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Caring the Patients with Postpartum Depression

Caring the Patients with Postpartum Depression


Depression that occurs in women after pregnancy is called as postpartum depression (or peripartum depression) (Brockingham, 2004; Miller, 2002; Wisner, 2002). The depression thus formed exists as a dominant and challenging field in the area of treatment and intervention. I too therefore accepted it as a challenge in its exterior and far deep interior projection on the mood of a female patient. The changes in hormones that take place in the woman’s body after pregnancy are responsible for causing depression. It has been reported that essentially two hormones (estrogen and progesterone) significantly increases during the period of pregnancy. It has been found that the level of estrogen and progesterone decreases rapidly to the normal level just within a day after the birth of a child.

The scientists in the field hold an opinion that the changes that take place in the level of estrogen and progesterone can be considered as being responsible for the causation of depression in women (Brockingham, 2004; Miller, 2002; Wisner, 2002). Other important reasons for the changes in mood that take place in women include stress of day-to-day life, death, divorce, departure, disease, etc. These can cause changes in the level of chemicals and thus cause depression. Other reasons of depression include hereditary factors or previous history of depression in the patient or in the family of the patient. Anxiety as related to the childbirth as well as to problems that take place with the birth of child results in the causation of postpartum depression.

The signs of depression as seen for a period of two or more than two weeks includes the following as stated in the list (Black. J., M., et al., 2005, p.300): Restless of irritable feelings, Feeling overwhelmed or sad for most of the day or nearly ever, Lot of weeping, Indecisiveness, Psychomotor agitation or retardation, Lack of or loss of energy (fatigue) and loss of positive motivation, Anorexia (loss of desire to eat) or overeating, Insomnia (marked decrease in sleeping time) or excessive sleeping, Loss of pleasure in activities (in all or almost all activities), A feeling of worthlessness and/or of inappropriate guilt, Desire to stay alone or withdrawal from colleagues or roommates, Having headache, cardiac palpitation or chest pain or causing in the penetration of fast and shallow breathing in the otherwise normal system, Recurrent thoughts of death, recurrent suicidal ideation or a suicide attempt or a plan for committing suicide thus loss of interest in life is seen in these patients (Magill, 2002).

As mentioned earlier, many patients develop postpartum depression, especially if they experience important loss. Miss. Smith is a good example. At 26, she was diagnosed with postpartum depression, and had left Mt. Sinai Hospital some one to two weeks ago. She then was required to be counseled by all means. She was alone by herself, an orphan and had no husband or boyfriend at her end to support her during the pregnancy and after that at emotional level. Being a nurse, I attempted to provide her the finest blend of psychotherapy and all nursing interventions so as to be sure that she did survive well with positive attitude after pregnancy. I read some articles (Kennedy, H.P., et al. 2002; Lydon-Rochelle. et al. 2001) based on postpartum depression so as to have a greater insight in her case and thereby support her more through several interventions. The diagnosis of depression was based on the following: in the last one to two weeks after giving birth to a baby boy she lost weight (approximately 25 pounds); suffered from insomnia; had a general feeling of malaise; had a dominant feeling of guilt for getting pregnant before being married to his boyfriend; she also suffered from general anxiety regarding the bringing up of the child as the sole parent; and suffered from indecisiveness regarding her plans for future. She also suffered from a feeling of guilt as to how she shall face the world with a baby in arms of unknown father. She felt that she has done a deed of shame and had therefore spoilt the image of her family in front of all. As a result of all these factors she brought to the scientific knowledge about her plans to commit suicide.

The purpose of this current admission was to monitor her for postpartum depression detected in her acquaintance. When I met her for the first time, I concluded her as being a depressed or distressed patient requiring psychotherapy or counseling by all means so as to overcome the episode of depression (O'Hara MW, 2000). She was on medication for depression and also for a tonic in order to get rid of anemia. She also had reported of being disinterested in all activities (Black. J., M., et al., 2005, p.300). Her prior hobby of reading novels before bedtime seemed to her as been drawn away with all other activities (Black. J., M., et al., 2005, p.300). She thus was not taking interest in any of the activities. She was eating less than she usually did, infact she was likely to miss her meals for no reason. Her interest in watching television had also evaporated with time. She was disinclined to taking medication or not very sure of her stay in the hospital. She all the time worried and cried when it came to her believes that she had to bring up the child as a single parent.

