Modes of Childbirth and Causes of Postpartum Depression

The end of gestation or pregnancy phase is marked by the birth of the baby, either through vagina or through a Cesarean section. Childbirth is also known as delivery or labor. The most common type of childbirth is the vaginal birth, a natural mode of childbirth. Cesarean Birth, commonly known as C-section is a surgical method of childbirth in which incisions are made on the abdomen and uterus of the mother. C-sections are performed usually when complications arise during vaginal birth or when either the mother or the baby, or both have a risk. Although the feeling of childbirth is euphoric; a complete rush and sense of accomplishment, it is a very painful experience irrespective of the mode of childbirth. The long term effects of trauma on millions of women are still ignored to a great extent. Many women experience feelings of unhappiness, worry, and fatigue after having a baby, which are generally called as “Baby Blue”. As babies require a lot of care, it’s normal for mothers to be worried about, or tired from, providing that care. Up to 80 percent of mothers experience baby blues’ feelings that are somewhat mild, last a week or two, and go away on their own.

However, some women experience extreme feelings of anxiety, sadness, changes in eating and sleeping patterns, and irritability that interfere with their abilities to take care of themselves, the baby and of the family. This condition is termed as Postpartum Depression. This condition effects nearly 15 – 20% of mothers; beginning shortly before or anytime after childbirth. The symptoms commonly begin to appear within the firth month of childbirth.

What really causes postpartum depression is still unknown. Studies show that there can be a combination of various factors that can contribute to Postpartum Depression. These factors include hormonal, physical and emotional changes in women. Women who are at a higher risk of developing Postpartum Depression are:

  • The ones who have had unwanted or unplanned pregnancy and childbirth.
  • The ones who consume alcohol, illegal drugs or smoke.
  • The ones who have experienced pregnancy loss or any complications during the process of childbirth
  • The ones who have experienced a stressful or a traumatic event like loss of a loved one, divorce, loss of job, etc, soon after childbirth.
  • The ones who have had a history of depression, anxiety, bipolar disorder.
  • The ones who have relationship conflicts with their partners, financial difficulties, etc
  • The ones who lack moral and social support from family and friends.

With the high prevalence of Postpartum Depression and the associated serious and multidimensional risks it poses towards the mother and the child, the causal factors need to be focused on. Since there are a limited number of studies explaining how the mode childbirth effects postpartum depression, this study hopes to add up to the existing literature.

Review of Literature

Kaya and Cigdem (2019) conducted a study to investigate the impact of the mode of delivery on the occurrence of PD in primiparous mothers. The study was performed on 244 primiparous women (aged 15-49 years) in 17 primary health-care centers. The Edinburgh Postnatal Depression Scale (EPDS) was used to gather data from women during the 1st and 3rd months after delivery. The relationship between the obstetric features and EPDS scores were evaluated thereby revealing that the desired and performed modes of delivery, induction, episiotomy, and spinal anesthesia were not linked with EPDS scores. The study concluded that Effective measures must be established for early recognition of factors affecting the occurrence of PD. The study concluded that efforts must be made by health planners and policymakers to promote the knowledge and attitudes of mothers during pregnancy.

Eckerdal P et.al (2018) conducted a study to explore the association between mode of delivery and postpartum depression, considering the potentially mediating or confounding role of several covariates. A longitudinal-cohort study in Uppsala, Sweden, on 3888 unique pregnancies followed up postpartum, the effect of mode of delivery (spontaneous vaginal delivery, vacuum extraction, elective cesarean section, and emergency cesarean section) on self-reported postpartum depressive symptoms at 6 weeks after childbirth was investigated through logistic regression models and path analysis. In comparison to vaginal birth, women who delivered by emergency cesarean section were at higher risk for postpartum depression 6 weeks after delivery in crude (odds ratio 1.45, 95% confidence interval 1.04 – 2.01) but not in adjusted analysis. However, the path analysis revealed that emergency cesarean section and vacuum extraction were indirectly associated with increased risk of postpartum depression, by leading to postpartum complications, self-reported physical symptoms postpartum, and therefore a negative delivery experience. On the contrary, the odds of postpartum depression increased with a history of depression and fear of delivery, which furthermore led to elective cesarean section; however, it was associated with a positive delivery experience. The study concluded that the mode of delivery has no direct impact on risk of postpartum depression; nevertheless, several modifiable or non-modifiable mediators are present in this association. Women delivering in an emergency setting by emergency cesarean section or vacuum extraction, and reporting negatively experienced delivery, constitute a high-risk group for postpartum depression.

