Postpartum Depression Nursing Diagnoses

Anxiety r/t new parenting responsibilities AEB verbalization of anxiety, difficulty sleeping, restlessness.

Fatigue r/t postpartum state AEB lack of energy, exhaustion, irritability.

Ineffective role performance r/t new parenting responsibilities AEB not responding to baby crying, not making eye contact with the baby.

Postpartum Support Groups

There are many important elements to facilitating an effective support group for postpartum depression. One of the first things that is crucial for a facilitator to establish is a culture that invites the sharing of difficult, potentially taboo subjects. Cara Fairfax, a social worker who has been running her own support group for folks with postpartum depression talks about how it is important to establish mandatory reporter guidelines so women know that they can share many things without loosing their child to child protective services. To a postpartum mother struggling with suicidal or homicidal ideation, they may feel they have to carry that burden themselves for fear of losing their child. It is important to allow women to have a space to share feelings of regret, anger towards their child, fear about losing their relationship and difficulty with sex and intimacy postpartum, and also suicidal and homicidal ideation.

Taboo subjects are not only emotional either. The physical symptoms postpartum mothers experience often are considered shameful or inappropriate to talk about, such as leaking breasts, hemorrhoids, and loss of bladder control. Being able to share these symptoms makes it so women feel less shame and instead experience camaraderie with other people experiencing the same things as them.

It is important to choose a good location for the support group. Addrienne Griffin talks about her postpartum support group and talks about how important it has been for her to host her group at a hospital. This is good because women who have given birth at that hospital already know about their group. Also, the hospital advertises for them in their publication and on their website. Griffin talked about how hosting it at a hospital was helpful because there are other postpartum resources operating in the hospital, such as breastfeeding classes. The classes and groups in the hospital formed good rapport with each other. They made sure to reach out to the folks receiving services from them and suggest other classes and resources from the hospital to them.

  

Apps for Postpartum Depression

 Postpartum depression presents a challenging set of experiences for any new mother, and the more support she can get, the better. There are many apps that can assist new mothers who are experiencing postpartum depression.

Start- This is an app where a person can track their depression medication along with their symptoms and response to the medication. Depression medication takes time to be effective, so it is important to track a person's progress to see if they are responding in an effective way to their medication.

http://www.iodine.com/start/postpartum

Optimism- This app allows people to track their mood and allows planning for coping strategies such as diet, exercise, and relaxation techniques. This is helpful because it allows people to track patterns in their mood and pick out possible triggers for certain feelings.

http://www.findingoptimism.com/

Sleep Genius- This app plays relaxing music that is designed to facilitate deep and restful sleep. Since changing sleep patterns and insomnia play a significant role in postpartum depression, this could be a very helpful resource for new mothers.

http://sleepgenius.com/

Beyond Blue Check In App- This app is designed for the support system of someone experiencing mental illness. This app helps a person design a conversation they can have with a person they love who is going through a difficult time or a mental health crisis. It provides them with resources they could suggest for their loved one and lets them report back how their conversation went.

https://www.beyondblue.org.au/about-us/about-our-work/youthbeyondblue/the-check-in-app

Breathe- This app measures your heart-rate through the camera in your phone. Then, through breathing techniques, helps you lower your breathing and heart rate. Feelings of anxiety often accompany postpartum depression, so this could be an important tool in lowering ones stress levels.

http://au.reachout.com/reachout-breathe-app

Here is a link to a buzzfeed article with a list of general mental health apps that I found to be helpful.

http://www.buzzfeed.com/ariannarebolini/amazing-apps-for-anyone-living-with-anxiety#.fm06DRej4

And here is one more.

http://www.buzzfeed.com/nicolaharvey/courage-is-knowing-what-not-to-fear#.vsLG48wJP

Postpartum Depression Websites

Postpartum depression is not an easy thing to navigate. It is essential that those battling postpartum depression receive support from others and utilize the resources available to them. The internet, though not without its fair share of faulty information, can be an excellent resource. There are websites that provide reliable, well-researched information in a way that is accessible and easy to understand, as well as websites that connect people struggling with postpartum depression to create a supportive online community. 

