SUSAN KUSHNER RESNICK

When Michelle Seener stopped taking showers, her husband, Tom, knew something was wrong. He called her midwife and reported what was happening: Michelle didn't want to get out of bed. She'd always been so mellow, but now she was snapping at their three kids.

What he didn't know - yet -- is that she had refused his offers to help with the laundry because in the solitude of her laundry room he couldn't hear her cry. The Warwick woman also hadn't told him that she felt as if she were going to burst out of her skin, or that she was incredibly angry at her children or that she had thought about hurting herself.

The midwife told him to call the Day Program at Women &Infants Hospital in Providence, which treats pregnant and postpartum women on an outpatient basis for five-day stretches. The next week, Michelle and her baby began treatment there. Five days later, she felt like a new woman.

"This program has helped me so much," Michelle said during her final group therapy session. "If I hadn't come to this program, I don't know if I would have lived."

The Women & Infants Day Program is the only one of its kind in the country, according to director Margaret Howard. While other hospitals offer day treatment for people with mental illness or inpatient treatment for postpartum depression, the Day Program is the only place where women can bring their babies with them while they're getting help for postpartum depression, then go home to their husbands and other children every night. The babies spend the days in their mothers' arms or in a nursery a few steps away.

The mothers spend the day in group and individual therapy, getting a solid kick start on recovery. In the end, everyone appears to win: the mothers don't have to separate from their babies, the insurance companies avoid paying for inpatient hospitalization, and the professionals finally have a place to send women who used to fit nowhere.

About eight women attend the program each weekday, arriving at 8:30 a.m. and leaving at 2:30 p.m. During those hours, they see a psychiatrist for medication management; have group and individual therapy sessions; learn baby massage and relaxation techniques; and get training in topics such as Anger Management, Parenting Through Depression, and Role Transitions. Once during their stay, they have a family meeting with their husbands or other significant adults in their lives.

Having the babies around allows the staff to monitor what they call "attachment issues." Many women with postpartum depression are either too attached or disinterested in their babies.

"We want to be able to observe the mother-baby dynamics," Howard says.

The staff also thinks it's important to have the women go home and practice their new skills.

"It gives us a way to measure their progress," she says. Such as "when a mom comes in and says, 'I sat down and read a story to my 3-year-old for the first time' or 'I cooked dinner for the first time in three months.' "

The program works for the women because, in addition to getting treatment and advice, they become part of a sisterhood.

"Connecting with the other women helped so much more than if I just went to an individual therapist," Michelle Seener says. "It's almost like getting validation."

Even visiting the program before she started and seeing all the other mothers and babies eased Michelle's isolation.

"I had no idea so many people went through this," she says.

Michelle never had an easy life. Childhood abuse lead to years of sitting in therapists' offices. None of them ever diagnosed the 35-year-old with a mild form of bipolar disorder. The psychiatrist at the Day Program recognized it on the first day, in addition to a case of depression.

Michelle started on medication and began to look at what had happened to her. After her first two children, Victoria, 12, and Benjamin, 2, were born, she felt fine (though, in retrospect, she thinks she had some postpartum depression after Benjamin's birth). After her third child, Jonathan, arrived this past March, she felt euphoric. Until he was a month old.

"I would be slamming doors and screaming like a lunatic, but I was saying, 'I'm fine -- I just need a vacation,' " she says from her living room, as the baby sleeps and Benjamin eats a Popsicle in front of a cartoon.

When she stopped nursing the baby, she started to feel even worse.

"I felt like a failure," she says. "I felt like I let him down."

She wanted to do nothing but sleep. She began "spiraling rapidly" and had no hope that she'd ever feel better. She wanted to give up on life, but her love for her children saved her.

"I was going to get in the car and drive to Newport and drive off the bridge," she says. "But I don't go anywhere without my kids, and I didn't want to hurt them."

As she sits in a circle during group therapy on her last day, she tells the other women, "There's no way in hell I'd want to kill myself now."

She says at first she feared the program would consist of a bunch of drugged-out zombies. But none of the women in the program look any different from any other group of moms and babies.

