Postpartum Stress and Women’s Health Nursing

Postpartum Stress and Women’s Health Nursing

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Postpartum Stress and Women’s Health Nursing

Clinical situation

As a clinical extern nurse in postnatal care at Humber River Hospital, I was expected to deliver nursing services to patients in the same way that any other nurse in the hospital would be expected to. Throughout the course of delivering treatment to my patients, I came across several incidents that I had not previously heard about in my theoretical studies. The experiences were varied, with some being fascinating and others shocking, but at the end of the day, they provided me with a clear image of what I may expect later in my career as a registered nurse. During our conversation, I came across Rose, a 22-year-old immigrant and college student. She was six weeks postpartum with her first child. Before this, she had been diagnosed with depression as well as a generalized anxiety disorder. In addition to taking medication, she was receiving cognitive behavioral therapy (CBT) and did well for many years. Rose had come to the hospital that day for postpartum treatment. She was in tears and felt like a "parent failure," which she admitted to herself. Her infant screamed nonstop, and she was unable to sleep because of it. Having trouble latching the baby and not wanting to have to feed him formula were the two main reasons for her decision. Rose got outraged for being required to obtain an epidural and inducement because of her condition. She had set her heart on having a "natural" birth and was disappointed that the results turned opposite from her expectations. Rose’s infant exhibited a higher than usual levels of bilirubin which could be a case of jaundice in newborns, but the mother attributed this to her own actions. After being observed in the NICU, he was allowed to be discharged.

Rose had been made to understand what sudden infant death syndrome (SIDS) is and this made her irritation grow to an extend she couldn’t get sleep for the rest of the night. She could not be able to soothe her infant as a result. When it came to feeding, pumping, and changing, she felt like she was constantly in a race against the clock. Every time she touched a bottle or a diaper, she'd wipe it down. She was appalled by her physical look. She planned to return to her pre-pregnancy clothes as soon as possible after the birth of her child. She hadn't eaten in peace, had not gotten manicure and hair done, and the thought of having sex with anyone at the moment could not cross her mind. As a nurse, I assisted Rose in rehabilitating herself and counseled her about her current mental state. The alternatives we discussed were cognitive-behavioral therapy (CBT). We also considered other options, such as medication. Rose decided to repeat her previous antidepressant prescription because it had proven to be quite effective in the past for her depression. In addition, she also joined a group of mothers where she got cognitive-behavioral therapy (CBT) on a weekly basis. As a result of increasing her physical activity, sleeping more, and receiving more support over the following few months, her mood and energy both improved dramatically. In addition, I had offered her suggestions for enhancing her sleep hygiene.

She later informed me that she was in much better spirits than before. In addition, she expressed delight in sharing that she had identified books on self-help parenting which she found would later help her for other moms. One of the mothers remarked that it actually takes a community to bring up a child. The speaker talked about how, long ago in our societies, newlyweds depended on extended family for guidance, something is seldom there today. Furthermore, incorrect beliefs about newborns, such as the notion that they are easy to care for and that parents enjoy being with their newborns, contribute to guilt that is accompanied by conflict and stress. Rose got used to the stress of parenting very comfortably and she found the experience extremely therapeutic.

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Description of Issue, Development of a Question & Research Approach

Postpartum depression in women's health refers to the moderate disorders that new moms endure during the first 4-6 weeks following childbirth. Postpartum depression affects at least 20% of women following childbirth and it is characterized by a variety of clinical symptoms, including sleeplessness, persistent fatigue, irritability, anxiety, poor concentration, and psychomotor retardation or agitation. Additionally, minor diseases are typically classed as postpartum onset if symptoms begin within four weeks of delivery. These disorders, commonly called postpartum blues, might impair a mother's ability to care for her newborn. Some women may even feel ashamed and unworthy, while others may feel that caring for the newborn is excessively taxing (Hutchens & Kearney, 2020). Postpartum depression, on the other hand, affects the patient's brain, particularly the areas that enable her to observe and understand varied facial expressions and nonverbal communication. As a result, it is a severe clinical concern, as affected mothers may be unaware of their infants' cues and signs. In this circumstance, they may be unable to meet their needs appropriately. Numerous medications are used to aid mothers suffering from these symptoms, including mood stabilizers, antidepressants, and antipsychotics. On the other side, electroconvulsive treatment (ECT) is used to induce chemical changes in the affected individual's brain. Because new moms tolerate this treatment, it is an excellent method for treating postpartum psychosis.

PICOT question: In postpartum women with postpartum depression and anxiety, what is the effect of medication therapy on depression and anxiety compared with alternative therapy (exercise and socialization) within six months?

Search Strategy

 This study aims to learn more about the experiences of postpartum immigrant mothers in the western hemisphere. If women in the Western world who live near to their families suffer from postpartum depression, what can be done to help immigrant women who do not have close family and friends to turn to for support? It is also common for immigrant women in the western world to encounter various cultures to which they are not accustomed. Specifically, what factors enhance the likelihood of postpartum immigrant moms suffering postpartum depression is being investigated.

