- According to the U.S. Centers for Disease Control and Prevention (CDC), about one in eight women in the U.S. experiences symptoms of postpartum depression (PPD).
- PPD may be hard to identify, as symptoms can mimic those of other conditions.
- Proper assessments and patient education are vital for identifying, diagnosing, and treating PPD.
This article covers the best ways for nurses to care for mothers with PPD. Discover how to spot this mood disorder and explore ways to encourage treatment.
The Challenges of Postpartum Depression
During the postpartum period, the safety of both mom and baby is top priority. In order for the healthcare team to correctly diagnose and treat PPD, nurses must be able to identify the signs and symptoms.
What Is Postpartum Depression?
Postpartum depression (also called postnatal depression or maternal depression) is a mood disorder that occurs in mothers who have recently given birth. Adoptive mothers can also experience postadoption depression, with similar symptoms to PPD.
PPD is characterized by a depressive episode that is unrelated to a separate disease. PPD typically starts within three weeks of childbirth and can last up to a year.
Signs and Symptoms
- Feelings of worthlessness or guilt
- Insomnia or hypersomnia
- Loss of energy or fatigue
- Suicide attempt or suicidal ideation
- Feelings of wanting to harm the baby
- Impaired concentration
- Change in weight or appetite
- Adolescent age
- Personal and/or family history of depression, anxiety, and/or mood disorders
- Pregnancy/childbirth complications
- Stressful life events
- Lack of social support
If left untreated, PPD can have devastating effects on new mothers, their babies, and their families. Nurses must address the challenges associated with identifying this disorder so that an accurate diagnosis can be made.
Challenges in Identifying Postpartum Depression
After giving birth, many mothers experience several symptoms that can mask PPD. Some symptoms can mistakenly be attributed to the typical recovery period, especially if the mother had a cesarean section. For example, the recovery period is often associated with sleep deprivation and fatigue.
The so-called “baby blues” — what the CDC describes as a general sense of worry, sadness, and tiredness mothers often experience after childbirth — can also be confused with the more serious PPD if not explored further. Baby blues usually last up to two weeks after childbirth.
Many facilities and agencies have robust safety and practice protocols in place to protect new babies and parents. Still, there are areas that require particular consideration when it comes to PPD.
Gaps in the Care of Postpartum Mothers
The diagnosis and treatment of PPD in postpartum mothers may often be difficult because of inadequate assessments, screenings, and patient education. Here are four care gaps that require attention.
- With 80% of new mothers experiencing the baby blues, the urgency to perform a focused PPD risk assessment during the two-week period after childbirth may be lessened. Many symptoms may be dismissed as the baby blues during this time period.
- The heavy reliance on subjective data may lead to gaps in care. Many mothers may withhold information that they feel is not relevant or would otherwise cause embarrassment or guilt.
- Treatment for PPD includes various forms of therapies that may be stigmatized. Some mothers may feel uncomfortable with the thought of having a mental health disorder that requires therapy and, therefore, may decline treatment.
- Chestfeeding mothers diagnosed with PPD may decline pharmacological treatment as it may be a risk to the baby.
Postpartum nurses (or any nurse) can address these care gaps by performing thorough assessments, providing patient education, and offering support as needed.
How Nurses Can Spot and Treat Postpartum Depression
Identifying and treating PPD requires nurses to assess, teach, make referrals, and offer resources. Here are four ways PPD can be identified and treated.
There are screening tools in place to help identify and diagnose PPD, including the Edinburgh Postnatal Depression Scale. These tools require the nurse to ask the mother and family or significant other certain questions to assess for PPD risk.
Avoid using screening tools as the only form of assessment. Rather, these tools should help guide the assessment. Nurses should ask additional questions as needed, especially during the initial two-week period after childbirth (the time when symptoms of the baby blues and early PPD can overlap).
Postpartum mothers may not be able to identify symptoms of PPD and may assume that they are simply tired or stressed. Nurses must advocate for the safety of mom and baby by asking the right questions.
Since identification of PPD relies heavily on subjective data, nurses should educate the mother and family/significant other on the signs and symptoms of PPD and the importance of prompt reporting. Ensuring a safe environment for mothers to disclose symptoms is key.
Nurses should acknowledge and address the embarrassment and guilt that mothers may feel in reporting symptoms, especially those that are most concerning (like wanting to harm the baby). Sharing stories of other mothers who have experienced similar feelings, received treatment, and are doing better may help.
Antidepressants and anti-anxiety medications are useful in the treatment of PPD. Antidepressants can take 4-8 weeks to start working. For this reason, nurses should ensure that the mother and family/significant other understand the importance of following through with treatment.
For the chestfeeding mother who is hesitant to take antidepressants due to the risk of transfer to the baby, additional education may be necessary. Nurses should help the mother to understand that the risk is generally low and, depending on the severity of PPD symptoms, the immediate safety of the baby should be taken into consideration.
Therapies and Support Groups
PPD is often treated with talk therapy (psychotherapy or counseling). Nurses should ensure that appointments have been arranged for the mother to speak with a psychiatrist, counselor, or other trained professional about ways to cope.
Transcranial magnetic stimulation or TMS is a noninvasive therapy that uses magnetic fields to stimulate the brain. According to multiple studies, this therapy has been proven to be effective in the treatment of PPD; depression remission rates were higher than those of the general adult population.
Nurses should address the stigma associated with these therapies in mothers who are hesitant to participate. Nurses may do this through patient education and referral to support groups.
When mothers see other mothers with PPD who use therapy, they may feel more comfortable participating as well. In addition, they may share more of their thoughts and feelings to care providers which can help with ongoing evaluation of the treatment plan.
Early identification of PPD can make a significant difference in the lives of mothers who suffer with this disorder. Nurses should continue to learn about the many challenges mothers can face during the postpartum period and be prepared to address all mental health disorders that may arise.