According to the CDC, about one in nine women
experience postpartum depression. Oftentimes, nurses may be able to recognize
this in their patients and assist them in getting help. First, though, you have
to know what you’re looking for.
Susan Altman, DNP, CNM, FACNM, a clinical assistant professor and midwifery program director at the NYU Rory Meyers College of Nursing, has been a midwife for more than 20 years. She took some time to answer our questions on recognizing postpartum depression in new moms.
What are the main symptoms of postpartum depression in new moms? How can nurses learn to recognize what are the signs of PPD as opposed to something else?
Many women who give birth experience changes in mood due to significant changes in hormone levels after the birth. These changes do not cause depression in all women. The most common of perinatal mood changes in the postpartum period is postpartum blues or “baby blues,” which manifests itself with such symptoms as sadness, crying, and mood swings. Most often these signs begin 5-7 days after the birth, lasting just several weeks.
PPD, a major depressive disorder, can also begin in
the days following birth, and may be mistaken for baby blues at
first. But the symptoms are more commonly noticed several weeks
or months after the birth, and their duration is usually much longer. Symptoms
are more severe in PPD than they are in postpartum blues. Those diagnosed with
PPD often have symptoms with severe features such as feeling sad and hopeless,
crying for no apparent reason, being worried or overly anxious, oversleeping,
having difficulty concentrating or remembering things, losing interest in
activities that were once enjoyed, being angry, withdrawing from family and
friends, not feeling emotionally attaching to baby, and thinking about harming
themselves.
Nurses and midwives are experts in assessment and
should carefully investigate and look more closely at the postpartum person who
is frequently crying, having trouble sleeping, reports low energy or appetite
changes or loss of enjoyment of activities that were once enjoyed.
It is important to be mindful that increased anxiety is often associated with perinatal depression, so assess for signs of this as well. A thorough, comprehensive review of the person’s prenatal history in order to flag certain risk factors for PPD is important to help clinicians distinguish between diagnoses. Risk factors include prior history of any depression or mental illness, stressful life events during pregnancy, and little or no social support, just to name a few.
Most importantly, providers must listen to
what the person is saying about what they are feeling or experiencing. Most patients
know that something is not right. They know themselves the best.
If
a nurse recognizes some of the signs in a new mom, what should s/he do?
Approach the mom? What should s/he say? Please explain.
Nurses and midwives who suspect postpartum mood
disorders in anyone they take care of must intervene. PPD should not be ignored.
In approaching a mom, nurses and midwives need to
let the person know what symptoms they are observing and why they are concerned.
The person must be educated that postpartum depression is common and that they
are not alone. Explaining that PPD is simply a complication of birth can be
helpful. Always acknowledge that the person has done nothing wrong. Include
that although PPD may be difficult to deal with, it is possible that with the right
individual treatment and emotional support, management of symptoms and recovery
is very likely.
Suppose
the mom denies it. What should the nurse do then?
From my experience, when someone is approached, they
rarely deny it. They often already know that something is not right in how they
are feeling, and they are often relieved that someone has reached out to them
to help. Again, telling them that they are not alone and that there is care
that they can get which can make them feel better is helpful.
If the person really does deny it and does not see the need for help, this is where family members and friends should be recruited to help. Family and friends may actually have already recognized the symptoms of PPD in this person and are often very willing to get involved. They can help reinforce what the nurse has explained and encourage the person to meet with a mental health care provider. They can also offer ongoing emotional support, assist with transportation to appointments, and care for the baby or help with household chores—freeing up the person to go for care. Again, underscore that the person is not alone in this recovery process.
What
if the nurse recognizes the symptoms after the mom has left the hospital—like
in a home health visit? What should s/he do?
Because, in most cases, PPD does not manifest
itself until weeks or months after birth, it is quite common that the nurse who
works at the bedside immediately postpartum will not be the one to recognize
the signs and symptoms of postpartum depression.
Our standard system of postpartum care for birthing individuals is generally only a postpartum visit at six weeks after birth with little or no communication until that visit. Many suffer with signs of PPD during this six-week window, not knowing that what they are feeling is not normal and may require professional help. More often than not, recognition of signs and symptoms of PPD can come from nurses other than those working in the postpartum unit. For instance, nurses making home visits, taking office phone calls, or perhaps taking care of the baby in the pediatrician’s office are sometimes the ones who bring the symptoms to the postpartum person’s attention.
Any nurse who recognizes PPD has the responsibility to educate and then provide resources and referral to providers skilled in caring for those with symptoms noted. In this way, nurses can be instrumental in helping women get the care they need in a timelier manner.
Rachel Ellis, RN, works in the ICU and, for the past five years, has primarily worked in the critical care setting, but on the side, though, she provides postpartum care to new moms.
Here’s her story. We edited the interview for length and clarity.
Why did you decide to start your postpartum side gig? When did you start it, and how did you go about it?
The decision to start a side gig in postpartum care stems back to 2009, after the birth of my first child. At that time, I didn’t have the language for the postpartum experience I found myself in. Sadly, this is a common theme for most new mothers in modern-day America.