Meta-synthesis was used in this study. A systematic literature search of qualitative studies reporting on postpartum depression among immigrant mothers was conducted, followed by a critical appraisal of the studies. Finally, a meta-synthesis of the studies that were found to be relevant was conducted. The search sites used were CINAHL, MEDLINE, Psych INFO, PubMed, and EMBASE, ranging from 1990 to 2014. A total of 620 publications were removed from consideration due to redundancy, non-qualitative approaches, and a lack of emphasis on PPD. A total of 16 studies were chosen. Immigrant or ethnic minority moms residing in western nations with PMD comprised the study's sample population.

Study Findings

The study's findings revealed two major themes, which were migratory considerations and cultural influences, respectively. Gender roles, adherence to delivery rites and practices, and cultural ideas and values were all included in the study's cultural influence analysis. In the western world, mothers face stress since they are not in their cultural environment and hence find it difficult to participate in cultural rituals. According to the study's findings, the migration factor increased the likelihood of mothers developing postpartum depression (PPD). They felt alone because they were separated from their families and friends. Relationship challenges with husbands, in-laws, and one's own family might arise from jobs and other obligations. Finally, real-life concerns such as language barriers, strange cultures, and financial difficulties are all standard. The combination of cultural impacts and migration considerations sheds light on the psychosocial understanding of PPD. As a result, most of these moms turn to self-help coping measures. PPD was attributed to mothers' lack of social support, loneliness, and isolation, according to the mothers. According to the study's findings, these immigrant women are more likely to have PPD because of these pressures. One significant disadvantage of the study was the inclusion of settled descendants of former migrants, who have significant distinctions from their recently moved moms in terms of cultural and linguistic backgrounds. Migrant moms from high-income nations are also barred from participating, which is an additional restriction.

Rating System

The purpose of this paper is to conduct a systematic review of qualitative investigations. According to the Association of Preoperative Nurses, this is a moderate-risk procedure graded at level 3 on the evidence grading model. This rating system was chosen since it enables the study to be classified and rated. Additionally, this rating system was created to evaluate the evidence before implementation to determine whether the study requires additional research or is sufficient. The article has a C level of evidence since it is a meta synthesis of studies, and it employed qualitative investigations to identify a common theme among related studies.

Article 1	Bodnar-Deren, S., Benn, E. K. T., Balbierz, A., & Howell, E. A. (2017). Stigma and postpartum depression treatment acceptability among black and white women in the first six months postpartum. Maternal and child health journal, 21(7), 1457-1468.
Article 2	Pessagno, R. A., & Hunker, D. (2013). Using Short‐Term Group Psychotherapy as an Evidence‐Based Intervention for First‐Time Mothers at Risk for Postpartum Depression. Perspectives in psychiatric care, 49(3), 202-209.
Article 3	Wittkowski, A., Patel, S., & Fox, J. R. (2017). The experience of postnatal depression in immigrant mothers living in Western countries: A meta‐synthesis. Clinical psychology & psychotherapy, 24(2), 411-427.

Title, journal, year published	Type of study	The research question or hypothesis	The study methodology	The level of the evidence	Description of the subjects and sample size	Significant findings from the study
1. Depression Treatment Acceptability Among Black and White Women in the First Six Months Postpartum, Maternal & Child Health Journal, 2017	A randomized control trial was conducted to determine the level of stigma associated with postpartum depression and the acceptability of treatment.	Is there a link between race, stigma, and treatment acceptance among women suffering from postpartum depression?	A baseline in-hospital survey was conducted, with telephone interviews conducted three weeks, three months, and six months after the birth.	Level B.  The study includes a randomized control trial that examines the disparities between postpartum mothers of color and white women.	Women over the age of 18 who had recently given birth were used. Two trials were going on at the same time. A total of 890 people took part in the study.	The study discovered that postpartum depression therapy was widely recognized. Black moms were less likely than white mothers to accept prescription medicine and mental health counseling for postpartum depression treatment but were more likely to embrace spiritual counseling. The variation in treatment acceptance was not explained by stigma.
2. Using Short-Term Group Psychotherapy as an Evidence-Based Intervention for First-time Mothers at Risk for Postpartum Depression. Perspectives in Psychiatric Care, 2013	As an intervention for first-time mothers at risk for postpartum depression, this randomized controlled study examines the effectiveness of short-term group psychotherapy as a preventative measure.	Is it possible that short-term group psychotherapy can help minimize the likelihood of first-time moms suffering from postnatal depression?	First-time mothers are invited to participate in an 8-week short-term psychotherapy group led by an advanced practice psychiatric nurse. The Edinburgh Postnatal Depression Scale (EDPS) was completed by the mothers three days after giving birth. The participants were divided into groups.	Level B	Sixteen women who were three days postpartum were selected for participation. The mean age was 28.5 years.	According to the study's findings, group psychotherapy can have long-term effects on reducing the risk and symptoms of postpartum depression, even up to 6 months after the therapy session has ended.
3. The Experience of Postnatal Depression in Immigrant Mothers Living in Western Countries: A Meta-Synthesis. Clinical Psychology & Psychotherapy, (2017).	Meta Synthesis	Are immigrant mothers living in western countries at greater risk for developing postnatal depression?	Articles about postnatal depression were searched within CINAHL, MEDLIN, PsychINFO, PubMed, and EMBASE between 1990 and 2014. A Meta-synthesis of the 16 studies selected was performed	Level C	Six hundred twenty studies were considered, 598 studies were excluded. Out of the 22 lefts, only 16 studies were selected because 337 mothers met the inclusion or exclusion criteria. The inclusion criteria included immigrant or ethnic minority mothers living in western countries with postnatal depression	Immigrant mothers living in western countries tend to be susceptible to developing postnatal depression due to many factors and stressors such as lack of friends, family, social support, and cultural practices. A culturally competent healthcare provider is needed to understand the conflicts faced by these mothers.

