Postpartum depression overview
Postpartum depression can be termed as non-psychotic depressive episodes that often start and extend to the first years of postpartum period. It is often viewed as a certain state of mental health disorder and a variant of depression (Castillo-Angeles et al., 2021). Generally, the disorder is often undertreated and unrecognized and is triggered by various psychosocial stressors that may have drastic effects on the growth of the baby. Postpartum depression is mainly grouped under mood disorders and impacts approximately 10 to 15% of new mothers. In the US alone, the prevalence of the disease ranges between 7% and 20% (Kiaei et al., 2021). Lifetime risks are also between 10% and 25% risk. Therefore, there is a need for postpartum support since untreated maternal depression may have drastic impacts on the child’s development, lead to increased rates of anxiety, and a lack of bond between the mother and the child. Management of postpartum depression is an essential part of satisfactory medical care (Kiaei et al., 2021). Additionally, healthcare practitioners, including the pediatrician and obstetrician, play a significant role in screening and managing postpartum depression. To get the drastic outcomes connected to depression and its effects on the child, be aware of the certain signs and symptoms, the appropriate screening methods, and proper treatment.
An integrative literature review was used to find the sources required for the nursing intervention. The methodology mainly focuses on analyzing information based on hypotheses and questions, which directs the clarifications, synthesis, and find reviews. The method further played a significant role as it gathered and integrated data that informs scholarly debates and suggests research areas (Kotasthane & Kotasthane, 2017). An integrative literature review was preferred since it provides an organized approach to identify and further interpret different changes and subjects in the literature. Google search engine was used to locate the articles. The search term used was postpartum depression, antidepressants, treatment, and psychotherapy. The reference lists of the article were further had searched from supplementary sources. Two main questions guided the evaluation. The first question was about postpartum stress’s impact on both the mother and the child. The second guiding question was about the steps that can be implemented to prevent and manage postpartum stress among women.
Anokye, R., Acheampong, E., Budu-Ainooson, A., Obeng, E. I., & Akwasi, A. G. (2018). Prevalence of Postpartum Depression and Interventions Utilized for Its Management. Annals of General Psychiatry, 17(1). https://doi.org/10.1186/s12991-018-0188-0
The main aim of the research was to find the most effective postpartum intervention among mothers with postpartum depression. The study design used a descriptive cross-sectional using a quantitative method. The study was conducted in KOmfo Anokye Hospital, which is a government-owned establishment and has various maternal units, surgical units, medical records, and health insurance units. for the cross-sectional studies, the researchers did not follow individual times and preferred to assess the prevalence of the illness at that moment.
The sample included mothers within 12 months after birth since postpartum often impacts females within 12 months after giving birth. Additionally, the healthcare practitioners were enlisted for the research to offer data about the psychosocial and psychological interventions effectively used to manage postpartum depression in the hospital. The research was done for two months.
Prevalence and impact
A simple random technique was used to choose the mothers for the data collection. The method chose by chance or by none zero mothers for the study, and five assistants collected data in one month. For choosing the respondents of the study, random numbers from the already prepared casual number table were issued to the names of the participants who were available when the data was being collected. A Patient Health Questionnaire was used to screen for depression, and a structured questionnaire that contained closed-ended questions was used. The questionnaire was preferred to be effective for data collection since it was cost-effective, was easy to quantify the analysis, and was easy to administer.
The data was analyzed using inferential statistical and descriptive tools incorporated into statistical software SPSS version 6.0. The questionnaire was pretested at the Anwaal hospital to ensure validity and reliable data, and the contradictory problems were solved before the data collection process.
The key findings were that postpartum depression was reported among 7% of the recruited population. The relentlessness of the illness ranged from nominal to severe depression. Among the interventions used for women, psychosocial support demonstrated to be the most operative intervention used by healthcare practitioners in reducing the symptoms.
Regarding ethical considerations, the research was conducted in a government-owned hospital, which implied that the government was aware of the study and approved it.
One weakness of the study is that it used a smaller sample size and one screening tool to detect signs of postpartum depression. Therefore, the study missed the mothers who were absent at the time of the study. Additionally, the researchers failed to define the occurrence of PPD-based tools. One strength of the study is that it used the Patient Health Questionnaire, which has the aptitude of incorporating DSM-IV depression diagnostic standards with other main depressive symptoms.
George, M., & Johnson, A. R. (2018, 6). Postpartum and Newborn Care-A Qualitative Study. ResearchGate. https://www.researchgate.net/publication/327981448_Postpartum_and_Newborn_Care-A_Qualitative_study
The main aim of the research was to explore the cultural beliefs and practices about postpartum care of mothers and their newborns in rural Karnataka. The study design used a qualitative study was carried out between March and May 2016 among newly lactating mothers and their female caregivers in a rural maternity ward located in the Ramnagara district.
