Admissions Summary and Analysis Postpartum Depression (PPD)

Admissions Summary and Analysis

Postpartum depression (PPD) represents increased symptoms of depression that are correlated to having recently given birth. Although rather un-discussed in mainstream social communications, it often tends to have a relevantly strong presence in new mothers. Its recorded prevalence has ranged dramatically, from some reports of as low as 5.5%, and others as high as 25% (Lee et al. 2011). Various literature also poses the idea that rates of PPD can depend on cultural factors as well, with some cultures having much higher rates of PPD incidences than others. This incredibly variant nature of PPD often makes it hard for clinical practice to understand and predict. Moreover, postpartum depression can occur over a wide period of time, ranging independently based on individual women. Lee et al. (2011) show that it occurs more so in cases of earlier periods after birth rather than longer stretches of time. In fact, the research shows that it occurs most frequently within the first month after giving birth. However, postpartum depression symptoms can also occur often throughout the first year as well.

Lee et al. (2011) show how PPD can also be witnesses in heightened levels within the cases of women who had previously undergone in vitro fertilization (IVF). Unfortunately, dealing with the systematic stresses of the process of conceiving through IVF methods can be damaging on the mental state of the soon to be mother. The stresses of having to deal with previous assumptions of infertility can greatly impact the later development of PPT symptoms in new mothers. Lee et al. posits that assisted reproductive technology (ART) does impact the potential for new mothers to develop symptoms of PPD. Here, the research suggests that "successful ART treatment, mostly through in vitro fertilization (IVF), or infertility produces a special obstetric experience that contributes to particular concerns about women's postnatal mental health," (Lee et al. 2011). Still, previous research had not exposed statistically significant differences between the rates of IVF impregnated mothers and traditional cases of conception. The previous research has left this category of women relatively unrecognized through contemporary clinical trials and research. Lee et al. states that "little is known about the prevalence of PPD among mothers who conceived by IVF," (Lee et al. 2009). This leaves open numerous questions in terms of how conceiving through IVF and PPD really correlate with one another.

Thus, this study aims to answer some of those unanswered questions. Essentially, the study objective of this research was to examine potential correlations between IVF treatments and increased rates of PPD. Lee et al. (2011) wanted to not only understand how IVF factored into cases of PPT, but also to name and categorize other potential factors in the persistence of PPT. Thus, the research aimed to explore and categorize potential elements that may contribute to later PPD symptoms as a way to help provide pre-emptive services to a potentially high risk population. By understanding elements that help contribute to cases of PPD, physicians can better provide for patients through more effective strategies and even methods of prevention. Therefore, Lee et al. (2011) wants to help create predictable categories of women that might benefit from progressive counseling and treatment.

The study relied on statistical testing of PPD frequency when compared to numbers of women with IVF treatments. Methods were designed to incorporate a number of relative elements that may or may not contribute to cases of PPD in new mothers. The study structure reflected a cross-sectional design. Lee et al. (2011) incorporated 71 new mothers who had conceived their children through methods of IVF participated in the research. These mothers were recruited from a single infertility treatment located in Taiwan, where the study took place from September 2003 to February 2004. Invitations to participate in the study were given to mothers within the first five to eight weeks after having given birth. After gaining approval by the Institutional Review Board of the Chung Shan Medical University, women who had been identified has having conceived through methods of IVF were asked to join the study process. The primary method of the study included the use of an independently executed questionnaire. According to Lee et al. (2011), "Potentially eligible women were invited to participate in the study and complete a structured questionnaire." This questionnaire was then rated into numerical form using the Chinese version of the Beck Depression Inventory, Second Edition. It is a very carefully designed questionnaire of twenty-one questions that cover the potential presence of depression symptoms. It was designed "to measure women's self-confidence and maternal parenting skills," (Lee et al. 2011). Moreover the element of family function was measured through a series of five questions revolving around family adaptation after the birth of a child. The Interpersonal Support Evaluation List was also incorporated to help "measure personal perception of social resources," (Lee et al. 2011). This allowed researchers to ask close-ended questions listed on scale responses using the Likert scale. Finally, the Perceived Stress Scale was also used within the context of this research. This scale was designed to measure how much stress an individual mother reported going through, both before and after conception of her new child. Results were then tested using regression through SPSS, with a defined P. value of less than .05.

