Mood and Affect(1)highlighted
Mood and Affect
Overview of the Postpartum Period
Definition: The postpartum period is a time of readjustment after childbirth, marked by multiple factors:
Arrival of a new family member
Common postpartum discomforts
Changes in body image
Conclusion of pregnancy (puerperium)
Physical changes begin to revert to normal
Postpartum Blues vs. Depression
Postpartum Blues (Baby Blues)
Defined as a common and transient emotional state following childbirth.
Symptoms usually resolve without treatment within days to weeks.
Postpartum Depression
Considered a major depressive disorder with a peripartum onset that may begin during pregnancy or within the first four weeks postpartum.
Normal Presentation of New Mothers
Initial Maternal Behavior
Joy and Anxiety: Pregnancy is joyful yet often anxiety-inducing for many mothers.
First Days After Birth: The new mother may prioritize food and sleep, appearing passive.
Transition: By the second or third day, they start to regain control but may still face anxiety.
Family Attachment Development
Factors Influencing Attachment
Personal characteristics that affect interaction with the infant include:
Level of trust and self-esteem
Capacity for enjoyment
Knowledge adequacy
Prevailing mood during pregnancy
Maternal Attachment Behavior
Engagement with the Infant:
Tangible behaviors: fingertip exploration and palmar contact.
Enfolding the infant with hands and arms as attachment increases over time.
Reliance on sensory experiences, may show signs of shock, disbelief, or denial initially.
Cultural Influences in Postpartum Care
Variability Across Cultures
Western culture emphasizes the birth event, while others focus on the postpartum experience.
Cultural beliefs impact family dynamics and the care received:
Variations such as European heritage and Islamic practices
Importance of adherence to rituals and family roles in caregiving.
Understanding Postpartum Blues
Symptoms and Duration
Manifestations of Blues:
Mood swings, feelings of anger, anorexia, sleep difficulties, and tearfulness.
Typically resolves in 10-14 days; persistent symptoms require further evaluation.
Assessment and Reassurance
Assessment Tools:
Edinburgh Postnatal Depression Scale and Postpartum Depression Predictor Inventory.
Importance of Support: Family relationships and social support become crucial for recovery, including partner surveillance for depressive signs.
Postpartum Mood Disorders
Types and Features
Postpartum Depression:
Affects 3-6% of women; may or may not include psychotic features.
Risk factors include:
First-time motherhood (primiparity)
Prior history of postpartum depression or bipolar disorder
Absence of social support
Postpartum Psychosis:
Rarer (1 in 500-1000) but requires urgent attention due to risks of suicide or harm.
Collaborative Care Approaches
Treatment and Referrals
Women with prior risk factors should be referred to mental health professionals between weeks 2-6 postpartum.
Pharmacotherapy: Use of antidepressants, with sertraline as a first-line treatment, remains controversial during breastfeeding.
Nursing Process and Responsibility
Data Collection
Comprehensive assessment of the client’s history, particularly psychiatric diseases.
Utilize depression scales to quantify severity.
Involve family for input on observations.
Nursing Problems Identified
Potential nursing issues include:
Ineffective Coping
Risk for Impaired Parenting
Risk of Self-Directed or Other-Directed Violence
Planning and Implementation Strategies
Goals include ensuring safety, promoting effective care for the newborn, and fostering communication of feelings and treatment adherence.
Implementation: Educate the family on recognizing symptoms of blues and depression, including follow-ups regarding anxiety and fatigue.
Evaluation of Outcomes
Expected outcomes include timely recognition and treatment of depressive symptoms, safety for both mother and newborn, and successful integration of the newborn into the family unit.