The study obtained informed consent for ethical consideration, which included permission to audio record the discussions held.
Data collection was obtained from a Focused Group Discussion (FGD) and In-Depth Interviews (IDI). The guides for topics in the study were face validated and modified under the guidance of an expert. The data was saturated and was attained using the Focused Group Discussions. Three of them were done with postnatal mothers and with female caregivers at the hospital. About 6 to 8 participants were involved, with each discussion lasting for about 45 to 60 minutes.
Data analysis was done by translating the recordings verbatim to English. The information was then entered into a word document, coded, and thematically analyzed.
The key findings were that various themes were identified among the mothers. The first theme was the postpartum care of the mother, which involved various subthemes, including personal hygiene, male participation, food taboos, family planning, and physical activities. The second theme was newborn care, whose subthemes included aspects like eye care, cord care, and the care of sick newborns. The last theme was breastfeeding and included aspects like expressed breast milk, colostrum, and exclusive breastfeeding.
Effective intervention strategies
One weakness of the study was it included only 6 to 8 participants. Such aspects tend to limit the findings and discovery of accurate information concerning postpartum illness since many women are experiencing postpartum stress. One strength of the study is that it used a qualitative study that captures the changing attitudes within the targeted groups and offers a more flexible approach to the issue.
Loiola, A. M., Alves, V. H., Vieira, B. D., Rodrigues, D. P., Souza, K. V., & Marchiori, G. R. (2020). Delivery Plan As A Care Technology: Eperience of Women In The Postpartum Perion in a Birth Centre: ExperiÊncia de PUÉRPERAS Em Uma Casa de PARTO. Cogitare Enfermagem, 25. https://doi.org/10.5380/ce.v25i0.66039
The study’s main aim was to analyze the perceptions of women who adopted the delivery plan in the birth centre in South Brazil. The study design used was a descriptive study with a qualitative approach. It was conducted in a Birth centre located in Rio de Janeiro. The inclusion procedure included women who were 18 years or older and further took part in rounds of discussions and individual sessions on prenatal care to develop birth plans. Females who had already begun educational activities but avoided participants in the monitoring activities were exempted from the research.
The research was sanctioned by the Ethics and Research Committee of Universidade Federal Fluminense for ethical consideration.
For the data collection process, a semi-structured interview was used. It used a tool with closed and open-ended questions that the researchers further elaborated on. The tool was mainly used as an interview guide. Face-to-face interviews were carried out in a secluded room. There were various questions asked to the participants. The first question was to define the procedures of their delivery plan and the variances apparent in the presentation of the health unit throughout the delivery and birth of the child. The researchers documented and recorded the answers to offer a verbatim account of the interviews. They included mothers branded by the letter P, accompanied by the interview order, for instance, P5, to ensure they remain anonymous.
For data analysis, a thematic content analysis was used. The method has three main steps and has a specific guide. The first approach was pre-analysis. The second approach was material exploration. The third approach was processing the results, inference, and interpretations. The method allowed the thematic units to be highlighted and analyzed based on the projected goals . After the interviews were recorded and transcribed and the Recording Units acknowledged, the collimator was specifically used to identify and categorize related RUs.
The key findings of the research were that the mothers reported the care offered by abstract nurses was mainly founded on their delivery plans. The plans were also based on the ethical behaviours of the participants and the scientific evidence. Delivery plans proved to be effective since they offered safety, individualized care, and reverential care throughout the process for the new mothers.
One weakness of the study is that it excluded the birth centres from the research, thus making it difficult to increase its sample size. One strength of the study is that it used focused group discussions, which have various advantages. The first advantage is it clarifies and further tests the pre-convinced findings and notions. Secondly, it comprehends both the needs that are met and unmet. Lastly, it uncovers the concepts and issues that may have been previously not considered as being important.
Medical professional roles
The most common interventions used to manage postpartum among respondents in Ghana included psychological support, cognitive therapy, postpartum home visits that were professionally based, and interpersonal therapy (Anokye et al., 2018). Conversely, among the stated interventions, the most effective among the patients was psychosocial support since others had the minimum influence on improving the symptoms. Psychosocial evidence is often nonstructured and includes peer support and nondirective counseling. The influence of the intervention in the management of postpartum depression can be confirmed by Prevart et al., (2018), which involved a study of approximately 50 women who had postpartum depression and were randomized to about 8 weeks of nondirective counseling with a health visitor. The recovery rate, in this case, was 69% effective and greater as compared to the control group, which was about 38%.from the research, both cognitive therapy is, and psychotherapy interventions were discovered to be ineffective in reducing postpartum depression symptoms. Such aspects imply that interpersonal psychotherapy is not dependable as an intervention for the disease among new mothers. Conversely, the efficiency of interpersonal psychotherapy in managing postpartum depression has been established to be effective in other studies. Mittal (2020) randomized new mothers who had postpartum depression in a 12-week therapy for about 60 minutes. The sessions mainly focused on the manualized interpersonal psychotherapy session was mainly done by a trained therapist. Women who underwent the whole procedure reported a drastic decrease in their PPD symptoms. As compared to the waistline group that received no canceling.
