This paper converse about life-limiting psychiatric illness affecting women post child birth to an extent, where there independent living witnesses a drastic blow requiring interventions both medically and psychologically. Depression tops the list of psychiatric disorders which disable women in the child bearing years. With increasing prevalence of the same around the globe, especially in developing countries like Canada, it is important to debate about the required update in nursing care to meet the patient demands. This paper duly mentions the current status of the illness in Canada. A part of paper entails the nursing assessment that can prevent and optimize patient outcomes. The essay ends on the significance of the mental health issue in Canadian women and implications for future research.
Child birth is a period of drastic fluctuations impeding major physiological, psychological and social vagaries. The mother experiencing a mental illness at crucial times like child birth is daunting to both mother and child leaving bad imprints to family. In no time, it becomes a major public concern causing poor maternal and child health. It was centuries before the professionals noted a positive association between child birth and mental illness with women having amplified risk of affective disorder in the post-partum period (Premji et al., 2019, pp. 100888).
Post-partum depression is a non-psychotic depressive episode that is initiated during pregnancy and extends till post-partum period. PPD is similar to clinical depression and symptoms mimic general depression. Learning the prevalence, PPD is a major health concern for women around the globe (Verreault et al., 2014, pp. 84-91). Countries like Singapore have 0% prevalence to 23% in Canada. The provinces affected include Saskatchewan (16%) and Nova Scotia (31%). Internationally, several diverse predictors have been correlated to cause of PPD namely; demographic factors, maternal, social factors and economic factors. Several cohort studies in Canada reported low household income as a main factor in predicting PPD in Vancouver and Calgary (Falah-Hassani & Dennis, 2015, pp. 67-82). Major maternal factors like history of depression, previous child birth experience and existing medical conditions determine the severity of PPD in women. Age, mothers between 15-19 have an impending risk of PPD, enhanced in those with history of smoking during 3rd trimester. In Canada, lack of social support also has been seen to induce PPD symptoms. Additionally, marital conflicts and poor prenatal care have been negatively co-linked with PPD (Yim et al., 2015, pp. 99-137).
Several Canadian studies also demonstrated high prevalence in some Canadian territories due to dense population of Aboriginals, who have been seen to have increased risk of depression. Immigrants have been seen to have hiked odds of manifesting PPD in comparison to non-immigrants. PPD is an exacerbation of baby blues, or manifest after child birth lasting up to nearly 14 months (Bowen et al., 2013, pp. 93-111). The major signs and symptoms include unmanageable anxiety and guilt feelings. The mother manifest negative maternal attitude and lack of self-efficacy in parenting. PPD affects mother in diverse ways including the loss of ability of coping with life stressors and parenting tasks (Kettunen & Hintikka, 2014, pp.1-9). The mother in lieu of the illness may evident a withdrawn and disengaged approach towards the newborn. The offspring on the other side may not remain unaffected and can have immediate ill effects (Kettunen & Hintikka, 2014, pp.1-9). Besides that, the evident symptoms include depressed mood, anxiety feelings, anhedonia, weight and appetite changes, sleep disturbances, fatigue, psychomotor retardation and diminished concentration to parenting and other tasks. The mother may even complain of recurrent thoughts of self-harm (Kettunen & Hintikka, 2014, pp.1-9).
In order to make a certain diagnosis of PPD, standardized clinical interviews still remain the gold standard, essentially noting if symptoms meet the diagnostic criteria, in severity and duration. Generally formal classification system like DSM-5 are applied to ensure correct diagnosis (Sharma & Pathak, 2015, pp. 216). Considering treatment, the mother is usually prescribed with antidepressants with a blend of psychological assistance (Kim & Tamim, 2014, pp. 1-9). Supportive psychotherapy including interpersonal and cognitive psychotherapy remain cornerstones of care. Relaxation therapies have been seen to improve maternal outcomes. Besides that, bright light therapy and hormone therapy have been seen to improve both maternal and child health outcomes (Kim & Tamim, 2014, pp. 1-9).