Analysis of Literature and Application to Practice:

Article 1

Bodnar et al. (2017) summarize the paper's purpose, study design, results, discussion, and conclusion. Four different methods of postpartum depression therapy were evaluated for their impact on racial and ethnic stigma, as well as its relationship with postpartum mother race (as examined by Bodnar et al., 2017). Among postpartum women of color, spiritual counseling was preferred to prescription medication. There was less stigma attached to PPD medication use among black mothers. Stigma does not explain why black women were less likely than white women to accept prescription treatment for postpartum depression. Based on my reading of this research, I believe that Bodnar et al. (2017) cited the current and relevant nursing literature.

The authors' sample size was acceptable. After birth in a large urban hospital, 481 black and white women were interviewed six months later. The survey covered sociodemographic and clinical variables, stigma, and postpartum depression therapy. Bivariate and multivariate analyses were used to assess race, stigma, and treatment acceptability. The authors have prepared a detailed discussion based on the findings, integrating the theoretical background, study objective, and clinical application. Although treatment stigma is linked to decreased postpartum depression treatment acceptability, it does not explain the disparity among black women. More study is needed on postpartum depression treatment hurdles for black women.

Article 2

The purpose of the study by Pessagno et al. (2013) is to see if the Edinburgh Postnatal Depression Scale (EPDS) scores of women at risk of postpartum depression changed after participating in a short-term psychotherapy group for 8 weeks (PPD). According to the findings, descriptive statistics and a large enough sample of eligible women were used to convey the results. The average of all group members' scores, regardless of whether they have a history of depression, is shown in these numbers. From pre-intervention to post-intervention, EPDS scores for both groups of women who had previously been depressed and those who had never been depressed decreased significantly. The study found that postpartum moms who sought healthcare services improved their mental health and had a favorable influence on both their physical and mental health and that of their infants.

The use of a nondirective group process approach for this intervention was the critical constraint. The nondirected group approach enhances the ability to focus more on relationships and create empathy. The group psychotherapy session was provided to participants free of charge as another project limitation. For pregnant and postpartum women, programs that integrate such interventions in healthcare facilities could increase access to mental health care and have a good effect on both their physical and mental health and that of their infants.

Article 3

In this meta-analysis by Wittkowski et al. (2017), the authors investigated the experience of postnatal depression among immigrant women who live in western countries, such as the United Kingdom, the United States, and Canada. During the evaluation process, sixteen qualitative studies were looked at, and their methodological quality was evaluated. According to the findings, 337 women participated in the study, which is an adequate sample. Two underlying themes were observed, referred to as 'cultural influences' and 'migration considerations,' and both elements influenced how these women dealt with their postnatal depression. These immigrant women benefited from social support, which served as a buffer between them.

After completing the short-term group psychotherapy intervention, participants exhibited a decrease in their Edinburgh Postnatal Depression Scale scores, which decreased their risk of experiencing postpartum depression. Because it is an effective and scientifically supported intervention for preventing PPD, group psychotherapy is suggested as a current competency for psychiatric advanced practice nurses.

References

Bodnar-Deren, S., Benn, E. K. T., Balbierz, A., & Howell, E. A. (2017). Stigma and postpartum depression treatment acceptability among black and white women in the first six months postpartum. Maternal and child health journal, 21(7), 1457-1468.

Hutchens, B. F., & Kearney, J. (2020). Risk factors for postpartum depression: an umbrella review. Journal of midwifery & women's health, 65(1), 96-108.

Pessagno, R. A., & Hunker, D. (2013). Using Short‐Term Group Psychotherapy as an Evidence‐Based Intervention for First‐Time Mothers at Risk for Postpartum Depression. Perspectives in psychiatric care, 49(3), 202-209.

Wittkowski, A., Patel, S., & Fox, J. R. (2017). The experience of postnatal depression in immigrant mothers living in Western countries: A meta‐synthesis. Clinical psychology & psychotherapy, 24(2), 411-427.