The effects of psychotherapy on postpartum depression

¶ … Psychotherapy on Postpartum Depression

The concern over women of advanced maternal age (over 35) giving birth has had a long history. There are many that think it is dangerous, and not just for the physical health of the mother, but for her mental and emotional health as well. Much of this has to do with the fact that there are many risks that come with having a baby, and the older the mother is when she has her first child the harder it often is for her. This is especially true of women who are over the age of 35, but some women have babies when they are in the late thirties or their forties with no apparent ill effects. Nevertheless, the concerns are very real and should not be ignored by women over 35 who are considering having their first child.

Throughout this paper, many of the issues that these women face will be addressed, but the focus will remain on fatigue and depression, as these seem to be two of the main complaints that are had by women of advanced maternal age. Why these complaints are so prevalent will be discussed, as well as the purpose behind this study and the theoretical framework that it deals with. Also discussed will be the methodology that will be used to study this issue and what type of findings would likely be seen by study of this subject. Postpartum depression is a very serious issue and for women of advanced maternal age it is often more prevalent and much more severe than it is for younger women. This does not mean that younger women cannot have problems with postpartum depression, but only that older women see it more often, which is why they will be the focus of study here. Psychotherapy can help some of these women, but not all of them respond to it and that issue must be addressed as well.

A review of the literature will also help with some of the lack of understanding that most people have about first-time mothers over the age of 35 and the mental and emotional difficulties that they face. How this type of data would be analyzed and what should be done for research in the future where this subject is concerned will also be dealt with in the following pages to ensure that there is a complete understanding of the importance of the problem, what research has already been done into it, and what should be done for the future. This will help to make sure that women over the age of 35 who are considering becoming first-time mothers are aware of the risks that they will be taking so that they can get help if they find that they need it as their pregnancy advances or after the baby is born. Many of them are not aware of psychotherapy and what it can and cannot do for them when they suffer from postpartum depression, which is becoming a serious concern in today's society.

Significance of the Problem

The main problem with this is that women over the age of 35 are considered as being of 'advanced maternal age.' This does not mean that women over 35 should consider themselves old, but only that they are reaching the upper limit for childbirth and that things that might have been easy for them in their twenties will be more difficult now. A women's brain chemistry can be affected as well as her physical shape, and this can lead to postpartum depression. While this, as well as fatigue and irritability, are somewhat common in all first-time mothers, they can be very pronounced and even somewhat dangerous for women over 35, and the risk increases even further for women who are over 40 when they have their first child.

It becomes necessary, therefore, to look into the problems that many of these mothers have with postpartum depression and try to help determine either how these problems can be avoided or how they can be treated once they occur. It is likely that there is no way to completely avoid the fatigue and depression that many of these women face, but finding out if there are any type of specific attitudes or beliefs that these mothers have that seem to lead to fatigue and depression will help find ways to treat this problem and protect these mothers from potentially harming themselves or their children it is not likely that many of these women who experience postpartum depression will actually do harm to anyone, but postpartum depression can be very serious and women who find themselves dealing with it and not getting the support that they need from others sometimes do harm themselves or their children. This is, naturally, a very serious concern and because of this it is necessary to look into this issue and determine what can be done to reduce the risk of these types of things happening to these women and their brand new babies.

Presentation of the Problem

Women who become first-time mothers at the age of 35 have usually spent time in their careers, have developed solid and lasting relationships in their lives, and have experienced the autonomy of being able to do things on their own (Milligan, Lenz, Parks, Pugh, & Kitzman, 1996). Many of these women then decide that a child is what they need to make their life complete because they have already had the other things in life that they wanted to achieve, such as a career (Jannke, 1992). There is also a certain level of apprehension for many women who have children over the age of 35, and this is especially true for women over the age of 40 (Beck, 2002). However, it is interesting to determine how much of this is actually factual and how much of it is based only on the idea that women who are over the age of 35 should not be having children.

Whether women should be birthing children when over the age of 35 has been a very long discussion and a great deal of anxiety has been dealt with in this issue. These women do have an increased risk of having a child that has a genetic abnormality, and it is important to look at this issue (Beck, 2002). Another concern for these women is that they may be at slightly higher risk for gestational diabetes and hypertension (Beutler, Clarkin, & Bongar, 2000). However, most of these women are paying more attention to stress management, cardiovascular fitness, awareness in various nutritional aspects, and many other issues that are changing the way that doctors and others look at these women when they wish to become mothers (Beutler, Clarkin, & Bongar, 2000). Despite this, though, depression and fatigue still remain important factors for these women (Dobrzyknoski & Stern, 2003).

Many women tend to work overtime not only at the office in their careers but also at home, in the community, and in relationships that they have with others (Beutler, Clarkin, & Bongar, 2000). On average, women will spend approximately 15 hours more each week doing work related tasks that men will (Beck, 2002). They also do 75% of the housework in the average household in this country where 60% of the men in this country do housework very little or not at all (Beck, 2002). When women get married, the amount of unpaid labor that they do increases by approximately 60% and this goes up to 91% when this woman has a child (Beck, 2002). Stress begins to work on these individuals and even though they may be coping quite well in a physical sense this does not mean that they are doing well emotionally, and this is especially true of those of low socioeconomic status or ethnic minority that might not get the care that they truly need and sometimes tend to have larger families (Templeton, Velleman, Persaud, & Milner, 2003).

Women who find themselves pregnant often find a little bit of rest from much of this stress and they look for new ways to either avoid these stressors in the future or find different ways to react to them so that once the baby is born they are not rushing back into the life that they had full speed ahead and not taking time for the baby and for themselves as well (McVeigh, 1997). Unfortunately, women who wait until they are older to have children sometimes have extra problems with this issue (Fowles, 1998). They are normally used to being in control of not only themselves but their relationships and their work as well (Fowles, 1998). They are used to being in charge and many of the things, both physical and mental, that happen during pregnancy are completely out of their control (Caltabiano & Caltabiano, 1996).

This may actually cause extra stress rather than help to reduce the amount of stress that these women feel. They are often frightened by the appetites that they have, the way that they gain weight during pregnancy, and many of the other feelings and thoughts that they have as their bodies and hormones change (Cronin, 2003). 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.