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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.