Connection between Cultural Background of Birthing Practices and Childbirth Experiences

The leading purpose of this article is to understand why cesarean deliveries are overused, considering the increased risk of complications that affect mother and fetus. The author makes it a point to focus on the larger scale of cultural factors that are associated with a key clinical measure of quality care for the maternal population. In this study, they recruited obstetricians, family physicians, midwives, anesthesiologists, and labor nurses from 79 hospitals in California. The Labor Culture Survey (LCS) consisted of 29 items with 6 subscales: “Best Practices to Reduce Cesarean Overuse”, “Fear of Vaginal Birth”, ”Unit Microculture”, “Physician Oversight”, ”Maternal Agency”, and “Cesarean Safety”. These factors were included on a large scale validation study that suggested the LCS was a valid, reliable instrument to use. The authors of this study believe that the quality of care has been compromised because of lack of clear quality metrics, a strong history of the individualistic approach to caring for pregnant mothers, and undervaluing maternal outcomes in birth. Why is a low-risk female delivering her newborn by a cesarean delivery? A cesarean delivery is an invasive procedure specifically indicated for fetal intolerance of labor, failure to progress, or other complications that hinder the fetus or mother. Furthermore, the factors analyzed were closely observed and measured, creating the LCS to focus on constructs unique to birth. This being the value of vaginal birth, reducing unnecessary intervention, and empowering women. The article concludes that the LCS is beneficial because it targets the process of implementation towards specific attitudes, unit norms, knowledge deficits, communication gaps, and behaviors. After all, future work should look at testing individuals among a diverse population in states other than California. This being said, the attitudes about birthing practices show a positive correlation when it comes to mothers experience. The birthing process is a time in a woman’s life that is surreal. A woman giving birth vaginally, unless contraindicated, is an empowering moment for her because her body made this human being and she was able to bring it into this world. Ultimately, if a female is able to have a normal birth, then her healthcare staff should respect her decision and properly educate her (Van Gompel et.al, 2019).

Holten and Miranda (2016) draws a close study analyzing literature that explores women’s motivations to ‘birth outside the system’. She outlines research of women who choose to have an unassisted birth, home-birth in countries where home-birth was not integrated into the maternity care system, or a midwife attended high-risk home birth, from Sweden, USA, Australia, Canada, and Finland. The focal point is understanding women’s freedom of choice in maternity care and how to respectively deal with if a woman chooses to birth ‘outside the system’. The author emphasizes five main themes as significant factors: 1) resisting the biomedical model of birth by trusting intuition, 2) challenging the dominant discourse on risk by considering the hospital as a dangerous place, 3) feeling that true autonomous choice is only possible at home, 4) perceiving birth as an intimate or religious experience, and 5) taking responsibility as a reflection of true control over decision-making. The authors of this study conclude that there is a lack of fit between the health needs of pregnant women and the current system of maternity care. Why do women feel the need to have unassisted child births? Perhaps, many women feel a sense of empowerment in themselves or lack of faith in the healthcare system.There is approximately 200 planned unassisted child births yearly. This is a direct result of the data the article identified that influences women to deliver outside the system. Discussed throughout the article, women’s motivation to deliver at home is due to wanting to have more involvement with the birth, as well as, avoiding unnecessary medical interventions. There will always be a patient that does not want to adhere to medical advice. The women in this study are set on their beliefs and want to experience the birth of their child in a natural/holistic environment. A hospital does not offer this for them, which drives them to unassisted childbirth or high-risk home-birth. Future research is needed to understand the motivations and actions among women and to explore the scope of women birthing outside the system with the experiences of healthcare professionals. It’s not an easy and quick process no matter where you are, so it’s important to understand that at home child-birth can result in an increase in complications. This article provides us with a concise overview of attitudes that are presented around the different approaches of ‘birthing outside the system’ and women’s autonomy over their bodies (Holten & Miranda, 2016).