One of the most popular blogs dealing with maternal mental illness is postpartumprogress.com. The website functions primarily as a blog but also has a lot of very helpful information and resources on it such as: descriptions of signs and symptoms, information about treatment and support groups, books on PPD, discussion forums, and answers to common questions about PPD.

Another blog that offers a lot of good general information about postpartum depression is www.1800ppdmoms.org. This website isn’t quite as expansive as the first website mentioned but offers a good overview of the PPD basics on its homepage. A highlight of this site is that it dedicates a section to debunking a few common PPD myths.

There are a number of other websites offering various amounts and kinds of information. Some of these are:

www.marchofdimes.org

www.womensmentalhealth.org

www.womenshealth.gov

www.cdc.gov

While the internet is a good source for general information about postpartum depression, it should by no means be considered your ultimate authority. Information should first come from health professionals and the internet should be used to reenforce or round out information relayed by specialists, and even then, taken with a grain of salt. Above all, the internet provides an excellent platform from which to meet other people going through similar struggles, learn from each other, and build a supportive community. 

Treatment of Postpartum Depression

Treatment for postpartum depression is very similar to treatment for depression and other mood disorders. Hospitalization may be necessary in cases where the mother is suicidal or feels they may harm their baby. Postpartum depression can be treated with antidepressants, usually in combination with therapy or a support group. Selective serotonin reuptake inhibitors are one option for antidepressants, as are tricyclics. Both of these medications are thought to be safe for women who are breastfeeding. This can often be a conflict for mothers. Some mothers may be concerned about the way the medication affects their breastfeeding baby, and some medications may be unsafe for breastfeeding babies. Because of this, some women may need to choose between breastfeeding and taking their medication. This is challenging because breastfeeding is good for the baby and helps the baby and the mother to bond. For a women who may already be experiencing worry and anxiety about how well they are caring for their baby, taking medications that make it so they must stop breastfeeding may feel like a failure to them. However, it is important for people to take the medications that help them function best.

Some new mothers may choose to use herbal medicine as one way to treat their symptoms. St. John's wort, which helps with depression, and kava, which helps with insomnia and anxiety, are both used to treat postpartum depression. Other new mothers may choose to use traditional Chinese medicine which utilizes herbs and roots to treat abnormal symptoms. Treatment by Chinese medicine is personalized, so it will vary from person to person. Omega 3 fatty acids have also been used as a treatment for depression. Both infant and maternal massage has been used as a treatment for postpartum depression. People experiencing postpartum depression may also want to use aromatherapy using essential oils. Acupuncture is another common complementary or alternative treatment.

Signs and Symptoms of Postpartum Depression

There is a large overlap in the signs and symptoms of depression and postpartum depression. According to the center for disease control (CDC), some signs of depression a person might have whether or not it is related to childbirth are persistent feelings of sadness, anxiety or emptiness, hopelessness and pessimism, and feelings of guilt, worthlessness, or helplessness. Furthermore, the depressed person may experience loss of interest in the hobbies and activities they used to find fulfilling, lose energy, or have difficulty focusing and making decisions.A common symptom is either an increase or decrease in appetite. There may be aches and pains that aren't getting better with treatment. Finally, there may be self harm, thoughts of suicide, or suicide attempts.

According to the CDC some symptoms that are more specific to postpartum depression are crying more often than usual, feelings of anger, withdrawal from family and friends, feelings of numbness or not being able to bond with one's baby, worrying about hurting the baby, and feeling guilty about how one is caring for the baby.

There are a few very common and destructive misconceptions and myths about the signs and symptoms of postpartum depression.One harmful misconception is that signs and symptoms will always begin about three months after the birth of the child. This is problematic, because in many cases signs and symptoms don't show up until later; some mothers may not show symptoms until up to a year after birth of their child.

