Postpartum Disorder

8/9/2019 Postpartum Disorder

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POSTPARTUM DEPRESSION

BEYOND THE BLUES

Debby Carapezza, R.N., M..S.N.Nurse Consultant, Reproductive Health Program

tah Department o! Health


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"NC"D#NC# $% D#PR#SS"$N

#ach year, &'( to )*( o! adults in the

nited States e+perience a maor depression

-he incidence among omen is tice that

o! men and pea/s beteen &0 to 11 years o!

age 2 the childbearing years


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D#PR#SS"$N "N 3$M#N

3omen are at increased ris/ o! mood

disorders during periods o! hormonal

!luctuation2 premenstrual

postpartum

perimenopausal


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P$S-P4R-M D#PR#SS"$N

;.0( to &;.'( o! omen e+perience

postpartum depression


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S8MP-$MS $%

P$S-P4R-M D#PR#SS"$NHopelessness 6oss o! pleasure in activities

Helplessness Mood changes

Persistent sadness "nability to adust to role o! motherhood

"rritability "nability to concentrate

6o. sel!2esteem Sleep >appetite disturbances


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R4N5# $% S8MP-$MS

Symptoms range2 !rom mild dysphoria

to suicidal ideation

to psychotic depression


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DR4-"$N $% S8MP-$MS

ntreated, symptoms can last?

several months

into the second year postpartum


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-H# #-"$6$58 $%

P$S-P4R-M D#PR#SS"$N7arious theories based in physiological

changes have been postulated? hormonal e+cesses or de!iciencies o! estrogen,

progesterone, prolactin, thyro+ine, tryptophan,

among others


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#-"$6$58 $% P$S-P4R-M

D#PR#SS"$N$ther theories cite numerous psychosocial

!actors associated ith PMD? marital con!lict child2care di!!iculties

problems=

perception by mother o! an in!ant ith adi!!icult temperament

history o! !amily or personal depression


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"N -4H

3hat can PR4MS@ data tell usA

@PR4MS is an ongoing, population2based ris/ !actor surveillance

system designed to identi!y B monitor selected maternal

e+periences that occur be!ore B during pregnancy B e+periences

o! the childs early in!ancy.


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"ND"CD#NC# $%P$S-P4R-M D#PR#SS"$N

4M$N5 )*** -4H PR4MS

R#SP$ND#N-S)1.&( o! PR4MS respondents indicatedthat in the months a!ter delivery they ere

moderately to very depressed


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3hen the results o! the survey are eighted

to represent all 1,EE& tah omen ho

had a live birth in )***, this means anestimated &&,1&; omen reported being

moderately or very depressed.


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Higher rates o! depression ere

noted among omen ho?


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-H# "MP4C- $%



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6$N5 -#RM

C$NS#F#NC#S $% PMD

Negative impact on the in!ant Gs social,

emotional and cognitive development

) month old in!ants o! mothers ith PMD had

decreased cognitive ability and e+pressed morenegative emotions during testing


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6$N5 -#RM

C$NS#F#NC#S $% PMDabies o! mothers

ith PMD ere

perceived by theirmothers as more

di!!icult to care !or

and more bothersome.


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B M4-#RN46 M$R-46"-8"N -4H

"n recent years, there have been tomaternal deaths due to suicide by omen

ithin one year o! giving birth.

Neither oman had been screened !orpostpartum depression


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R"SI %4C-$RS %$R PMD

-%amily history o! mood

disorder

-Child2care di!!iculties?

!eeding, sleeping, health

-Client history o! mood

disorder prior to pregnancy

-Marital con!lict

-4n+iety>depression during

pregnancy

-Stress!ul li!e events

-Previous postpartum

depression

-Poor social support

-aby blues !ollo.ing current

delivery


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"N-#R7#N-"$NS

SCR##N"N5 %$R PMD


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SCR##N 466 P$S-P4R-M3$M#N %$R PMD #C4S#

4 3$M4N M48?

e unable to recognize she is depressed


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4 3$M4N M48?

elieve her symptoms are 9normal: !or ne

moms


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4 3$M4N M48?

%ear being labeled a 9bad mother: i! she

admits her maternal e+perience does not

meet societys picture o! bliss


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3H#N -$ SCR##N %$R PMD

4t preconception visit

During prenatal inta/e B subseJuent visits

During postpartum e+amsDuring in!ants 3CC B 3"C visits

3hen in!ant is seen !or sic/ care or in #R

4t early intervention home visits

4t !amily planning visits during the !irst year

postpartum

4t mothers visits !or routine episodic care


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SCR##N"N5 -$$6S

-here are several tools available? #dinburgh Postnatal Depression Scale


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4 3$RD 4$- SCR##N"N5

-$$6SKe !amiliar ith the tool 2 its validity and

limitations

Have a re!erral netor/ available !or omenscreening positive

Document the screening and any re!errals

made%ollo2up ith your client to assure that she

received needed assistance


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#D"NR5H P$S-N4-46

D#PR#SS"$N SC46#


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S4MP6# #PDS F#S-"$NS

&. " have been able to laugh B see the

!unny side o! things 4s much as " alays could Not Juite so much no

De!initely not so much not

Not at all


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S4MP6# #PDS F#S"-$NS


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S4MP6# #PDS F#S-"$NS


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-R#4-M#N-

&. #ducate the oman and her support

system regarding the diagnosis o!postpartum depression.


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-R#4-M#N- $P-"$NS

Pharmacological intervention

Counseling, individual and>or group

Support groups


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$-H#R C$NS"D#R4-"$NS?

Provider must be !amiliar ith agents and

the hepatic !unction o! mother and in!ant

Client must be in!ormed o! ris/s>bene!its o!treatment 7s. no treatment !or hersel! and

her in!ant

un/non impact o! long2term use o!medications on neurodevelopment o! in!ant


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$ther Considerations 2 Cont.

"! the oman chooses to breast!eed hile on

psychotropics, she should or/

collaboratively ith a psychiatrist and her

pediatrician"! the in!ant e+periences insomnia or other

behavior changes, his serum should be

assayed !or the presence o! medicationDocument all discussions regarding treatment

in the clients chart


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C$NS#6"N5

Ino re!erral sources in your locale,

especially those that? accept Medicaid

utilize a sliding !ee ill develop a payment plan ith the client

o!!er !ree counseling

e !amiliar ith indigent drug programsavailable through various pharmaceutical

manu!acturers


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Counseling 2 Cont.

4ny oman ith symptoms o! psychosis or

ith serious suicidal>homicidal ideation

should be re!erred !or emergencypsychiatric evaluation


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SPP$R- 5R$PS

Numerous postpartum support groups are

available. Contact?6ocal mental health agencies

Hospitals

3ebsites


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WEBSITE INFO & SUPPORT

Depression 4!ter Delivery 2

http?>>.depressiona!terdelivery.com

Postpartum Support "nternational

2http?>>.postpartum.net>

-he Postpartum Stress Center2http?>>.postpartumstress.com>

Postpartum #ducation !or Parents

2http?>>.sbpep.org$!!ice on 3omens Health

2http?>>.1omen.gov2pregnancy2a!ter the

baby is born2PPD


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3ebsites and $ther Resources

Mental Health 4ssociation in tah http?>>.+mission.com>mhaut>

%or in!ormation on medication hile

breast!eeding, call Pregnancy Ris/6ine? "n Salt 6a/e City? E)0248


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Re!erences &. ec/ 4-, 3ard, CH, Mendelson M, Moc/ , #rbaugh . 4n inventory !or

measuring depression. 4rchives o! 5eneral Psychiatry.


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Re!erences

Postpartum Disorder

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