According to the 2018 article (Leyva-Moral et. al, 2018), Reproductive decision-making in women living with human immunodeficiency virus, the information in this review can lead to establishing high quality care to women living with HIV, who would like to conceive. The authors make it a point to understand the reproductive decisions made by women living with human immunodeficiency virus. In this study, there are many factors that contributed to the rising pregnancy rates among women living with HIV. This includes the increased life span of HIV-infected women in childbearing age, improved clinical status, and awareness of low risk mother-to-child transmission. On the other hand, there are still social issues that have occurred such as stigma and discrimination against women living with HIV, and the thought of them conceiving a child. This being said, women are not receiving accurate, family centered, culturally competent, and evidence-based care to inform their decision-making process regarding reproduction. If women are not receiving quality, accurate care from their providers, what would make them want to stay with that specific practitioner? These authors concluded that this evidence could be related to the lack of health care provider cultural competence, as well as, the knowledge deficiency about the current evidence-based practices. This discourages women who have this disease and drives them have little trust in the healthcare system. However, this study revealed that multiple women found satisfaction with their care from specialized teams. These specialized teams offer high activity anti-retroviral therapy during pregnancy, neonatal prophylaxis, avoidance of breastfeeding, in addition to scheduled cesarean birth, are effective in preventing HIV mother-to-child transmission. Overall, this study presents evidence-based practice guidelines that indicate women can reproduce and have a family with a healthy future (Leyva-Moral et. al, 2018).

Many women have concerns about the safety and risk of birth, which are fundamental to the decisions women make about pregnancy and delivery. Midwives are a safety net for most women, in terms of traditional birth choices. This is because they can choose the place for birth, move freely during labor, and have family present for the birth, none of which is allowed in medical facilities. Cultural practices, economic and logistic realities, and education are the main influence on women’s preferences for childbirth. Healthcare professionals should inform these women about the pros and cons pertaining to an at home birth vs. hospital birth. However, childbirth may cause adverse outcomes, such as postpartum hemorrhaging. How is one medical professional going to ensure the mother’s safety if she decides to deliver at home? This statement is not meant to be biased, but it is important to consider all the facts before deciding on a birth plan. Some of the women interviewed stated, “they do not feel that they are being controlled by medicine or forced into decisions through their doctor’s expertise of authority; instead, they experience agency and a sense of control in the choices they make to trust the medical establishment.” With this being said, it is important to have the required medical technology, constant observation to minimize risks, and rely on the competence of medical professionals that they will do everything in their power to ensure the mother and baby are safe. Furthermore, historical attitudes can change a woman’s mind in regards to her birth plan. They consider if women were able to deliver children before new scientific technology, then why can’t they have an at home delivery. This may work for some women, but childbirth is not always as straightforward as one may think. There are several complications that can have fatal outcomes. Ultimately, it will be a mother’s preference in how she wants to deliver her child. It is critical for healthcare professionals to communicate with these women about the complications that exist if they experience adverse effects with at home deliveries and do not have the proper medical equipment or staff (Miller & Shriver, 2012).

Maternal bonding is a key factor for the development of a newborn. The first hour of birth is essential because this is a critical time for the mother and newborn to become acquainted. Bonding is a pivotal role for the newborn to develop important, healthy relationships and offers them security and self-esteem for their future selves. Women who gave birth to children in the past often had wet nurses care and feed their newborns. This made the maternal bonding difficult for those children because they were confused about who they should be connected towards. This most likely caused developmental issues later in life because of the confusion growing older. The main factors that influence the emotional-involvement between the mother and her newborn consist of several components. These include socio-demographics, previous life events, types of delivery, pain at childbirth, support from partner, infant characteristics, early experiences with the newborn, and mother’s mood. The outcomes of this study indicated that maternal attachment is an interactive process between the mother and the child, seeing that some infants qualities interfered in the excitement the mother had toward the child. The results concluded that mothers with depressive symptoms, unemployment history, and mothers without a partner contributed to a negative bonding experience with their newborn. With this being said, early postpartum mood should be a priority after delivery to help the bonding experience for the newborn. The mother’s experience during pregnancy and delivery should be one that is filled with joy and excitement. The bonding process is involved with this experience. If a mother does not develop this maternal attachment to her newborn, the child will feel insufficient and withdrawal from emotional connectedness. The bonding experience also consists of breastfeeding the newborn. This not only helps promote the mother-infant bonding, but it helps the mother heal from delivery. This is because breastfeeding helps the uterus contract and keep the fundus firm postpartum. In conclusion, this article illustrates the importance of promoting a mother-child bonding experience. Regardless of birthing practices, early attachment after delivery helps enhance the psychological development of the child. This is often related to the mother’s involvement and feelings during and after birth (Figueiredo et.al, 2008).