Results showed clear statistically significant correlations between certain elements and incidences of PPD cases. Out of all the 71 participants incorporated into the study, 25% were labeled at having been experiencing symptoms of PPD. Out of this 25%, 16.7% were reported with mild symptoms, 6.7% moderate, and 1.7% severe (Lee et al. 2011). Results showed that the average time period of infertility before conception was around four years. However, this tended to prove unimportant in terms of later rates of PPD symptoms. What elements did prove statistically important were several categories that could be defined and labeled by researchers. First, results showed that the stress of undergoing IVF treatments does show to statistically correlate with more prevalent numbers of PPD cases in new mothers. In fact, the rate of PPD was higher in cases were IVF was used compared to general data collection of new mothers in general. Still, there were other, more specific factors that augmented the increased rates of PPD seen in cases were IVF was the method of conception. In fact, family and social support proved to be elements that helped decrease rates of reported PPD symptoms. Using the scales and designed questions, the research found that new mothers with a greater perception of social and familial support had less rates of PPD symptoms, where mothers with little social support showed higher risk rates for experiencing PPD. Additionally, the study also found that the method of birth was another common factor in potential predispositions to PPD. In fact, the research shows that cesarean births can also come with higher frequencies of PPD conditions.

Such findings lead to the development of the conclusions posited by Lee et al. (2011). It is clear that there are higher rates of PPD in women who had undergone infertility treatments, most often due to the stress caused by the process of IVF itself. Additionally, the existence of other crucial elements, including social support and method of birth also impacted PPD rates significantly. The more elements present in the individual responses, the higher the rates of PPD was. Thus, the author concludes that this research should be used to help allocate appropriate resources available to mothers labeled in the most vulnerable positions offering education and counseling services to those in higher risk situations.

Lee et al. (2011) proved to have several major strengths in terms of its research design and structure. First, the questionnaire used to gather data from the new mother participants. The use of the Chinese form of the Beck Depression Inventory, Second Edition scale helps provide their research methods with previously structured successes. The scale has been used in numerous previous studies, and has been shown to be a reliable scale to determine levels of present depression in individuals in question. This scale successfully provided a way to translate the participants' answers in open ended form into a measurable numerical format which could later be used for the purpose of regression analysis which was the backbone of the study. The scale used help create reliable transformation of open ended question responses into measurable data. Additionally, the study used a number of other measurement devices to help relate the women's answer responses to statistically graspable data measurements. This included not only the previously discussed scale, but also the Family APGAR Index which measured "problems in family adaptation" within the scope of 5 questions on the questionnaire (Lee et al. 2011). Other measurement devices used included the Interpersonal Support Evaluation List and the Perceived Stress Scale.

There are a number of clear weaknesses within the context of the research conducted by Lee et al. In 2011. First, there is the case of having an extremely limited perspective based on the incorporation of only a single infertility treatment examined

As of now, the research study findings really only represent a single cultural perspective, and thus does not account for potential differences in PPT rates based on cultural or ethnic factors. Therefore, the study findings are limited in terms to exactly who they represent. This creates a situation where they can then be made to make assumptions on a very small percentage of people, thus limiting its potential to help create movements in progressive counseling strategies for various high risk populations of new mothers. What may be happening in Taiwan may not be occurring in the United States or Morocco. What is needed to address this clear weakness is a broader spectrum of study participants in similar future clinical trials. Further clinical trials conducted with a broader spectrum of individuals. Future research should incorporate participants from a number of different locations around the country, and potentially even the globe. In fact, using participants from very different cultural backgrounds can help provide more detailed information on a broader spectrum of new mothers. A larger database of various people can help research decipher certain cultural elements that may also contribute to increase PPD symptoms in correlation with the presence of infertility. Additionally, there was a weak element in the study by the researchers only using one method of data collection. Although the questionnaire used in the study was highly structured, it still was the only instrument of data collection used within the context of the study itself. With the questionnaire being independently completed, there is no real way to professionally guarantee more absolute findings beyond what the women involved were willing to admit. Measurement tools proved numerous, but the essential collection of data was in singular form. To strengthen this weakness, it would have benefitted the research to use a more multi-faceted approach. This may have included the use of an interview conducted by a professional in order to have something to compare the results of the independently completed questionnaire. Having an external third party provide data on depression symptoms would have helped strengthen the study results. Future research trials can incorporate other strategies to help augment the viability in the research data collected.

