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Postpartum Depression: Killing Moms Softly in America
Over the past two decades, many Americans have encountered numerous tragic and horrific stories on the daily and nightly news, most involving mothers who suffered silently with postpartum depression and ultimately did the unthinkable: took the lives of their children. The most unforgettable story in American history has been that of Andrea Yates, who, like many mothers, suffered with postpartum depression and did not receive proper treatment. Andrea came to a breaking point and drowned all five of her young children in the bathtub. One way that postpartum depression can be defined is as an “abnormal” mental state that involves feelings of “extreme sadness,” worthlessness, and hopelessness after giving birth (Mosby, 2009, p. 531). Another source describes it as a condition in which the mother who has given birth experiences “anxiety, mental confusion, low maternal self-esteem, a limited sense of self-efficacy with regard to parenting, and intense shame and guilt surrounding one’s experience of depression” (Paris, Bolton, and Weinberg, 2009, pp. 309-310). Many moms in the United States suffer from postpartum depression due to hormonal changes and many life stressors. The incidence of postpartum depression in the United States can be reduced by monitoring the mother’s mental health throughout pregnancy, getting the family actively involved during the pregnancy as well as after childbirth, and helping the mother find support groups.
The Existence of Postpartum Depression and Its Causes
The incidence of postpartum depression in the United States is steadily rising. According to Field (2010), 20% to 40% of mothers who were a part of a large study sample reported having postpartum depression. In addition, Tracy (2012) states that “400,000 children are born to depressed mothers every year,” which is an alarming statistic due to the danger that the mothers and the children may face. Fluctuating hormone levels and many life stressors are the main causes for the development of postpartum depression. The development of postpartum depression is due to a combination of “biological vulnerability, psychological factors, and life stressors” (Harvard Medical School, 2011, p. 1). Life stressors include fatigue and lack of support from friends and/or family. There have been many research studies conducted on postpartum depression, and statistical data suggests that postpartum depression tends to be underreported and misdiagnosed. When postpartum depression is not properly treated, it poses a major threat to the life of the child and mother.
Fluctuating Hormone Levels
A woman’s hormone levels tend to fluctuate depending upon the monthly menstrual cycle as well as with pregnancy. Two main reproductive hormones focused on during pregnancy are estrogen and progesterone. According to Harvard Medical School (2011), a dramatic rise in the levels of estrogen and progesterone occurs during pregnancy. Estrogen and progesterone help the uterus expand to allow the baby room to grow, keeping the lining of the uterus intact, and helping to preserve the placenta (Harvard Medical School, 2011). Forty-eight hours after childbirth, estrogen and progesterone levels plunge fairly rapidly (Harvard Medical School, 2011). This can lead to emotional instability in the mother, which can lead to the development of postpartum depression.
The stresses of daily life can take a toll on a person’s health. Too much stress can lead to heart attacks and strokes, and even to the development of postpartum depression. Sometimes unexpected events take place such as the loss of a job or the loss of a loved one. According to Harvard Medical School (2011), when parents experience these types of life stresses, the risk of developing postpartum depression increases.
Taking care of a newborn baby can be exhausting. Sleep deprivation has not yet proven to be a direct cause of postpartum depression; however, it can cause a person to have an altered mental state. Harvard Medical School (2011) reported that one study they reviewed found that sleep disturbances increased a woman’s risk of developing postpartum depression.
Lack of Support
Support from family and friends plays a significant role on a mother’s mental health. If the mother feels as though no one cares about her or the unborn child, it can take a toll on her mental state. In addition, if the mother is experiencing problems in her marriage or relationship with her significant other, this could also increase her risk of developing postpartum depression (Harvard Medical School, 2011).
Criteria for an Effective Solution
A solution must meet certain goals in order to be effective and avoid creating new problems that simply replace the ones it is trying to solve.
To solve the problem of post-partum depression effectively, women must be sufficiently educated about it. In addition, educational materials must be current and accessible to all women across the United States. Many testimonials exist of women who were not given the proper education on postpartum depression. According to Glavin, Smith, Sorum and Ellefsen (2010), one problem with detecting postpartum depression is the lack of knowledge that women have about the condition.
It is no secret that healthcare in the United States is expensive and many U.S. citizens are not able to afford it, especially when it comes to mental health. According to Glavin et al. (2010), economic hardship was reported to be one cause of low treatment rates for women who were at-risk for developing postpartum depression (as reported by Horowitz & Cousins, 2006). Insel (2011) reports that the direct cost of mental health in the United States represents around 6% of overall healthcare costs and of all Americans, 36.2 million paid for mental health services; which totaled $57.5 billion in 2006. This data implies that nowadays, the cost of mental health services is much higher due to inflation and rising costs of healthcare. In order for women to seek help for postpartum depression, mental health services must be affordable, especially for women of low-economic status. In addition, funding is needed for updated printed materials on postpartum depression for every healthcare institution or clinic.
Protection of Patient Rights
In order to avoid violating the rights of the patient, all patient records, including a patient’s medical history, must remain confidential at all times according to the Health Insurance Portability and Accountability Act (HIPAA) of 1996. However, medical information can be shared with other healthcare providers if the patient has signed a release or consent form.
Women who may suffer from postpartum depression must not feel as though they are being judged by others because of how they feel as resulting stigma may prevent women from seeking help for postpartum depression.