Mattal (2020) further argues that women with postpartum depression were mainly dispensed with psychotherapy interventions for about 12 weeks, whereas some underwent mother-infant therapy. Both groups reported significant improvement in their PPD symptoms to other therapy methods used. In this light, there is sufficient research conducted with positive outcomes that demonstrate that interpersonal psychotherapy is more effective for mothers who have PPD symptoms than other therapeutic strategies. Therefore, it could act as a first-line treatment specifically for breastfeeding mothers.
Both cultures’ beliefs and practices have an impact on the postpartum care of new mothers and newborns. Such factors are often dynamic and change with time since aspects like technology and education influence them (George & Johnson, 2018). With improved female education, various negative and outdated practices, for instance, discarding the colostrum and branding the baby, have been stooped among various communities over the years. Conversely, certain practices and beliefs remain unchanged, for instance, the notions of cold and hot food that result in withholding protein-rich foods like vegetables, water, fish, and eggs. Such restrictions may lead to poor quality and quantity of breast milk. Besides, factors like protracted bed rest and insufficient ambulation of new mothers in the postpartum period may play a significant role in increasing the risks of deep vein thrombosis (George and Johnson, 2018). In addition, separating both the husband and the wife for approximately one year or more after the birth child may lead to lack of the father’s support, extra-marital relations, and increased risks of HIV and STIs.
Research on postpartum depression
There are various studies that backups the arguments. For the Idupi-coastal Karnataka, the diet taboos accompanied by the postnatal mothers were the same. Other studies conducted in regions like Uttar Pradesh also revealed that the limited water intake to prevent abdominal distension and drying out of the uterus had drastic impacts on the new mother’s health. It also led to poor quality of the mother’s breastmilk (Sibarani & Fachry, 2020). In states like Afghanistan, new mothers are often confined for about 40 days in their home, during which they are only expected to sleep and rest since they have lost lots of blood and therefore need more time to recover with the anticipation that the postpartum women will further reduce their interactions with their husbands. Sch aspect is a prevailing norm that increases women’s risk of postpartum depression.
Generally, the health of newborns has continued to be negatively affected by harmful practices, including applying cow dung and turmeric in their umbilical cord, which may lead to neonatal tetanus, a practice of pre-lacteal feeds that is often accompanied by health risks to the infant (Sibarani & Fachry, 2020). The urge to promote healthy healing and to fasten the cord desperation are underlying beliefs directly connected to the use of certain materials in the umbilical cord. In recent studies, however, there is a certain transformation of leaving the umbilical cord alone and evading the pre-lacteal feeds, which may be mainly caused by the increase in female education by community health workers.
According to Loiola et al., (2020), a delivery plan is a technology that enhances the incorporation between the pregnant mother and healthcare practitioners. It works by strengthening health communication among new mothers. It further tends to express the wishes of lactating females regarding the contexts of parturition and further emphasizes that the majority of women are often accountable for the decisions made concerning their bodies. Thus, the delivery plan should be designed in such a way that it jointly prepares the woman and the Obstet practitioners and can be prepared with the family doctor or at the ward hospital based on the comprehension that the invention of the birth plan begins from the start of the pregnancy with the aim of reproductive privileges and exclusivity of a woman (Baldwin et al., 2018). It may also comprise operative communication among practitioners, new mothers, and their families. The use of individualized care should also be founded on the values of justice and kindness and finally becomes a tool that factors the joining of pregnant women to the necessary interventions and healthcare practitioners.
For the majority of women, safe deliveries often equate to having the coincidence in the healthcare team throughout the labor process and further ensuring that the mother is actively involved. The assistance offered by healthcare practitioners should therefore generate a sense of freedom and autonomy for the new mother so that they feel their needs and demands are met. Such aspects allow for qualified care that is in line with the pregnant woman’s choice. The delivery plan offers various actons that reinforce the relationship between the new mothers, their families, and healthcare practitioners (Loiola et al., 2020). This is because they are arbitrated by data about the best practices during delivery and birth care and their rights. For instance, the availability of companionship, free diet, and availability of companionship tend to strengthen and favor an empathetic approach that focuses on improving the mother’s well-being and their newborn. The delivery plan also characterizes positive experiences of both birth and delivery. Besides, the delivery plan often offers women knowledge of female physiology, specifically the gestation process and the processes that occur during the reproductive stage, thus making them aware of their various choices (Loiola et al., 2020). The process further translates to meanings about the moralities and needs of women and the active contribution to their care during the time of delivery.