Still, despite such apparent weaknesses within the research, I do agree with Lee's conclusions regarding the nature of PPD as it correlates to the various elements spelled out by the study. The research design provides reliability and strength in creating analysis that can lead to strong assumptions regarding the elements which contribute most to incidences of PPD, especially when seen in conjunction with one another. I do believe that the stresses of going through IVF can have a significant impact on later development of PPD, based on the emotional rollercoaster that infertility treatment consists of. Moreover, it was interesting to see that the method of birth also had a significant impact on later development of PPD. This is something that I had never heard before, so may have doubted; yet, the statistics clearly show that this is a significant factor in the increased rates of PPD after birth. Thus, overall, I agree with Lee et al. (2011) and the research findings within the study.

This research does correlate with key elements within the field of midwifery. Understanding how significant factors can be predetermined can help midwives start planning early on to help progressively avoid occurrences of PPD in new mothers. By understanding clear risk factors, midwives can help augment physician care treatments by providing further educational resources and counseling to women in high risk categories for developing symptoms of PPD. It is important for midwives to keep updated on such findings, as they will undoubtedly help the effectiveness of the midwife position within creating a high quality of life before and after child birth for new mothers.

Admissions Essay Questions

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I have always been fascinated with the field of midwifery. I have made sure to keep active in my pursuit of knowledge in the field. Thus, I have extensively studied the field of midwifery independently and through various educational and professional organizations. In addition, I am currently an associate member of the American College of Midwives. This helps expose me to current trends, but also clinical research resources to further augment my growing education. I am also learning independently through exposure to various important contemporary literature in the field. In fact, I currently subscribe to The Journal of Midwifery and Women's Health as well as Obstetrics and Gynecology.

There are several reasons as to why I would want to become a midwife, especially now. I have always wanted to enter into the career in order to offer emotional support to women in a time of great need and vulnerability. Thus, it has always been a goal of mine to provide a caring environment to women throughout their child birth experience.

The role of midwife is a very unique one, and it differs dramatically from the practices of nursing and other forms of healthcare positions. Midwives are not only there in the crunch time, and help provide support throughout the pregnancy and birthing process. Midwives are there before the birth to address both emotional and physical needs of new mothers, whereas traditional nurses tend to offer only physical support in limited times of need. I have always desired to have an advanced practice license in nursing as a practitioner so that I can offer the most caring support and comfort to others in need.

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I am fortunate to also have vast experience with the process of distance education through online platforms. I have used numerous distance education methods in the past. In fact, I achieved two Associate degrees through online platforms as well as a Bachelor Degree in Science which was heavily dependent on distance education facilitated through the internet. Moreover, I had been previously employed as an investment banker. During this context, all of my training was conducted through distance education platforms. This past experience will help me deal with and succeed in future distance education programs.

Still, I have to assume that I will have both strengths and weaknesses as I pursue my further education in the field of midwifery. I know my previous experience with distance education will help strengthen my ability to succeed in the field. This will help me deal with the superficial elements of the educational process so that I can focus on the more important elements of learning how to be an effective midwife in real life practice. Additionally, my professional experience shadowing real midwives in practice will help me prepare for actual practice. Yet, I know I will have some weaknesses as I continue with my education. Actually implementing what I learn will be difficult at first. However, the more practice in the field via shadowing and observation sessions, I know I will be prepared when the time comes to actually start the practice.