Another myth is that excessive crying and sadness is always a sign and symptom of postpartum depression. However, for many mothers, they experience anger, numbness, anxiety, or other emotions or experiences that don't lead them to cry and aren't necessarily sadness.

Furthermore, media depictions of postpartum depression tend to sensationalize  the signs and symptoms and focus of excessive sadness and constant crying. Most destructively, the media focuses on stories of mothers who have harmed their babies. This adds to the stress a mother who is experiencing postpartum depression is experiencing and may make them even more hesitant to seek help.

http://www.womenshealthmag.com/health/postpartum-depression-myths

http://www.empowher.com/postpartum-depression/content/postpartum-depression-myths-and-misconceptions-keep-women-seeking-help?page=0,1

http://www.cdc.gov/reproductivehealth/depression/

Diagnosis of Postpartum Depression

When diagnosing postpartum depression it is important to have a holistic understanding of the person experiencing symptoms experience. Elements such as socioeconomic class, race and ethnicity, religions, culture, and sexual orientation play a role in the way people experience postpartum depression as well as the resources they have access to. Because of this, it is incredibly important to take all of these elements into account when diagnosing postpartum depression. The person diagnosing postpartum depression in a patient should either perform or request a general physical examination to see if there are physical illnesses that could contribute to mental health issues. Often this includes blood tests to determine whether or not the mother has an underactive thyroid. Under-active thyroid often contributes to depressive symptoms. Diagnosing postpartum depression also involves doing general intake questions or a depression questionnaire which may include questions about the mother's mood, substance use, mental health history and suicidal thoughts.

It is important when diagnosing postpartum depression that the symptoms are very similar to the “baby blues.” It is extremely common for mothers to feel sadness, anxiety, irritability, confusion, and crying more frequently then they are used to. However, this normally peaks around day four and resolves around day ten. This is also important in terms of patient education. A mother may be experiencing these symptoms but not seek help because she thinks these symptoms will pass and are too common to need medical assistance. 

Another barrier in terms of diagnosis is that mothers may feel shame or embarrassment around their symptoms. Motherhood is often idealized, so feeling anything other than joy or experiencing anything other than bonding with their baby may be a difficult experience to communicate.

http://www.mayoclinic.org/diseases-conditions/postpartum-depression/basics/tests-diagnosis/con-20029130

http://www.medicinenet.com/postpartum_depression/page3.htm

http://www.cdc.gov/reproductivehealth/depression/

Etiology and Pathophysiology of Postpartum Depression

Postpartum depression is characterized by many different symptoms such as depressed mood and lack of interest in normal, daily activities, disturbances in sleep and appetite, lack of energy, and suicidal thoughts or actions. This can be challenging for healthcare professionals because changes in appetite and sleep which lead to lack of energy are extremely common because of the nature of having a new member of the family to take care of. 

The risk of depression is increased within the first year of childbirth, with adolescents being more susceptible to postpartum depression than other women. People who have experienced depression before are more likely to experience postpartum depression. Social factors play a major role in the likelihood of a person experiencing postpartum depression. Women who have low levels of education, little social support such as the lack of a partner, women experiencing poverty and women who abuse drugs or alcohol are more likely to experience postpartum depression than other women. Another factor is the pregnancy and delivery itself. Unplanned pregnancy, problems during pregnancy and delivery, and the mode of delivery have been argued as factors that can contribute to postpartum depression.

Postpartum depression not only affects the mother and her well-being, but affects the wellbeing of the child. Infancy is a crucial time for development, and if the mother does not have the capacity to bond with her baby, the child will experience developmental delays. Furthermore, postpartum depression increases instances of infanticide and infant neglect.

