Cover Story

Motherhood is supposed to be a happy time. But for many women, the birth of a child results in great anxiety and even life-threatening depression. That's where psychologist Diane G. Sanford, PhD, comes in.

"Women wonder why they don't feel like the storybook mom who looks like she's just having the best time in the world with her infant," says Sanford, president of Women's Healthcare Partnership in St. Louis, Mo., and co-author of "Postpartum Survival Guide" (New Harbinger, 1994). "As a culture we depict motherhood that way, but I don't believe it's true."

For the last 14 years, Sanford has specialized in postpartum problems and just about everything else related to female hormones. Whether the issue is infertility, pregnancy loss, postpartum adjustment or menopause, Sanford provides behaviorally oriented interventions with a problem-solving focus. And she wonders why more psychologists aren't moving into this booming field.

A reproductive focus

Sanford never set out to become a specialist in women's health. For many years, she had a general psychotherapy practice emphasizing marital and family issues. Then she started collaborating with a psychiatrist whose clients included women with postpartum depression.

Working with some of these clients sparked Sanford's interest in hormones and their effect on women's health. Once she discovered what an unmet need there was for competent services in the area, she was hooked.

"Women are just thirsting for someone who can understand their problems," says Sanford. "I've had people come to me and say they've been to practitioners who just wanted to talk about their childhoods. That's not helpful. In fact, many of these women got worse in the meantime."

Today Sanford has a thriving practice focused almost exclusively on helping women and their partners cope with a wide range of reproductive issues. Instead of delving into childhood traumas, Sanford offers practical advice she says helps women get well fast.

Take postpartum anxiety and depression, which afflict an estimated 15 percent to 20 percent of new mothers. Among women who have had high-risk pregnancies, the rate of postpartum anxiety and depression may be as high as one in three.

Sanford begins by helping clients think of concrete steps they can take to ease their emotional turmoil during this major life transition. New mothers may need help figuring out ways to get partners and others to help with their infants. Or they may just need to be reassured that they can handle the responsibilities of parenthood. Sanford also works with psychiatrists to ensure that women who need medication get it.

Once the immediate crisis has passed, Sanford focuses on helping clients develop skills they can use to manage anxiety or depression more generally. Using a cognitive-behavioral approach, Sanford teaches them how to talk back to negative thoughts and worries. She also teaches them relaxation techniques they can use for the rest of their lives.

Although much of Sanford's practice focuses on postpartum issues, many of her clients can't get pregnant in the first place. Although Sanford uses the same basic approach with these women, the issues they're grappling with are somewhat different.

Grief is the primary issue that brings in infertile clients. According to one researcher, women with infertility have the same rate of depression as women struggling with cancer and other life-threatening illnesses.

"Many women think that motherhood is going to be a part of their lives and that if they don't have their own biological child they're failures as women," says Sanford. "They need help dealing with the negative feelings they've developed about themselves and their bodies."

Sanford also helps women understand the impact infertility drugs may have on their emotions. Most women aren't told that infertility drugs are strong medicine that can prompt anxiety and depression by altering their brain chemistry. Simply educating them about the drugs' effects can help, says Sanford.

Sanford doesn't just see the women, however. Drawing on her background in marital and family counseling, she also sees couples. The struggle to conceive often begins to monopolize couples' lives, she explains, and that stress can cause relationships to dissolve. Couples may need help finding outlets for their feelings, deciding whether to continue their quest or dealing with the comments made by family members, friends and others.

An entrepreneurial spirit

This practical approach has helped Sanford's practice thrive.

After years of practicing on her own, she and an advanced practice women's health nurse formed Women's Healthcare Partnership five years ago. In addition to the two partners, the staff now includes a full-time counselor with a PhD in marriage and family counseling, one full-time licensed clinical social worker and two part-time ones. Three nurse educators, a dietician and a fitness expert work on a consulting basis. Even with all of these, the practice sometimes has to refer patients to other practitioners simply because schedules are already jam-packed.

The practice hasn't had to do any marketing for years, Sanford confesses. In the early stages, Sanford lectured frequently to women and families in her community and offered in-service training to physicians, nurses and childbirth instructors. The practice also "dabbled in advertising" and developed brochures.

Over the years, these marketing techniques have been supplanted by simple word of mouth. The practice now relies on referrals from obstetricians/gynecologists, primary-care physicians, labor room nurses and childbirth educators. And patients tend to stick with the practice, even after their children are grown.

Sanford does bring a strong entrepreneurial attitude to her work, however.

When American Baby magazine asked her to broadcast a keynote address to a conference for childbirth instructors, for instance, Sanford leveraged the task into much more. While she was at the taping session, she took the opportunity to meet with one of the magazine's partner companies to discuss other distance-learning possibilities. The result was an invitation to develop a series of lectures on women's health that are delivered via satellite broadcast to a thousand hospitals around the country.

In addition, the practice recently contracted with a managed-care company to pilot a class for women with postpartum anxiety and depression. The managed-care company will authorize payment for the eight-session class upfront, and Sanford will analyze pre- and postclass evaluations to show the classes' impact on women's psychological functioning. Led by Sanford and a nurse practitioner, the curriculum teaches women and their partners how to adjust to their new roles and culminates in the development of individual "postpartum survival plans."

Sanford hopes other psychologists will follow in her footsteps. Psychologists who are interested in the area should begin by educating themselves through continuing education workshops and clinical supervision. Get involved in women's health organizations, Sanford urges. Call hospitals' directors of women's health education programs and offer to give talks. Then get to know a small group of physicians and nurses.

Women's health offers psychologists more than the satisfaction of meeting an unmet need. According to Sanford, the field offers greater financial rewards than more general psychotherapy.

"People are much more willing to pay fee-for-service for these services," says Sanford, who just removed herself from her last managed-care panel. "The specialty has really allowed me the flexibility and financial independence a lot of practitioners have had to sacrifice over the last five to 10 years."

Sanford's next project is to design a practice-development kit for psychologists who want to specialize in women's reproduction health and a consumer-education kit for clients.

Rebecca A. Clay is a writer in Washington, D.C.