears the baby won't bond if the mother is absent during the night.
According to national guidelines set by Canada's public health service, mothers and infants are to be cared for as a unit and should not be separated unless absolutely necessary.
It's a concern Steiner brushes off.
"Nothing will happen," he said, adding mothers in his program have actually had better results when it came to breastfeeding.
Ariel Dalfen, a staff psychologist at Mount Sinai Hospital in Toronto which has participated in the study for several years, agrees.
"It's not like the woman's never with the baby," she said. "It's a few hours of crucial sleep."
Proponents of the program say cost is the bigger hurdle.
Dalfen admits she's being pushed by hospital administrators to cut or scale back the project because of the price tag.
"We're justifying it by the medical outcome," she said. "It's like a small investment in the mom's well-being."
Steiner argues it'll actually save money in the long run.
"It will probably cost the system more if we didn't do that and we have women who then need to be treated for postpartum depression," he said.
"What does it do to the baby when the mom is depressed for four to six months? You weigh the costs and benefits."
According to the Canadian Institute for Health Information, the average cost for a single day of inpatient care at a Canadian hospital is $951. Pregnancy and childbirth account for the highest volume of stays but represent just five per cent of the total cost for inpatient care.
