Recognizing Postpartum Depression in New Moms

Recognizing Postpartum Depression in New Moms

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.

UNLV Nursing Professor Improving PPD Screening Rates

UNLV Nursing Professor Improving PPD Screening Rates

An assistant professor at the University of Nevada Las Vegas is doing all that she can to help pregnant women get screened for perinatal depression. Marcia Clevesy, DNP, has been working at a Las Vegas clinic to improve screenings and documentation on a local level, particularly for postpartum depression.

Perinatal depression is the occurrence of a major or minor depressive episode during pregnancy or up to one year after childbirth, and affects as many as one in seven mothers. This term also includes postpartum depression (PPD), a common complication that occurs after childbirth.  But routine screenings for these occurrences is not standard for most health care providers.

Recently, the U.S. Preventive Services Task Force published a recommendation to provide or refer pregnant women with an increased risk of perinatal depression to interventions. But while this report has just been released, Dr. Clevesy has been working to progress research and care for those with PPD, especially early on in pregnancy.

“It is important for a focus to be placed on detecting perinatal depression early on to prevent complications,” Dr. Clevesy shared with the UNLV News Center. “The earlier we can identify maternal depression the better, because we are then able to get patients into therapy and treatment sooner.”

Opening Up A National Discussion

Dr. Clevesy’s work has major positive impact both locally and nationally, especially as discussions of mental health overall are becoming more common and more open throughout the United States. As more people open up about their mental health in media and online, women are feeling more comfortable and secure discussing their own concerns and issues with their healthcare providers, allowing Clevesy and her colleagues to help strengthen their work in the Las Vegas area.

“I’ve been a women’s health nurse practitioner for many years, and want to continue to elevate the standard of PPD screening beyond simply asking patients if they’re depressed,” Dr. Clevesy told the UNLV News Center. “In collaboration with Dr. Tricia Gatlin, associate dean for undergraduate affairs at the School of Nursing, I recently implemented a system for providers at a local clinic to use an existing, reliable and validated screening tool — the Edinburgh Postnatal Depression Scale (EPDS) — to screen for PPD as a means of promoting best practice among the maternal-child population.”

Dr. Clevesy also shared that since implementing the new system, PPD screening documentation rates have nearly doubled. Dr. Clevesy’s work is crucial for enlisting more Las Vegas health care providers to provide depression screenings for their pregnant patients, whether they use her screening tool or not.

“One tool is not necessarily preferred over the other. What matters is that health care providers are using a validated tool to effectively screen and promote a discussion regarding depression symptoms,” Dr. Clevesy said. “This assessment should start at the beginning of pregnancy and continue into the postpartum period.”