Postpartum Depression (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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      Slides Postpartum Complications Nursing.pdf
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      Slides Postpartum Complications Postpartum Depression Nursing.pdf
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      Reference List Maternity Nursing Care of the Childbearing Family.pdf
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    00:01 Moving on to our next complication, we're going to talk about the mind, postpartum depression.

    00:07 So postpartum depression by definition is depression that persist longer than two weeks after birth, and that can go up to two years after birth, so it's a long time.

    00:19 Clinical features include persistent sadness or anxiety.

    00:24 Inability to bond with the baby or lack of desire for self-care.

    00:30 Sometimes this presents as a client who's three or weeks postpartum and just really doesn't want to get up.

    00:36 Not just that they're too tired to get up, they just are not interested in taking a shower or eating or doing any of those things that they need in order to be healthy.

    00:45 And, finally, an inclination towards self-harm.

    00:48 So, taken to the extreme, postpartum depression can lead to self-harm or harming of that child or other children in the household.

    00:57 Risk factors for postpartum depression include depression prior to delivery.

    01:03 So someone who's had a history of depression is definitely at risk for postpartum depression.

    01:08 History of maternity blues.

    01:10 Now, 80% of patients experience maternity blues, and that's considered normal.

    01:15 But, remember, postpartum persist two weeks after that period. A recent stressful life event.

    01:22 Not just the delivery of the baby, but maybe, there's something going on, a change in partner, a change in financial status, job, any of those things; a loss of someone important to them, any of those things can contribute to developing postpartum depression.

    01:38 Inadequate social support.

    01:40 So, imagine having to take care of this wonderful little bundle of joy all by yourself without anyone to help, that can set you up for postpartum depression.

    01:49 Poor primary relationship. So, the primary relationship could be a spouse, it could be a partner, could be a friend, but if that relationship is not healthy, it increases the chances of developing postpartum depression.

    02:02 And, finally, a difficult infant.

    02:04 So an infant that's particularly uncomfortable or has reflux or who is up a lot and doesn't sleep very well can really lead to maternal exhaustion, which ultimately can lead to postpartum depression.

    02:18 Diagnosing postpartum depression.

    02:20 First of all, really understanding the symptoms.

    02:24 So if you know the timeframe, that will help.

    02:26 So remember that postpartum blues is normal, after two weeks, that's postpartum depression.

    02:33 We can also use a couple of different diagnostic tools.

    02:36 One is called the Beck Depression Scale, the other is called the Edinburgh Depression Scale.

    02:41 This is the Edinburgh Depression Scale.

    02:44 It's a series of ten questions that asks about feelings of feeling good, feeling happy, and question number 10 asks about feelings of self-harm.

    02:54 If the client answers this question in any other way other than never, they need a referral.

    03:01 Otherwise, if we add up the score, a score of greater than 10 indicates postpartum depression.

    03:08 So let's talk about the spectrum of postpartum depression.

    03:12 So we start off with postpartum blues, this is very common.

    03:16 And when I say common, about 80% of patients experienced that, so we want to make the client understand that it's normal to have those feelings of anxiety and overwhelm right after delivery. That can continue up to two weeks.

    03:30 Now, when we go past two weeks, if there either is new onset symptoms or continuation of the postpartum blues, then that patient will be diagnosed with postpartum depression.

    03:42 We add to the clinical features of postpartum depression the idea of not wanting to participate in self-care, so taking a shower, eating, sleeping, and potentially a feeling of self-harm or harming the baby or something like that.

    03:59 We move on to the 3rd category which is really rare, almost never happens, but it's important that we talked about it because it does happen sometimes and that's postpartum psychosis.

    04:13 Postpartum psychosis is different than depression because it's a complete break with reality.

    04:18 The client may experience hallucinations or they may hear voices that are telling them to do all kinds of terrible things.

    04:25 Fortunately, it's rare, but it is an emergency and this client will need to be admitted in-patient ASAP.

    04:34 When we're taking care of a client whose experiencing postpartum depression, it's important that we encourage them to rest, that's one of the most helpful things that we can do.

    04:45 We can also look for ways for them to receive support, so maybe it's not from their primary relationship.

    04:51 Maybe it's from friends or from some other groups that they are a member of, but support can make a really big difference in allowing someone to get the rest they need to feel better.

    05:00 Also a referral. Maybe for therapy or maybe for just help, and that may be the best thing that we can do in order to help them get a handle of what's going on in their life and to move back to a normal space.

    05:14 Medication may be ordered by a provider in order to allow the client to rest and to get back to normal.

    05:21 And we can also educate the client.

    05:23 Sometimes clients are really adverse to telling us about their symptoms of depression, because what they have in their mind is postpartum psychosis and what they don't recognize is that we can treat and manage postpartum depression.

    05:36 Or they've heard some scary story about what's happened to somebody who's harmed themselves or harmed their baby and they think, "Ahh, that's not me.

    05:44 I don't want to tell anybody I have this." So we want to let them know that this is something we can manage, that it's okay to talk to people about it and we want you to feel better.

    05:54 It's not normal to feel bad just because you had a baby.

    About the Lecture

    The lecture Postpartum Depression (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Postpartum Complications (Nursing).

    Included Quiz Questions

    1. Always prefers the baby to be in the crib rather than holding them.
    2. Complaining of never getting enough sleep and being tired.
    3. Expressing disappointment with partner and family.
    4. Not eating as healthily as before being pregnant.
    1. Lack of self-care
    2. Symptoms last longer than 2 weeks.
    3. Symptoms only last 2 weeks postpartum.
    4. Hallucinations and out of tune with reality
    5. Must be admitted immediately
    1. Encourage rest
    2. Edinburgh Depression scale assessment
    3. Multiple gestation pregnancy
    4. Encourage the client to be alone
    5. Educate that the baby is at risk of maternal harm

    Author of lecture Postpartum Depression (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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