The Most Effective Solution to Postpartum Depression
Many research studies conducted on postpartum depression suggest medication as a form of treatment for this condition. However, medicine can have side effects and is often not an ideal solution. If there were other solutions in place to prevent postpartum depression from happening, then medication could be avoided all together. The most effective solutions for reducing the incidence of postpartum depression in the U.S. include monitoring the mother’s mental health throughout the pregnancy, getting the family actively involved during and after the pregnancy, and helping the mother find a support group to join.
Monitoring Mental Health
Monitoring the mother’s mental health throughout her pregnancy can help detect mental disturbances early. One U.S. research study found that having a universal screening tool for postpartum depression led to improved maternal outcomes at 12 months after childbirth (Yawn, Dietrich, Wollan, Bertram, Graham, Huff, Kurland, Madison & Pace, 2012). Monitoring the mother’s mental health during routine prenatal check-ups would involve asking the mother questions about her mood, sleep pattern, and about any stress that she may be experiencing. “Screening and early intervention on perinatal depression have the potential to reduce adverse outcomes for women, infants, and families” (Spooner, Rastle, & Elmore, 2012, p. 1208). In addition, Spooner et al. (2012) also mention that the Edinburgh Postnatal Depression Scale (EPDS) is the most common screening tool used to detect postpartum depression. Therefore, it is essential for all prenatal and postnatal care physicians to use this tool to screen for depression.
Getting the family actively involved during the pregnancy and after child birth is another effective solution. According to the American Psychological Association (2013), one successful strategy to prevent postpartum depression is to ensure friends and relatives will be supportive to the mother. Patel and Wisner (2012) found that women prefer psychiatric therapy with support from family and friends in addition to mental health specialists and more accessible treatments.
Helping at-risk mothers find support groups is another effective solution to reducing the incidence of postpartum depression. According to Glavin et al. (2011), one study found that a group of women who received support from their peers (other women who had given birth) were less likely to develop postpartum depression than those who did not. In fact, receiving support from their peers decreased their chances of developing postpartum depression by half (Galvin et al, 2011). Another research article stated, “Peers have been suggested as a potentially more cost-effective and acceptable source of support for mothers with postpartum depression” (Letourneau, Stewart, Dennis, Hegadoren, Duffet-Leger, & Watson, 2011, p. 346). In addition, women who had more support from peers had lower scores on the postpartum depression scale (Letourneau et al, 2011). Furthermore, the study found that mothers prefer to receive support from other mothers who have experienced postpartum depression because they are able to share their experiences with one another openly (Letourneau et al, 2011).
Implementing Solutions to Postpartum Depression
In order to implement the solution of monitoring the mother’s mental health during pregnancy, the obstetrician must first establish a good relationship with the patient. Most patients tend to be less trustworthy of a physician who does not take the time out to ask about their mood and how they have been feeling. The obstetrician should be linked with a psychiatrist specializing in women’s health. However, for this to occur, the physician or healthcare facility must have the appropriate funding. So, it will be necessary for them to seek out funding from the government or other resources. Funding will ensure physicians have necessary materials and equipment to detect depression early and minimize the mother’s risk of developing postpartum depression.
Sometimes getting family and friends actively involved during the pregnancy is difficult, especially if there are strained relationships in the mix. In order to implement this solution, it is essential for the obstetrician and the mother to sit down with the family and discuss what the mother may need emotionally and physically during the pregnancy. It is important for the family to make sure they remain positive and refrain from speaking negatively in order to ensure that the mother keeps a positive mindset during her pregnancy. Support from family and friends after the birth of the child is also important. They should not center everything around the baby, but include the mother also. The physician should also be the one to suggest the mother find a local support groups beyond the family.
Clearly, postpartum depression has become a major problem in the United States. Postpartum depression can take many moms to a cold and dark place in their lives and when they fail to seek help, mostly out of fear of being judged, it can endanger the lives of the children and the mothers. No woman wants to admit that she is hostile toward her newborn child or that she has no desire to care for the child, but speaking out and getting help is best when those feelings start to surface. However, postpartum depression can be prevented by the monitoring of the mother’s mental health throughout the pregnancy, getting the family actively involved during and after the pregnancy, and helping the mother find support groups to join. Postpartum depression no longer has to be kept a secret. It is time that there is some light shed on this dark issue in America in order to save the lives of many women and children across the nation.
American Psychological Association (2013). PPD can be effectively prevented and treated. Retrieved March 30, 2013 from: http://www.apa.org/pi/women/programs/depression/postpartum.aspx#
Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior and Development. Retrieved March 29, 2013 from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819576/
Glavin, K., Smith, L., Sorum, R. & Ellefsen, B. (2011, November 1). Redesigned community postpartum care to prevent and treat postpartum depression in women — a one-year follow-up study. Journal of Clinical Nursing, 19, 3051-3062. Retrieved March 29, 2013 from: https://ehis-ebscohost com.csuglobal.idm.oclc.org/ehost/pdfviewer/pdfviewer?sid=b36cced9-52ed-49e5-a9ec 64f1b4a0dee1%40sessionmgr104&vid=4&hid=101
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Yawn, B. P., Dietrich, A. J., Wollan, P., Bertram, S., Graham, D., Huff, J., Kurland, M., Madison, S., & Pace, W. D. (2012). TRIPPD: A practice-based network effectiveness study of postpartum depression screening and management. Annals of Family Medicine, 10(4), 320-329. Retrieved March 29, 2013 from: https://ehis-ebscohost com.csuglobal.idm.oclc.org/ehost/pdfviewer/pdfviewer?sid=e8de6047-97b0-4fef-970e 6284506c932a%40sessionmgr11&vid=4&hid=3