As the first and foremost step of our intervention, I inquired about her in a more open form. Miss. Smith though initially reluctant to answer my questions was later open enough to provide with a strong intent underneath her existence to commit suicide. Her thought of being single and without moral and financial support for bringing up the child initiated her to have such thought of suicide. I inquired about her suicidal intent and to my shock she was looking for a painless or the least painful manner of ending up her life. The only thing that I could do to make her live was her interest in bringing up an innocent infant who otherwise will have no societal support. She was thus engaged with me in a very informal talk. I tried all my energy to make her believe that she was being loved and cared by me as a nurse and above all as a person with profound humanity embedded. In order to deal with this I read articles of Kerr (1987/8) for deeper insight into the case. The nursing intervention in localizing whether the patient is having suicidal tendencies is vital in the prevention of suicide as well as in the treatment of depression in the patients of postpartum depression.

Another important intervention, which I considered, was an increase in the physical activity. This is because she was bedridden in the hospital and therefore required certain physical activity in order to speed up the body physiology. This was also important to increase the level of endorphins. This is because the body of the patient may become affected by an increase in the level of toxins, which hold their essential presence because of the dominance of constipation (this was taken as an essential theoretical consideration with regard to direct or indirect implication to the practical case).
I also used poetry therapy in order to help her come out of depression. I chalked out few poetry lines for her to repeat continuously so that she felt better. I also taught her Swami Ramdev Baba's Pranayams. I taught Anulom Villom and Kapal Bhati to her in the spare time of her treatment (Ramdev, 2006). She felt very well after practicing of Pranayams and Yoga. I also used music therapy and odor therapy in order to bring her back to life with pleasure and painstaking efforts. I also suggested her for a good diet and tried to implement good communication techniques in the process and recital of "OM" word as recommended by Swami Ramdev (Ramdev, 2006).

As a nursing student and working with postpartum depression patient I was able to provide with a nursing intervention inclusive of communication techniques, physical activity, poetry therapy, music therapy, yoga, pranayams and physical activity. She recuperated by these efforts and showed a good response to the nursing interventions designed for her postpartum depression treatment. As a future nurse I will care my patients by making a good nurse-client relationship, with empathy, by applying all above mentioned interventions and by referring her to public health for follow-up after her discharge to continue her treatment to obtain good results and patient centered care.

It is essential to note here that his paper was written as theoretical output of the practical steps taken in the treatment of postpartum depression thus the paper has been written as a theoretical output rather than a research report.











References

Anonymous. (2006). Swami Ramdev. Retrieved 28th September ,2006, from http://en.wikipedia.org/wiki/Swami_Ramdev
Black, Joyce M., Hawks, Jan Hokanson. (2005). Medical-Surgical Nursing: Clinical Management for Positive Outcomes. 7th Edition.
Brockingham I (2004). Postpartum psychiatric disorders. Lancet. 363(9405): 303–310.
Kennedy, H.P., Beck, C. T., Driscoll, J.W. (2002). A light in the fog: Caring for women with postpartum depression. Journal of midwifery & women’s health. Vol. 47, No.5, 318-327.
Kerr, N., J. (1987/8). Signs and symptoms of depression and principles of intervention. Perspectives in Psychiatric Care, 24(2), 48-63.
Lydon-Rochelle, M.T., Holt, V.L., Martin, D.P. (2001). Delivery method and self-reported postpartum general health status among primiparous women. Pediatric and Perinatal Epidemiology. 15, 232-240.
Magill, F. N., Rodriguez, J., Turner, L. (eds). (2002). International Encyclopedia of Psychology; vol. 1. Chicago, USA: Fitzroy Dearborn Publishers.
Miller L (2002). Postpartum depression. JAMA. 287(6): 762–765.
Ramdev, S. (2006). Pranayams. Retrieved 26th September, 2006, from HYPERLINK "http://www.divyayoga.com/" http://www.divyayoga.com/
O'Hara MW, et al. (2000). Efficacy of interpersonal psychotherapy for postpartum depression. Archives of General Psychiatry. 57: 1039–1045.
Wisner KL, et al. (2002). Postpartum depression. New England Journal of Medicine. 347(3): 194–199.
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Posted by: Andrea Louise

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