Yates case though tragic - still helping shine light on PPD

Juliana Heyward felt good after the birth of her first child two years ago. She had decided to put medical school on hold to be a stay-at-home mom, and she was excited about what awaited her.

Heyward and her husband, Tom, adjusted happily to the late-night feedings and diaper changes for their son, Noah. But soon Heyward found that she had trouble sleeping, lacked an appetite and had nagging doubts about her parenting skills. Frightening thoughts slipped into her mind.

"We have a spiral staircase, and I would be nervous walking down because I would have images of dropping him over and over again," said Heyward, 27. "I realized something was not normal. I knew I loved my son and I was happy to have a baby."

She called her father, a physician, who recognized the classic symptoms of postpartum depression and urged his daughter to get to a hospital. She was quickly diagnosed and prescribed medication, and a month later she was symptom-free, she said.
Another mother, Andrea Yates, struggled with similar symptoms a decade ago. But her battle with the illness ended in a tragedy that shocked the nation and put a spotlight on postpartum depression.

Ten years ago today, Yates drowned her five children, ages 6 months to 7 years, one by one in the bathtub of the family's Clear Lake home. The 36-year-old mother suffered from postpartum psychosis, the most severe but rarest form of postpartum depression.

In 2001 most people, including many doctors, didn't know about the condition and many women who had it suffered in silence, experts said. The past decade, however, has brought education and greater awareness, lessening the stigma and making it easier for women to seek help.

Screening tools have been developed to identify and assist mothers in getting further evaluation and medical care. Research on the causes and treatment of postpartum depression has advanced.

Lawmakers in a dozen states, including Texas, have passed legislation mandating screening or the distribution of information to mothers.
Last year, the Mother's Act became law as part of the federal health care reform legislation, signaling the government's commitment to fight the debilitating condition. The Department of Health and Human Services is coordinating efforts in research, education and support service programs.

"The act mandates that as a nation we start paying attention to postpartum depression and psychiatric illness, and that's groundbreaking," said Dr. Lucy Puryear, a Houston psychiatrist and president of Postpartum Support International, an advocacy group. "A lot of things have changed in 10 years."

Yet more work needs to be done, experts said. Mental health providers are scarce and many women lack access to speciality care.

Postpartum depression is common, with 1 out of 8 mothers developing it after delivery. Women generally experience sadness, difficulty sleeping, guilt and crying. They may also be afraid they or something else might harm their child.
One out of 1,000 women experiences postpartum psychosis. Mothers may feel confused, hear voices, see things and have thoughts of harming themselves or their baby.
The upside is that treatment with therapy and medication is effective. Therapist Sherry Duson, who runs a postpartum depression support group at Texas Children's Hospital, said she's never seen a woman fail to get well with treatment.
"I see moms come back to life," Duson said.

Attorney George Parnham, who represented Yates during her two capital murder trials, said he had never heard of postpartum depression when he got involved in the case.
Parnham and his wife, Mary, have since become staunch advocates. The couple founded the Yates Children Memorial Fund in partnership with Mental Health America of Greater Houston in 2002. The fund's advisory committee has launched initiatives to educate mothers, families and physicians.
Yates, who declined to be interviewed, is aware of the fund and its activities, Parnham said. She has written notes of thanks to the advisory committee. She also designs cards and aprons, which are sold in the gift shop at the Kerrville State Hospital where she is being treated. She sends the proceeds to the fund every 45 days, he said.

Yates was moved to the facility after a Harris County jury found her not guilty due to insanity at her second trial in 2006.
The Parnhams said Yates is stable and doing well. They visit her often and she has become part of their family, they said.
"We'll always defend her by keeping the children's legacy alive," Parnham said.
Yates' ex-husband, Rusty, said he appreciates the efforts of the Parnhams and others involved with the fund.

"They are helping families cope with postpartum mental illnesses, which is a great tribute to my children," Yates said. "The 10-year anniversary is a painful reminder to me of my family's loss. At the same time, I'm encouraged to see that the public's overall awareness of mental illness has significantly increased since then."
The couple divorced in 2005, but Yates keeps in touch with his ex-wife. He said she's looking forward to one day regaining her freedom and rebuilding her life.
The fund's advisory committee lobbied for a Yates-inspired bill, passed by the Legislature in 2003, that requires physicians to give expectant mothers information and resources on postpartum depression.

The committee also launched a program to screen low-income mothers at sites where they seek nutrition benefits, using a two-question assessment to identify and refer those who show indications of the condition to mental health professionals who provide free services.

About 6 percent of more than 60,000 screenings since 2006 have shown positive results, according to city health department records.
The fund's outreach efforts have included the development last year of a pilot program focusing on outreach, screening and training strategies for pediatricians and their staffs.


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