A 28-Year-Old Woman, Gravida 1 Para 1, Comes for a Routine

A 28-year-old woman, gravida 1 para 1, comes for a routine 4-week postpartum visit following an uncomplicated vaginal delivery.  The patient describes some mild vaginal soreness and breast tenderness but has no other physical problems.  She says, "The baby is adorable, but I worry about being a good mother."  She tearfully describes feeling exhausted and unable to return to sleep after getting up in the middle of the night to feed the baby.  She says, "The baby cries all the time and nothing I do helps.  I tried to breastfeed, but I gave it up because she was fussy and I was afraid she wasn't getting enough to eat.  My husband tries to be supportive and has offered to help with nighttime feedings, but I am up at night anyway because I can't sleep."  The patient has little time to care for herself and has been eating poorly.  She feels increasingly depressed and has little energy.  The patient says, "Everyone expects me to be happy, but it has been so hard.  I don't deserve to be a mother."  The patient has no psychiatric history and no thoughts of hurting herself or the baby.  Physical examination is normal.  Routine laboratory tests, including hemoglobin and TSH levels, are within normal range.  Which of the following is the most appropriate next step in management of this patient?

A) Reassure the patient that her postpartum blues will improve and schedule follow-up in 2 weeks
B) Recommend a support group for new mothers
C) Recommend psychiatric hospitalization
D) Recommend treatment with a selective serotonin reuptake inhibitor
E) Refer the patient for parenting skills training

Correct Answer:

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