I had spent nine months planning for a beautiful water birth but had completely neglected to prepare for the postpartum time. In hindsight, I noticed how providers offered little-to-no education or care about the postpartum period. Because of my wonderful birth experience, I initially chose to go into the nursing field to become a midwife but ended up in bedside nursing instead.
In 2020 while in my second pregnancy and during the height of the COVID-19 pandemic, I realized that I wasn’t doing what I felt most passionate about. Although nursing is rewarding, I felt burnt out and began to remember my “why.” Why did I get into nursing in the first place?
Throughout my second pregnancy, I began researching and prepping for my postpartum time instead of planning for my birth. While exploring, I found a podcast episode featuring Rachelle Garcia Seliga, a New Mexico midwife speaking about postpartum care.
After listening to a particular episode, I suddenly had the language missing from my previous postpartum experience. With intentional preparation, I went on to heal my story by having the most wonderful postpartum experience after the birth of my second child. I wanted everyone to know they could have the same experiences after birth. In 2022, I became a certified postpartum care practitioner through Innate Traditions and created a business called Nourished Beginnings. I had never worked in a postpartum care setting before this.
What need did you see in the community—so that you knew or at least thought this would work? What type of women uses your services? Why do they need assistance postpartum? Is this covered by insurance or a cash-based business?
Innate Traditions was created by Rachelle Garcia Seliga, a midwife in New Mexico, to teach people traditional postpartum care. This model of care is unique in our modern-day society as her teachings weave together the common threads of postpartum care from cultures around the world.
For millennia, communities have been utilizing specific modalities to tend to postpartum mothers’ physiologic design resulting in optimal health. Today–especially in America–most people associate postpartum with depression when in reality, the postpartum time is when a woman heals and should come out on the other side thriving. Luckily, in most intact cultures (China, India, New Mexico, Somalia), these traditions are still carried on and passed down from generation to generation. We are looking to the wisdom of these cultures to relearn and remember how to take care of new mothers.
This is important work for the collective of humanity because “Mothers are the soil from which humanity grows,” to quote my teacher Rachelle. I often notice how negatively women speak about their postpartum bodies, experiences, etc. The need for this work is so dire, in my opinion, as I’ve seen new mothers in the darkest moments of their lives after having a baby.
The type of women and families who seek out my services are typically not first-time mothers. They have already been through the trenches and realize the importance of having help outside their partners.
Most women seeking my services also live a holistic lifestyle and typically experience more natural ways of birthing, such as unmedicated or home birth. My type of service is not covered by insurance; however, I am connected to a large doula agency working in the tri-state area, which can match families looking to utilize health insurance or working on a sliding scale based on income.
Approximately how many patients do you serve? You can make it on a weekly/monthly basis. Is it challenging to balance your side gig and your full-time job?
In terms of service, I typically take on 1-2 clients a month. I will work with a new mother for the first month after her baby is born. My offering emphasizes nourishment, as I am passionate about food as medicine and utilizing a lot of bodywork in my care with a new mother.
It can be challenging to balance my life as a bedside nurse, running my business, and being a full-time mother. Still, I am choosing to go per diem as a bedside nurse shortly to allow room for my business to blossom, as this work will change how our society cares for mothers.
Did you have previous entrepreneurial experience? Or did you learn on the go? Did it take a lot of time or money to establish your business?
As someone with no previous entrepreneurial experience before this, navigating details such as website design, marketing, and social media, has been interesting. The program I took through Innate Traditions was an investment and a nine-month commitment. However, beyond that, it hasn’t taken much financially to start going out there and working within my community. It has been more of a time commitment than anything else.
What did you enjoy most about your side- gig?
What I enjoy most about my side gig is the freedom to create hours that work for my lifestyle and family.
I also love teaching the education series “Innate Traditions Planning for the fourth trimester” with clients and their partners/friends/families because it genuinely brings that piece of the community into the postpartum time before a woman even arrives there. So many families appreciate this education series and have told me they feel way more prepared to care for their loved ones than ever.
What are some of the challenges?
Some challenges I face are finding time to bulk cook for clients throughout the week with a toddler and infant at my side and learning certain things on the go since I am new at running my own business. Luckily, I have a great community that I’m a part of where I can ask questions when more support is needed.
What are the most significant rewards of having your side gig?
This work is gratifying because I witness new mothers come out of their postpartum cocoons feeling rejuvenated and wanting to do it all over again. It truly doesn’t feel like “work” at all. \
What would you say to someone considering starting a side gig like yours—with postpartum care?
Something I recommend to anyone looking to start a business like this is to remember your boundaries. It can be easy to become a babysitter to older children and occasionally perform some light household chores for new families. Remember to center the new mother and inform everyone in the new mother’s postpartum space what your role is. Education is so essential beforehand as this will help all parties recognize what you will be doing during that time.
Also, make sure you’re taking time to prioritize your needs. Remember that you can’t pour from an empty cup as you serve others.