One conflict medical professionals face when evaluating the etiology and pathophysiology of depression in new mothers is the tension between the positive and adverse effects of psychotropic medication. While giving a mother psychotropic medication decreases the risk of suicide, infanticide, substance abuse, and malnutrition, there may be adverse side effects for a fetus or child that is exposed to these drugs. However, there are also adverse side effects for the child if their mother's bonding with the child is disrupted during this crucial developmental stage.  

http://www.sciencedirect.com/science/article/pii/S0896627308005886

http://www.medscape.com/viewarticle/775406

http://dareallalucedoula.com/postpartum-support-for-new-moms/more-than-just-the-baby-blues-all-about-pnd-postnatal-depression/

Who Is Affected?

If you haven’t experienced postpartum depression or been aware of anyone close to you going through it, it may surprise you how common it actually is. The statistics vary from source to source and country to country, of course. The prevalence in Singapore is estimated to be nearly 0%, as opposed to almost 57% in Brazil. In the U.S., the estimated average prevalence rate comes out to about 15%, which means for every 4 million annual live births there are 600,000 new mothers who suffer from postpartum depression. Note that this takes into account only live births, and does not account for episodes of depression involving miscarriages or stillbirths. 

Obviously there is more to determining the likelihood of experiencing postpartum depression than just math. There are several risk factors for postpartum depression, including:

A history of depression or bipolar disorder.

Having a family member with a history of mental illness. 

Medical complications during childbirth.

Substance abuse.

Lack of emotional support from parter, family, or friends.

While postpartum depression can affect any mother, regardless of age, race, ethnicity, or socioeconomic status, there are certain demographic factors which seem to make it more likely for a woman to experience postpartum depression. Many studies have stated that the prevalence rate is higher in high-poverty areas, reaching as high as 25%. 

There has also been research suggesting that immigrant women in the U.S. are more susceptible to postpartum depression than are native born women. Researchers at Brigham Young University conducted interviews with ninety-six Hispanic women who had given birth within the past year. The women all completed the Postpartum Depression Screening Scale (PDSS) tool in Spanish, which asked questions about areas such as anxiety/insecurity, sleeping and eating disturbances, and guilt/shame. The results showed a prevalence of 54%, significantly higher than the average prevalence in the United States. This is consistent with other studies which have found a higher prevalence among Hispanic women. 

An important part of breaking down the stigma surrounding postpartum depression is realizing how many women actually are affected by it, and understanding there is a good chance that someone you know has been, is, or will be going through it too.

What is Postpartum Depression?

The period of time following labor is often portrayed as a season of joy and wonder for new mothers. After the long discomfort of pregnancy and the painful intensity of delivery, mom gets to hold her baby in her arms and hear his crying and cooing and see his face without the aid of an ultrasound machine. Everything has been building up to this and it’s considered a sort of payoff moment, with all the challenges and frustrations finally culminating in this beautiful meeting. 

This is the common picture of postpartum, but it is not reflective of many women’s experience. 

An immediate sense of bonding with your child is by no means a guarantee. Between 60% and 80% of new mothers experience “baby blues”, while about 15% of new mothers in the United States experience a more serious and long-lasting mood disorder known as postpartum depression. In defining postpartum depression, it is important to clarify what the baby blues are to emphasize that there is an important difference between the two.

The baby blues are common among the majority of new mothers. The baby blues are characterized by anxiety, irritability, mood swings, and crying, sometimes for no apparent reason. This tends to last no longer than ten days after delivery.

Postpartum depression sometimes gets confused with the postpartum blues and while there may initially be some similarities, the symptoms of postpartum depression are more severe and do not eventually go away on their own; they get worse over time and require treatment. Mothers with postpartum depression may experience feelings of guilt, worthlessness, hopelessness, sadness, and restlessness, just to name a few. Postpartum depression can present differently from individual to individual. For example, some mothers become overly anxious and worried about their new child while other mothers show little to no interest in their baby. 

Postpartum depression is a multi-faceted and complicated issue and, like most mental/mood disorders, is surrounded by stigma. It is important to encourage communication and education on postpartum depression to support the mothers, babies, and families whom it affects.