A 24-Year-Old Woman Calls Her Obstetrician After Giving Birth to a Healthy

question 2

Multiple Choice

A 24-year-old woman calls her obstetrician after giving birth to a healthy boy 5 days earlier.  She reports feeling depressed and irritable: "I thought I would be thrilled to have a baby, but then I felt really disappointed it was not a girl and find myself crying constantly."  The patient gets help from her sister during the day but is exhausted due to getting up at night to feed the baby.  She says, "My sister is so helpful, but I can't help snapping at her for no reason.  I get so worried that I won't be a decent mother."  The patient has no medical or psychiatric history, and the pregnancy and delivery were unremarkable.  She has no suicidal ideation or thoughts of harming the baby.  In addition to providing support, which of the following is the most appropriate response to the patient?

• A)I am concerned that your depression may interfere with your ability to care for your baby right now.
• B)I would like you to see a counselor for further evaluation of your mood.
• C)Mood changes are normal after giving birth; we can follow up at your 6-week postpartum checkup.
• D)Postpartum mood changes are common; please call me if you do not start to improve within the next week.
• E)We should consider starting an antidepressant for postpartum depression.

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