Postpartum Depression, comment

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I agree that a postpartum psychiatric evaluation is an important part of the postpartum patient assessment. Nurses should be looking for signs in the patient of potential problems of postpartum depression as opposed to postpartum blues. As a nurse that works on L & D and postpartum, I watch for things such as: 1) inability of mother to bond with infant or not wanting to hold infant after delivery, 2) Name calling of infant, 3) Just not showing interest in feeding or holding infant. I have witnessed all of these events in my department. Mothers who have a history of postpartum depression with prior deliveries should definitely be referred for a psychiatric evaluation and perhaps follow up visits after discharge, if necessary. Although postpartum depression is a real problem for some women, it is not excuse for child abuse or murder. It can be treated. As health care providers, we need to step in and refer these women by doing a thorough assessment and involve psychiatrics and/or social services in their care.

Original Post:
February 7, 2007
In response to the article “Postpartum Depression” from 9-16-06, I feel that after delivering the baby, a new mother must have a psych assessment done before going home with her baby and maybe they should have a home health nurse or some sort of social worker check in with the new mother at 1-2 weeks postpartum. I feel that these mothers such as Andrea Yates, sometimes claim postpartum depression as a cover up for something they definitely know they did wrong. I do agree that some mothers may have some depression after giving birth because of the hormone levels changing, but I do not believe they don’t know what they are doing at the time, such as murdering their children or drowning them. They sure know enough to be able to tell the police “I was crazy at the time and depressed.” So then they go for the “not guilty by reason of insanity” plea. I believe most of it is to get attention. Most of them also have no remorse.

Original Post:
September 16, 2006
What is postpartum depression? According to American Association for Marriage and Family Therapy (2002), “Postpartum depression is a biological illness caused by changes in brain chemistry that can occur following childbirth. During pregnancy, hormonal levels increase considerably, particularly progesterone and estrogen, and fall rapidly within hours to days after childbirth. Also, the amount of endorphins, the feel-good hormones that are produced by the placenta during pregnancy, drop significantly after delivery. Even the thyroid gland can be affected by the enormous hormonal changes that are associated with pregnancy and childbirth, leaving women more at risk for depression.” Additionally, AAMFT (2002) states, that “for 10 to 15% of those women, the period following childbirth becomes a nightmare as they experience sleeplessness, confusion, memory loss, and anxiety during the already stressful adjustment to motherhood.”
Source:
American Association for Family and Marriage

What comes to mind is the Andrea Yates case in which she murdered her children. A very notable forensic case that has been in the headline in the past but has recently come to light again as the Andrea Yates murder trial begins. In which she has claimed postpartum depression as the major reason she murdered her children. World Wide Web CNN- July 12, 2006, “Yates, 42, is being retried because her 2002 conviction was overturned by an appeals court that ruled erroneous testimony might have influenced the jury. She has again pleaded innocent by reason of insanity. Her attorneys say she suffered from severe postpartum psychosis and did not know that killing the children was wrong.” (www.cnn.com) this is a fascinating case, in the aspect that Yates had been in and out of psychiatric facilities for mental illness and depression prior to the murder of her children, so why did the psychiatrist not see this coming?

Today, with the many publicized murder trials of women who have murdered their children supposedly due to postpartum depression as the potential root cause, have encourage healthcare providers, nurses, and even new mom’s to look for the possible signs of this mental health condition. As a nurse, it is part of our nursing assessment skills in looking for potential signs that might indicate a new mom might need further assessment to rule out postpartum depression.

A great example was the other day a new mom of 4 months called the physicians office asking if there was a blood test to test if one might have postpartum depression. The woman claimed that she has noticed recently that she was having a few “sad days” and did not think she needed psychoanalysis but just wanted a blood test to check her hormone levels. When consulting with her physician, he stated that there is no specific blood test to find out if someone’s hormone levels are abnormal that would indicate postpartum depression and the only way to determine if the patient was truly having postpartum depression was an in-person evaluation, which a series of questions and lab work might be obtained. When the patient was advised of the physicians response to her questions, she agreed to a next day appointment but not before the nurse assessed if she was in any danger of hurting herself or anyone else.

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