Post Partum Depression

Postpartum depression is a serious illness that affects many women. PPD is divided into three levels. The first and least severe of these levels is commonly called "baby blues" and occurs in anywhere from 40-85% of postpartum women. "These symptoms peak between postpartum days 3 and 5, and typically resolve spontaneously within 24 to 72 hours. The primary treatment is supportive care and reassurance about the transient nature of the condition."(www.obgyn.net.) In the clinical setting supportive care and reassurance are care aspects that would often fall to the nurse to perform. Because of short amount of recovery time postpartum mother and babies are spending in the hospital, many patients will develop a peak in these symptoms once they are already home. While the patient is hospitalized the nurse needs to make sure that she/he has educated the family and the patient about the symptoms of these "baby blues", and need to make sure the patient knows that these symptoms generally resolve themselves. "If the signs and symptoms of depression don't lessen after a few weeks or if they're so severe that they interfere with ability to complete everyday tasks" the nurse should educate the patient to seek medical help at that time.(www.mayoclinic.com)

The most extreme level of this disorder is called puerperal psychosis. This is a very rare disorder, and only occurs in 0.1% to 0.2%. (www.obgyn.net) Most of the patients that do have puerperal psychosis suffer from comorbid disorders such as being bipolar or having schizophrenia. When we hear these terrible stories about mother drowning their children in the bathtub, they usually have this type of disorder. Many laymen and media will call this disorder "severe postpartum depression", but that is not a medically correct label. "Patients suffering from puerperal psychosis are severely impaired, suffering from hallucinations and delusions that frequently focus on the infant dying or being divine or demonic. These hallucinations often command the patient to hurt herself or others, placing these mothers at the highest risk for committing infanticide and/or suicide." (www.obgyn.net) This means that these patients need serious medical attention for their disorders and should be treated aggressively. They should never be on a 'wait and see' type of observation, such as very early "baby blues" would be. Any time any patient wants to hurt themselves or others they should be immediately placed under close observation by medical professionals.

The actual label of 'postpartum depression' refers a middle level between baby blues and puerperal psychosis. This problem occurs in 10-15% of all postpartum women that are over the age of 18, and in mother under 18 it occurs in 26-32% of women. There is a link between women who suffer from postpartum depression and latter reports of more depression. 80% of the women who are treated for postpartum depression will seek medical attention again in their lives for further depression. (www.obgyn.net)

There are studies that are seeking the long term effect of postpartum depression on the children whose mothers suffered with PPD. "Long-term follow-up studies of up to 4 years suggest that depressive episodes in a mother during the postpartum period were linked to poorer cognitive test scores in their children." (www.obgyn.net) This could be related to several factors, such as poverty, and is still preliminary in what it is finding.

The symptoms of postpartum depression can be variable but include; sad mood, loss of interest in usually pleasurable activities, difficulty concentrating or making decisions, psychomotor agitation or retardation, fatigue, changes in appetite or sleep, recurrent thoughts of death/suicide, feelings of worthlessness or guilt, especially failure at motherhood, and/or excessive anxiety over child's health. To be diagnosis with postpartum depression the patient must have feelings of sadness and any four of the other symptoms listed above for two weeks or more. The "symptoms must be present for more than 2 weeks postpartum to distinguish them from the "baby blues."" (www.obgyn.net)

There are many risk factors that can be linked to a predisposition for post partum depression. It must be made clear to patients that just because they have risk factors for PPD that does not mean that they will definitely have PPD, but the nurse and patient can use these risk factors as a guide. There is a 30% higher chance that a patient will have post partum depression if they have had a depressive episode in the past. (www.obgyn.net) "Studies show that most women who experience major depression after childbirth have had prior episodes of depression even though they may not have been diagnosed or treated." (www.med.umich.edu) Another risk factor for depression is a family history of depression. Other stressors, such as poor marital status or lack of social support, are also risk factors to postpartum depression. "Obstetric factors such as the length and difficulty of labor, multiple gestation, and advanced maternal age" can also be risk factors. (www.obgyn.net)

There are various forms of treatment for PPD ranging from therapy to medication, to a combination of both. Any medications that are given to a PPD patient