Postpartum depression (PPD) can be described as moderate to severe depression experienced by a woman after she has given birth. It may occur anytime during the one year after delivery. In most cases, it occurs within the three months after delivery. Pearson (2008) has defined PPD as “the presence of either depressed mood or decreased interest or pleasure occurring persistently for two weeks and resulting in a decline in functional status”.

Research has found that mothers who suffer from depression will encounter problems when interacting with their children. Due to this persistent state of 'baby blues', they are less likely to breastfeed and play with their children and the inconsistencies in their moods will disrupt the bonding process, resulting in the failure of a secure attachment forming between mother and child. A child who is insecurely attached to his mother is at risk for multiple developmental difficulties and delays, including those that are behavioral.

As such, for the sake of both mother and child, it is important to detect this condition in mothers and take the necessary steps towards both prevention and treatment where necessary, and nurses play an important role in this.

The prevalence of postpartum depression

In Singapore, it was found that the “prevalence of perinatal depression in Singapore is about 12% for antepartum depression and about 7% for postpartum depression. Peripartum depressive symptomatology is seen in up to 1 in 5 pregnant women, although not all amounting to major depression” (Chen et al., 2011). Meanwhile, KKH Women’s and Children’s Hospital reported that postpartum depression affects “1 in 12 local women”.

However, recent results are more worrying, indicating that this maternal illness has become more common, affecting more individuals than previously. As reported by Belluck (2014), “In the year after giving birth, studies suggest at least 1 in 8 and as many as 1 in 5 women develop symptoms of depression, anxiety, bipolar disorder, obsessive-compulsive disorder or a combination.”

Symptoms and clinical manifestations of PPD

Even small changes in hormone levels can affect a woman’s mood, such as before her menstrual period. Likewise, during pregnancy, the hormones estrogen and progesterone may increase rapidly. However, during the first 24 hours after childbirth, these hormones immediately drop to a normal non-pregnancy level. Also, the level of thyroid hormones drops, leading to fatigue and depression. These rapid hormonal changes, along with the changes in blood pressure, immune system functioning, and metabolism that new mothers experience, eventually trigger postpartum depression (Baker, 2006).

In practice, sufferers of PPD will experience symptoms that are fairly easy to detect, and nurses should pay close attention to these. They may notice a big change in the mother’s mood, particularly when she shows strong and persistent feelings of sadness, fatigue and irritability, sleeping difficulties, feelings of guilt and failure and a lack of interest in doing normal activities. More dangerously, they may have thoughts of self-harm or have ideation to make harm to the baby (Klossner, 2006).

If left untreated, postpartum depression could lead to problems such as infant injury, infant death and suicide. Children of mothers who have untreated postpartum depression are more likely to have behavioral problems, such as sleeping and eating difficulties, temper tantrums and hyperactivity. Delays in language development are common as well.

As such, nurses who suspect that a mother is suffering from postpartum depression can do the following to help: 

Be aware of how the patient is feeling

Once PPD has been diagnosed, nurses should assess the patient’s level of anxiety by encouraging her to verbalize her feelings regarding her health condition (Klossner, 2006). This is imperative to determine the factors that contribute to the patient’s anxiety and also for collecting adequate information as baseline data for the next nurse who intervenes.

Encourage constant familial support

A mother who suffers from PDD needs constant support, especially from family members, and it usually inevitably falls to the nurse to advise on how this support should be provided. For example, emphasis should be placed on family members being with the mother as often as possible to ensure her emotions are more stable, or helping to perform any chores/childcare that would cause her additional stress or emotional upheaval. Most importantly, they must be made aware that the mother needs plenty of time to to rest.

Nurses could also suggest that the mother join a new mothers support group, as this is effective in alleviating feelings of isolation. In Singapore, there are many support groups in this area, such as ‘New Mothers’ Support Group’ and ‘Breastfeeding Mothers’ Support Group’. 

Encourage a balanced diet

During confinement, a healthy and well-balanced diet is vital for the new mothers, but PPD may prevent them from adhering accordingly. Here, a nurse could step in using healthcare professional status to advise and reassure that all measures being taken are for the best. For example, they should be encouraged to have a high intake of green vegetables, milk, plain water and vitamins for breast milk supply and fast recovery.

PPD can develop into a serious mental health illness if left untreated. Therefore, nurses must help mothers who suffer from it to seek help right away, taking care to explain that the symptoms that they experience are beyond their control, and there is no reason to feel guilty. More importantly, they must be reassured that help and support is available, and they are definitely not beyond treatment. MIMS

Read more:
Being a nurse and pregnant all at once : 6 tips to guide you
Severely depressed women decrease chances of getting pregnant
Breastfeeding: Mothers have more problems than public discrimination
Major research on postpartum depression to use new research app

References:
Baker,P.N.(2006).Obstetrics By Ten Teachers. United States of America : Hodder Arnold.
Belluck, P. (2014). Thinking of Ways to Harm Her; New Findings on Timing and Range of Maternal Mental Illness. The New York Times. Retrieved from https://www.nytimes.com/2014/06/16/health/thinking-of-ways-to-harm-her.html?_r=0
Breastfeeding Mothers’ Support Group. Retrieved from http://breastfeeding.org.sg/
Chen, H., Wang, J., Ch’ing, Y.C., Mingoo, R., Lee, T., & Ong, J. (2011). Identifying Mothers with Postpartum Depression Early: Integrating Perinatal Mental Health Care into the Obstetric Setting. ISRN Obstetrics and Gynecology, 2011, 7.
Klossner,N.J.(2006). Introductory Maternity Nursing. United States of America: Lippincott Williams & Wilkins
McKinney, E. S., James, S. R., Murray, S. S., & Ashwill, J. W. (2009). Maternal-Child Nursing. Missouri: Saunders Elseviers
New Mothers’ Support Group. Retrieved from http://www.nmsg-singapore.com/
Pearson, E. (2008). Postpartum depression: Does early education help first-time mothers recognize and seek early treatment? Retrieved September 20, 2011 from http://books.google.com.my/books?id=sOdraeOt4FsC&printsec=frontcover#v=onepage&q&f=false