Because these women are older and more set in the ways that they do things they are often fearful of these changes and resistant to them because they feel that they have no control over anything anymore (Priel & Besser, 1999). They are working towards a transition that marks the middle of their life and they are used to having everything that they need (Windridge & Berryman, 1999). They need only a child to complete than and once they get pregnant and have the baby they realize that there are many changes that they must deal with in their lives that they were not actually expecting when they decided on a child (Chaudron, Klein, Remington, Palta, Allen, & Essex, 2001).
This is especially true for women of this age who do not have it all and are looking for the self-sufficiency and autonomy that they feel that they need, are looking to deal with major issues that they may have in a particular relationship, or are still trying to find a career and a comfort level that suits them (Dennis, 2004). These women, when they become first-time mothers over the age of 35 or particularly over the age of 40, often see this bearing of a child as a great source of upheaval in their lives (Bozoky & Corwin, 2001). It is hard for these women to be happy with what they have done and even though they love their children it is often difficult for them to truly be happy (LoBiondo-Wood & Haber, 2002). This can lead to fatigue and postpartum depression which can be very detrimental not only to the woman but to the child as well.
Nursing Management of the Problem
The theoretical framework for this issue and the way that nurses address it should deal with three individuals and their beliefs. Imogene King and the Theory of Goal Attainment is very important for many of these mothers because they believe that dealing with everything that they already have in their lives and having a child is one more goal that they wish to achieve (King, 1991). Because of this, they often refuse to admit that they have difficulty with postpartum depression or fatigue because it would make them appear that they have not reached their goal.
Mercer and the Maternal Role Attainment should also be part of an understanding by nurses when it comes to this problem because many women feel that this maternal role is part of what makes them whole and they must attain it to be complete individuals (Mercer, 1985). While many women realize that this is not true with a look at it logically, they still have a strong need to be a mother and fulfill the role that many of them believe they were created for.
Erickson should also be addressed, as his Stages of Development have much to do with women and how they perceive having children (Erickson, 1963). They do not believe in stagnating and instead want to generate new individuals who will be able to go on and live for them as they grow old and their children grow up. This is part of ensuring that the human race will continue and a new generation of individuals will be available when the older generation begins to pass on.
It is important to understand how serious fatigue and postpartum depression can be for these women who decide to become first-time mothers at 35 years of age or older. The main hypothesis for this type of issue is that these women will experience fatigue and postpartum depression at a higher rate than women who give birth when they are younger.
Postpartum depression is the serious depression that often comes to women after they have had a baby. They may be sleep deprived and their hormones are having difficulty readjusting to their prepregnancy levels. Because of this, there are many confused feelings that these women have to go through and often times they feel very despondent and alone. They often feel as though no one understands them and this can lead them to very painful thoughts of harming themselves or their children. Usually, postpartum depression is relatively mild and does not lead to any type of actual dangerous activity.
However, women who are over the age of 35, and particularly women who are over the age of 40, often have higher rates of postpartum depression that is very severe and can lead to dangerous thoughts and feelings either towards themselves or the child that they have just had. Because of this, it is very important that this issue be studied and that determinations of what causes this and what can be done to help these women who suffer with these issues be made so that tragedy does not strike. Psychotherapy can help with this but it does not always help every woman that has this problem, so care must be taken to find all possible ways to help an individual that is struggling.
Findings from studies of the past have shown that women over 35 years of age were definitely at greater risk for postpartum depression and fatigue when they chose to become mothers. This was largely due to the fact that women have more difficulty recovering from traumatic experiences such as childbirth as they get older. Not only do their bodies not recover as quickly, but their mental and emotional states often do not recover as quickly either. Due to this, these women often struggle with painful feelings that others would not have to face.
Another finding was that women who were farther advanced in age had more difficulty than women who were only 35 years of age. In other words, a 35-year-old woman and a 50-year-old woman would not have the same experiences during pregnancy and childbirth, and the woman who was 50 years old would have a great deal more difficulty emotionally on average then the woman who was only 35 years old.
This is not to imply that all women have difficulty as mothers when they get older. However, information and research does indicate that there is a greater chance of these older women having difficulty both physically and emotionally with their pregnancy and childbirth. Findings of this nature, however, are sometimes difficult to determine because many of these women are used to being in control of themselves and their environments. They do not wish to admit that they have any kind of problems and even given a survey or questionnaire that they must deal with and will be kept strictly confidential does not necessarily make them comfortable enough to completely admit to the problems that they have faced in the past.
This could affect the data that has been collected in studies to some degree but in general most individuals will answer truthfully enough that the data can be considered valid.
Where education is concerned, it is very important that women who are of this age group and are intending to become mothers be informed by their doctors of the risks that they may be dealing with. This is often done for physical risks such as gestational diabetes and birth defects, but is often not done for the mental and emotional problems that these women sometimes face. Much of this has to do with a lack of understanding about fatigue and postpartum depression. There are still doctors in this country that believe it is all in a woman's head and does not actually exist. However, postpartum depression is starting to be looked at more seriously and because of this more and more doctors are coming to terms with the fact that it is a real illness that must be discussed. Education of these women is extremely important to avoid potential tragedy in the future and to help women enjoy their pregnancy and childbirth experience, as well as their new baby, as much as they possibly can.
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Beutler, L.E., Clarkin, J.F., & Bongar, B. (2000). Guidelines for the systematic treatment of the depressed patient. New York: Oxford University Press.
Bozoky, I. & Corwin, E. (2001) Fatigue as a predictor of postpartum depression, Journal of Obstetric, Gynecologic, & Neonatal Nursing, 31, 436-442.
Caltabiano, N.J & Caltabiano, M.L. (1996). Relationship between exhaustion and postnatal depression. Psychological Reports 79(1), p. 225-226
Chaudron, L.H., Klein, M.H., Remington, P., Palta, M., Allen, C., & Essex, M.J. (2001). Predictors, prodromes and incidence of postpartum depression. Journal of Psychosomatic Obstetrics and Gynecology, 22, 103-112.
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Dennis, C.L. (2004). Can we identify mothers at risk for postpartum depression in the immediate postpartum period using the Edinburgh Postnatal Scale Depression Scale? Journal of Affective Disorders 78 (2), 163-169