As far as nursing assessment and care is concerned, the nurse involved in post-partum depression care must provide a patient-focused yet flexible post-partum care based on assessment of depressive symptoms and mother’s preference. It is important for the nurse to initiate necessary preventive measures for pregnant mothers in inpatient and community care (Feeley et al., 2015, pp. 120-130). Nursing assessment must be able to apply The Edinburgh Postnatal Depression Scale as a self-report tool to assess depression symptoms in postpartum mothers. The nurse must administer the tool at any time during the postpartum period to confirm diagnosis. The nurse provides complete privacy to mothers when completing EPDS. The nurse must be able to interpret the scores according to language spoken and cultural diversity. The nurse must combine the EPDS score and clinical judgement in order to complete diagnosis (Gillaspy et al., 2014, pp. 975).
Most importantly, the nurse must provide immediate assessment for patients with self-harm behavior., if mother scores positive on EPDS scale. The nurse must initiate necessary safety precautions for clients with suicidal behavior. The nurse must ensure weekly interactions and ongoing assessment focusing on the mental health needs of the postpartum mothers with depressive symptoms (Kim et al., 2015, pp. 885-893). For holistic care, the nurse must facilitate chances of accessing peer support for postpartum mothers experiencing depression. Additionally, since PPD has its detrimental effects on family as a whole, the nurse must facilitate partner and family involvement in accessing the care for post-partum mothers experiencing depression (Kim et al., 2015, pp. 885-893).
It is also expected as a nursing responsibility to promote self-care among new mothers in order to alleviate depression symptoms in the postpartum period. Lastly, the nurse must consult the appropriate health care resources to educate the postpartum depression patients about self-care and management of the illness (Kim et al., 2015, pp. 885-893).
Reflection of importance of postpartum depression
It is significant for the health care sector to understand the severity of the illness. The major drawback being that fact that the signs of depression are often neglected in new mothers as major signs like loss of sleep and appetite, mood changes and anhedonia are correlated to normal endeavors of motherhood (Werner et al., 2015, pp. 41-60). There is high chance of women being undiagnosed for major part of her illness. Additionally, new mothers have been seen to turn deaf and mute to these signs in order to meet the family and societal expectations of child care (Werner et al., 2015, pp. 41-60). The mother tends to ignore how she feels or thinks, in order to cater to child’s and family needs. Undiagnosed mothers are a threat to themselves and the child. It is both detrimental to health of the mother and the child. It undermines the attachment of mother to child and vice versa, impairing the long-term development of the child (Werner et al., 2015, pp. 41-60).
The topic is of great concern as child care requiring exquisite care from mother namely; breastfeeding. It has both health and psychological benefits for both mother and infants. Certain mothers prescribed with antidepressants may not adhere to treatment due to fear of possible side effects of the drug on breastfeeding (Bobo & Yawn, 2014, pp. 835-844). Lack of knowledge abstain the clients in adhering to treatment leading to poor prognosis. It is imperative for nurses to make clients understand that only certain drugs have been seen to get passed on from mother to child through breastfeeding (Bobo & Yawn, 2014, pp. 835-844).
Since, post-partum depression not only affects the mother-child relationship but is also a threat to family dynamics. Thus, it is important for the health care sector to make the treatment and therapies family focused. Disturbed family dynamics often create place for mental illness among other family members. The child growing in such ruinous environment is prone to physical and psychological issues, thus affecting growth and development. This is a concern not only for the family but country as a whole (Bobo & Yawn, 2014, pp. 835-844).
Postpartum depression accounts for a major population in Canadian women. It is a non-psychotic illness yet can induce major negative changes in lives of mother, child and the family. It is important to be able differentiate between symptoms of PPD and normal child birth fluctuations. The mothers must reach out for treatment in order to be holistically healthy and ensure optimal growing grounds for the child. Early diagnosis and treatment remain the cornerstone for limiting the incidence. A combination of pharmacological and psychotherapeutic approaches can ensure optimal patient outcomes and wellbeing of child and family. Appropriate and focused nursing care is most significant in managing women with PPD. Lastly, the essay discusses the significance of detailing the topic in health care to reduce the incidence in Canada and globally.
For future implications, it is important to engage family in patient management in PPD. The effect of patient literacy on patient outcomes in PPD must be studied. The role of nurse needs expansion and extension in prevention and management of PPD patients.
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