Charlene Marsella, who has eight-month-old quadruplets and a 3-year-old at home, spoons cereal into her baby Vinny's mouth. Another mom, a woman with long, blond hair who didn't want her name used, nurses her baby. When she talks, he lifts his head to watch her.

But when the women open their mouths, they distance themselves from happier mothers. Charlene talks about crying "all the time," and says she feels like a failure asking for help, even though she has four infants.

"I should be able to handle this," she says. "I'm a mom. I wanted this."

The blond woman, whose postpartum depression started with panic attacks shortly after her son was born, says she still does everything for her husband and other children.

"Then I go into the bathroom, close the door and cry," she says.

They talk about society's expectations of mothers and how the program has helped them to sidestep such assumptions.

"I've learned to stop putting so much pressure on myself to be the perfect mom," Michelle says.

Many Women in the Day Program have never been depressed before.

"The first year after having a baby is the most common time to have a major depression," Howard says. "If it's going to happen, it's going to happen then."

About 80 percent of the women admitted to the Day Program have major depression and all have some kind of mood disorder. To be admitted, they must take a survey that determines levels of depression. Michelle says she scored 23 out of a possible 30, which easily qualified her for the program. (On discharge day, she was down to an 8).

Most patients start on medication as soon as they arrive. Recent research has shown that there are several antidepressants that are safe for nursing mothers. When they're discharged after five or six days, they're linked up with an outpatient psychiatrist and therapist, invited to a weekly support group and to begin couples therapy, if necessary.

"It's vital that they stay in treatment for at least a year," Howard says.

Of the nearly 1,000 women who have been treated in the Day Program since it opened in February 2000, 65 percent had postpartum depression, or PPD. The rest were pregnant and depressed.

"The biggest risk factor for PPD is depression during pregnancy," Howard says.

By treating women in pregnancy, they hope to prevent postpartum depression. And if it develops, the women already have a safety net in place, Howard says.

On her last morning in the Day Program, Michelle was smiling and energetic. The next day, she panicked because she was alone with her kids again. The structure, the sisterhood, the reason for getting dressed and putting on makeup in the morning was gone. Plus, she thought she would be all better after the five days of treatment. That didn't exactly prove true.

But despite some "off" days, she never slipped back to her original state.

"Once you know what's going on, the bad days are easier to deal with," she says. "I know I'm not going crazy again, I'm just having a bad day."

The mood-stabilizing medication, which made her feel "peaceful and normal" after just two days, continues to improve her mood. She's started seeing a new therapist and has learned to lean on family and neighbors for help. She's thinking about going back to school to be a therapist.

"When all of this is said and done, I think I'll feel happier and healthier than I was before the PPD," she says.

Though the tears haven't completely stopped, she isn't afraid to tell her husband about them anymore. While she was out getting him some coffee recently, she found herself singing along with a song on the radio, something she hadn't done in a long time. She started to cry because she was so happy.

Susan Kushner Resnick can be reached at sresnick@projo.com.

Planning preceded hospital's program

Though the Day Program is only four years old, its genesis was years earlier.

Dr. Teri Pearlstein, a psychiatrist and director of Women's Behavioral Health at Women & Infants Hospital, had been working at the day hospital at Butler Hospital, where doctors often tried to send women with postpartum depression. But most of them weren't showing up. Either they didn't want to leave their babies behind, or they felt uncomfortable around the other patients, who had more severe, chronic mental conditions.

As a result, they weren't getting the treatment they needed, and they sometimes ended up in inpa-tient treatment.

''The vocal ob-gyn community said, 'We need someplace to send these women,' " says Margaret Howard, the Day Program's director.

The Women & Infants administration, which she calls ''enlightened, supportive and forward-thinking" backed the program. Pearlstein and other leaders of the program made presentations to local insurance companies.

''We tried to display to insurance companies that it was fiscally wise," Pearlstein says. ''It would, hopefully, prevent inpatient hospitalization down the line."

Before the program opened its doors in February 2000, all the local insurance providers were on board.

Susan Kushner Resnick

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