Study design for interventions
Postpartum support plays a significant role in regards to the prevention of PPD. The regular visits of mothers during such periods are imperative. Visits, psychotherapy interventions, and the use of delivery plans tend to positively impact the coping skills of the new mother in the new situations. This can be attributed to the fact that most of the problems that are often related to both the newborn and the mother happen during the first 10 days of postpartum (Gillespie et al., 2018). Such interventions also prevent the mothers’ needs to a certain extent and drastically reduce the prevalence of postpartum stress. The majority of women who had intervention groups in the study had a higher frequency of supplements and high satisfaction with various support and services that they were being provided with. Herefore, it should be recommended that the health authorities consider offering new mothers home care services and other interventions to promote their health. Such interventions may also be included in the new mother’s health protocol.
Conclusion
Over the years, the occurrence of postpartum depression has been difficult to be recognized, which can be attributed to various factors. It may further be triggered by the cultural practices and beliefs that drastically impacts the health of both the mother and their newborns. The interventions applied to mothers experiencing postpartum depression may range from supportive interpersonal groups, visits by healthcare practitioners, cognitive therapy, and pharmacological interventions. The most common type of psychological interventions used among the population includes psychosocial support, cognitive therapy, and professional-based care. However, among the intentions, psychosocial support was considered the most effective for mothers with PPD since it significantly reduced the symptoms associated with eh disease. Delivery plans can also be effectively used beginning from the onset of the pregnancy. Such interventions help make the mother feel that they are in control of various decisions made on their body.
References
Anokye, R., Acheampong, E., Budu-Ainooson, A., Obeng, E. I., & Akwasi, A. G. (2018). Prevalence of postpartum depression and interventions utilized for its management. Annals of General Psychiatry, 17(1). https://doi.org/10.1186/s12991-018-0188-0
Baldwin, M. K., Hart, K. D., & Rodriguez, M. L. (2018). Predictors for Follow-up Among Postpartum Patients Enrolled in a Clinical Trial. Science Direct.
Castillo-Angeles, M., Smink, D. S., & Rangel, E. L. (2021). Perspectives of US general surgery program directors on cultural and fiscal barriers to maternity leave and postpartum support during surgical training. JAMA Surgery, 156(7), 647.
https://doi.org/10.1001/jamasurg.2021.1807
George, M., & Johnson, A. R. (2018, 6). Postpartum and Newborn Care-A qualitative study. ResearchGate.
https://www.researchgate.net/publication/327981448_Postpartum_and_Newborn_Care-A_Qualitative_study
Gillespie, L., Mitchell, A. M., & Kolwasky, J. M. (2018). Maternal Parity and Perinatal Cortisol Adaptation: The Role of Pregnancy-Specific Distress and Implications for Postpartum Mood. Science Direct.
Kiaei, Z., Zahrani, S. T., Janati, P., & Nasiri, M. (2021). Paternal breastfeeding self-efficacy and maternal breastfeeding patterns at three months postpartum. https://doi.org/10.21203/rs.3.rs-1031489/v1
Kotasthane, D. S., & Kotasthane, V. D. (2017). Utility of interactive teaching tools in classroom Teaching-A review of literature. Annals of Applied Bio-Sciences, 4(1), R18-R21. https://doi.org/10.21276/aabs.2017.1345
Loiola, A. M., Alves, V. H., Vieira, B. D., Rodrigues, D. P., Souza, K. V., & Marchiori, G. R. (2020). Plano de parto Como TECNOLOGIA do CUIDADO: ExperiÊncia de PUÉRPERAS Em Uma Casa de PARTO. Cogitare Enfermagem, 25. https://doi.org/10.5380/ce.v25i0.66039
Mittal, L. P. (2020). Prevention of postpartum disorders. Postpartum Mental Health Disorders: A Casebook, 99-104.
https://doi.org/10.1093/med/9780190849955.003.0012
Sibarani, H. R., & Fachry, M. E. (2020). The Role of Tamiang’s Local Wisdom in Decreasing Postpartum Depression: A Linguistic Anthropology study?. sCIENCE Direct. https://doi.org/10.1016/j.enfcli.2019.07.145
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