Postpartum Mood Disorders The Nurse s Role in Identification and Intervention Van Gogh Mother Roulin 1888
Betty Bowles RNC, MSN Nelda Coleman RN, MSN Lauren Jansen RN, MSN Midwestern State University Wilson School of Nursing Wichita Falls, Texas
~Postpartum mood disorders affect individuals, families, and communities. Untreated symptoms have resulted in baby blues, mild to severe depression, and psychosis. Outcomes of untreated mood disorders may lead to dysfunction within the family unit, delays in cognitive, psychosocial, and social development of the newborn, and may pose the risk of the individual either harming or murdering her children~
Postpartum Mood Disorders Impact on Families Robs a mother of time spent with infant Affects marital relationships Hampers maternal-child bonding Inhibits normal cognitive and emotional development of children
Postpartum Mood Disorders Incidence 12% women report moderate depression after childbirth 6% women report severe depression after childbirth 36,500 mothers in Texas suffer from postpartum mood disorders
Postpartum Mood Disorders Incidence Postpartum mood disorders (PPD) is frequently seen in the first three months after delivery Episodes may last six months or more in 25-50% of mothers 80% of women experiencing PPD will have additional episodes Many women suffer covertly and are never diagnosed
Education and Assessment Recommendations ~The American Academy of Pediatrics (2002) and the American College of Obstetricians and Gynecologists (2002) recommend pregnant women should be educated about PPD in the third trimesters and assessed for risk during the postpartum period~
Baby Blues Incidence: Up to 80% women experience baby blues Occurs within the first week postpartum May persist for several hours to several weeks Symptoms: Mood swings Crying Sadness Anxiety Dependency Impatience Irritability Restlessness Loneliness
Baby Blues Causes: Emotional letdown after birth Increased responsibilities of motherhood Fatigue or sleep deprivations Feelings of disappointment with the birth experience Treatment: Rest Proper nutrition Help with infant and household responsibilities Family and friends support systems Avoidance of isolation
Postpartum Depression Incidence May occur any time during the first year postpartum Onset may be rapid or gradual with sadness and lack of joy in motherhood Affects 10-20% of mothers.
Psychological: Postpartum Mood Disorders: Postpartum Depression Depressed mood Mood swings Hopelessness Persistent guilt Indecisiveness Lack of focus or concentration Social withdrawal Poor hygiene Symptoms Physical: Constipation Exhaustion Eating disturbances Weight fluctuations Sleep problems Vague pain Hyperventilation Heart palpitations
Postpartum Depression Causes Thought to be related to hormonal changes within the body Possible effects on serotonin levels in the brain Treatment Requires assessment by a medical professional Medical care Counseling
Postpartum Psychosis Incidence Occurs in 1 or 2/1000 postpartum women Onset can vary from 2-3 days to 3 months after childbirth 5% suicide rate 4% infanticide rate Symptoms Insomnia Eating disorders Extreme anxiety and agitation Visual or auditory hallucinations Delusion denying birth or about infant s death Suicidal or homicidal thoughts Delirium Mania
Postpartum Psychosis Causes Unknown Treatment A severe medical emergency Requires immediate assessment by a medical professional Hospitalization for medical and psychiatric treatment
Pre-pregnancy Postpartum Mood Disorders Risk Indicators History of depression Substance abuse Severe premenstrual syndrome Premenstrual dysphoric disorder Mood instability while taking oral contraceptives or fertility medications Thyroid dysfunction Previous obstetric complications Pregnancy Unwanted pregnancy Increased number of somatic complaints during pregnancy Depression or anxiety during pregnancy
Postpartum Mood Disorders Risk Indicators Postpartum Premature or postmature birth Labor or birth complications Dissatisfaction with labor and/or delivery Separation from infant after delivery Early hospital discharge Newborn Difficult infant temperament Infants with medical, feeding and/or sleeping problems Abrupt weaning Bottle feeding
Postpartum Mood Disorders Risk Indicators Family Family history of depression Perceptions of patient s parent s parenting Not living with one s spouse or significant other Marital dissatisfaction or discord Lack of support from family and friends Other children at home Other Adverse life events Life stresses Bereavement Acculturation
Predictors (Beck, 1996) History of previous depression Prenatal anxiety Prenatal depression Maternity Blues Low marital satisfaction Los social support Difficult infant temperament Life stress Low self-esteem Single marital status Low socioeconomic status Unplanned/unwanted pregnancy
Educational Interventions Prenatal Classes Physician offices Health clinics Media blitzes Newspaper articles Women s health newsletters Community lectures Family involvement in the educational process Routine prenatal screening
Texas Initiatives House Bill 341 Requires physicians, midwives, hospitals and birthing centers to provide pregnant patients with a postpartum depression resource list Texas Department of Mental Health Provides healthcare providers and families with tips on dealing with depression through it s website
Screening Tools Edinburgh Postnatal Depression Scale (EPDS) High specificity and sensitivity in detecting minor and postpartum depression 10 item self-report scale May be administered during the antepartum or postpartum period Postpartum Depression Scale (PPDS) High specificity and sensitivity in detecting minor and postpartum depression May be administered during the antepartum or postpartum period Zung Scale Not specific to the postpartum period 20 item self-report scale May be used in the antepartum and postpartum periods
Referral and Support Organizations Texas Department of Health and Human Services Post Partum Resource Center of Texas National Mental Health Association Family/Community Support groups Phone bank Online support groups sponsored by professionals