Beyond the Baby Blues

From The Floor

Beyond the Baby Blues

How nurses can recognize postpartum depression

By Genevieve M. Clavreul, RN, Ph.D.
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As nurses we play an important role in people’s lives; some we directly affect when we are their “assigned” nurse and others we affect through our advocacy at city, county, state and federal levels. Poll after poll continues to show that the American public sees nurses as some of the most trusted professionals in our nation. This honor can weigh heavily on us, but most nurses acquit themselves well and thus earn this privileged position in our society.

One way nurses can affect the well-being of their community is by attending meetings and being involved with groups that share a core interest or concern. These groups can be organized around a nursing specialty or a governmental body, such as a city council meeting or commission meeting. You’d be surprised how often health issues are discussed during a council or a commission meeting, especially when said commission is the Los Angeles County Commission for Women.

The Los Angeles Commission for Women meets once a month and often invites speakers to help educate its membership. Recently, Kimberly Wong, from the Los Angeles County Public Defenders’ Office, presented a riveting presentation about postpartum depression (PPD). Her presentation was as insightful as it was personal.

The Inner Darkness Emerges

 She shared with us the story of her battle with PPD, suffered after the birth of her first child. The story she shared was of an up-and-coming young professional, an attorney with the Los Angeles County Public Defender's Office — a well-educated, self-assured young mother-to-be — someone who did not fit the typical PPD profile.

Her pregnancy had been without complications and she returned to work at the end of her maternity leave. It wasn’t long afterward that she began to sense not all was right with her world. Unsure of her doubts, she simply ignored the nagging suspicion, but then the dark feelings of depression became stronger, “pulling” at her.

She talked about how these feelings left her unable to sleep, and how this lack of sleep affected her ability to perform a gamut of normal things such as eating, interacting with others, being able to pay attention, recall what people had just told her, and so forth. These weren’t the normal feelings of being out-of-sorts or the anxiety that one might feel during everyday life. Her inner voice kept nagging her that something was very, very wrong.

Though she didn’t describe being suicidal or wanting to harm her child, she did describe feeling as though she’d wouldn’t care if she died. She shared her concerns with her husband. He believed her feelings were cause for alarm, and when she ask for professional help, he took her to their local emergency room to have a physician look at her.

Saved by the Treatment

The ER physician diagnosed her with a severe case of PPD. He suggested that the best treatment for her would be a psychiatric facility. She agreed and made the decision to be voluntarily admitted. Though this commitment might appear extreme, for Kim this was a necessary step in regaining her mental well being. Kim credited the treatment and care she received while in the psych ward for her ability to overcome her PPD and return home to her husband and newborn.

Ultimately Kim would accept voluntary commitment twice, returning for treatment one week after she was released, realizing that she’d been released from treatment too early. Kim’s experience with identifying and treating her PPD (although it was at a critical state) brought an awareness that there was much work to be done to differentiate between PPD and “Baby Blues.”

What is PPD?

Listening to her story revealed just how pernicious PPD can be for the sufferer and their family, and how our medical/nursing community often misses the symptoms of this illness, especially when the patient doesn’t fit the profile. National studies indicate that PPD affects roughly 10 percent of women during both pregnancy and in the postpartum period. General consensus is that this percentage would be higher if there were universal screening in place.

A definition of PPD from The National Center for Biotechnology Information, US National Library of Medicine (NCBI/NLM) says this: PPD is moderate to severe depression in a woman after she has given birth. It may occur soon after delivery or up to a year later. Most of the time, it occurs within the first 3 months after delivery.

Some of the symptoms of postpartum depression are as follows*:

Feelings of sadness
Mood swings, highs and lows, feeling overwhelmed
Difficulty concentrating
Lack of interest in things you used to enjoy
Changes in sleeping and eating habits
Panic attacks, nervousness, and anxiety
Excessive worry about your baby
Thoughts of harming yourself or your baby
Fearing that you can’t take care of your baby
Feelings of guilt and inadequacy
Difficulty accepting motherhood
Irrational thinking: seeing or hearing things that aren’t there.

*A more complete definition, along with signs, symptoms and treatment, can be found at; search “PPD.”

We Didn’t Know

As a NICU/PICU nurse I don’t recall any of our mothers being diagnosed with PPD. I’m not so naïve to think that none of our patients’ mothers were at risk; the adrenaline-charged and emotion-filled NICU/PICU may have held the mother’s symptoms at bay until the crisis passed.
Regardless, after learning more about the scope and impact of PPD, I thought about how helpful this knowledge would have been to my teammates and myself in our interaction with our NICU parents. Armed with what symptoms to look for, would we have been in a position to provide additional support to mothers showing signs or symptoms of PPD? I believe that the answer is a resounding “yes!”

Who Is Affected?

The experts aren’t always in agreement about what causes PPD and who is most vulnerable. Here is a summary:

• There is a negative correlation between the income of the mother and the likelihood of being diagnosed with PPD – the incidence of depression decreases as the mother’s income increases. Additional studies have also shown a correlation between a mother’s race, social class and/or sexual orientation and PPD.

• It had been postulated that the profound hormonal changes after childbirth were a causation of PPD; however, studies published in 1994 and 1995 failed to find such a relationship. Also, fathers have been diagnosed with PPD, and as we all know they don’t undergo hormonal changes during pregnancy! A study published in 2004 showed that fathers indeed suffered from PPD, at times at even higher rates than mothers.

Touching the Whole Family

Mothers (and fathers) are often reticent to speak to their healthcare team about symptoms that they suspect may be signs of PPD. However, great strides have been made in recent years to educate mothers, of all socioeconomic and cultural backgrounds about the signs and symptoms of PPD, as well as providing greater access to treatment.

Unfortunately, there’s still much work to do, especially in advocacy and legislation. For example, a friend who’s also a practicing OB/GYN shared with me that he’s not reimbursed for treating PPD via psychiatric methods and support, but is reimbursed if his patient agrees to medicate the problem. Medicating is helpful, but this is a band-aid on underlying psychiatric issues and does little in the way of long-term treatment, especially if that mother should have additional children. For a mother diagnosed with PPD, the risk increases with each subsequent child.

I learned a great deal from Kim that day and her story compelled me to dedicate my column this month to the topic of PPD. This depressive disorder touches the lives of the whole family, as well as the extended family, and if left untreated can have devastating effects.

As nursing professionals we often see ourselves getting information in the way of continuing education credits, hospital workshops, nursing journals and whatnot. Keep in mind, equally valuable information can be attained during the monthly healthcare committee meeting of the Los Angeles County Commission for Women.   

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