Postpartum Depression: The Preventive Role of Nurses

Introduction

Postpartum depression can represent a serious threat to maternal, infant, and family health, and for this reason it has garnered much attention over the past decade. However, the relatively recent attention paid to this condition means that generally accepted screening and treatment strategies have not yet been firmly established (reviewed by Yawn et al., 2012). In the absence of robust general practice guidelines for postpartum depression, nursing professionals may find themselves without reliable guidance. The potential impact of this inconsistency on individual, family, and societal health is probably significant. This essay examines several recent research articles and what they offer in terms of best practice approaches for treating women at risk for postpartum depression.

Factors Contributing to Postpartum Depression

Prospective mothers often ask their psychiatrist whether there is a risk that they might abuse their child (reviewed by Choi et al., 2010). Questions of this nature reveal the popular perception that there is a causal link between maternal mental health and the risk of child abuse. This possibility is supported by experts in the field, who have claimed that the risk factors for postpartum depression include a history of maltreatment as a child or exposure to poor parenting. Such experiences may increase the chances of mental health problems and reduce the mother's ability to handle stress, thereby contributing to infant neglect and other forms of abuse.

When Choi and colleagues (2010) investigated the possible causal relationships between various suspected risk factors for child abuse, they found that mothers with a poor childhood parenting experience who worried about the risk of child abuse were no more likely to abuse their child than mothers without such an experience. Although Choi and colleagues did not find a direct relationship between depression and abuse, they did find a significant relationship between depression and difficulty bonding (p < 0.001), and between difficulty bonding and abusive behavior (p < 0.001). This finding suggests there is an indirect causal relationship between depression and child abuse.

The Role of Bonding and Attachment

Zauderer (2008) found similar evidence for a causal link between postpartum depression and bonding; however, Zauderer makes a distinction between bonding and attachment, with the latter representing a more complex relationship that begins during pregnancy and develops progressively during the early years of infant parenting. Attachment is believed to be important for the cognitive, social, and emotional development of the child. In contrast, bonding occurs during the period immediately following childbirth but is believed to be essential to the attachment process.

By presenting a composite case study of postpartum depression, Zauderer (2008) reveals the common experiences of these patients. For example, mechanically caring for the newborn is a common trait arising from feeling trapped in the stay-at-home parent role and no longer in control of one's personal life and body. The immediate outcome of this lack of attachment is a more demanding infant, which in turn aggravates the mother's resistance to meeting the infant's needs. When this dynamic unfolds, treatment may involve the use of antidepressant medications, maternal health and nutrition instruction, promoting breastfeeding if still possible, encouraging strong family and social support ties, and parenting classes — all in an effort to foster reattachment.