As a cultural phenomenon, childbirth is an empowering personal event in a woman’s life. This can be recognized as a social experience that differs within each culture and society. It’s important to originate knowledge about the basic understanding of diversity. That being said, health care professionals need to effectively learn about an individual’s heritage, so they can provide effective care to their patients. The focal factors that contribute to childbirth within women of African descent consist of multiple aspects. These include a sense of responsibility, childbirth as a positive life event, the uniqueness of childbirth as a life experience, childbirth as a bitter-sweet paradox, and childbirth as a spiritual event (Etowa, 2012). Childbirth is a journey a woman takes control of in order to gain self-worth and hope. This journey consists of socio-economic, cultural and historical factors.

References:

  1. White Van Gompel, E., Perez, S., Wang, C., Datta, A., Cape, V., & Main, E. (2019). Measuring labor and delivery unit culture and clinicians’ attitudes toward birth: Revision and validation of the Labor Culture Survey. Birth: Issues in Perinatal Care, 46(2), 300–310. https://doi-org.libdb.dc.edu/10.1111/birt.12406
  2. Holten, L., & Miranda, E. D. (2016). Women׳s motivations for having unassisted childbirth or high-risk homebirth: An exploration of the literature on ‘birthing outside the system.’ Midwifery, 38, 55–62. doi: 10.1016/j.midw.2016.03.010
  3. Leyva-Moral, J. M., Palmieri, P. A., Feijoo-Cid, M., Cesario, S. K., Membrillo-Pillpe, N. J., Piscoya-Angeles, P. N., … Edwards, J. E. (2018). Reproductive decision-making in women living with human immunodeficiency virus: A systematic review. International Journal of Nursing Studies, 77, 207–221. doi: 10.1016/j.ijnurstu.2017.10.012
  4. Miller, A. C., & Shriver, T. E. (2012). Women’s childbirth preferences and practices in the United States. Social Science & Medicine, 75(4), 709–716. doi: 10.1016/j.socscimed.2012.03.051
  5. Figueiredo, B., Costa, R., Pacheco, A., & Pais, Á. (2008). Mother-to-Infant Emotional Involvement at Birth. Maternal and Child Health Journal, 13(4), 539–549. doi: 10.1007/s10995-008-0312-x
  6. Etowa, J. B. (2012). Becoming a mother: The meaning of childbirth for African–Canadian women. Contemporary Nurse, 41(1), 28–40. doi: 10.5172/conu.2012.41.1.28

Role of Informal Communication and Social Networks in Cultural Childbirth Understandings among Mirpur Women

This section explores the existing notions and understandings of childbirth that women have within the low income household communities of Mirpur. Drawing out their narratives and tracing the construction of those narratives allows us to see how women view their place in their own and in other women’s reproductive lives and to understand the intentions, motivations, desires and influences that lie behind their decisions of where to give birth, how much to rely on formal or informal healthcare providers, etc. (Unnithan, 2002; Rozario and Samuel, 2002; Afsana and Rashid, 2009).

As Jordan (1983) argues, ‘birth is everywhere socially marked and shaped”. Like many other cultures, there are many notions regarding childbirth practices in Bangladeshi society. In order to understand the existing birthing practices in Bangladesh, it is necessary to locate it within its larger social and cultural context. It is also paramount to look at dominant conceptions of birth and to consider how these are challenged by midwifery interventions, the likes of the birthing chair.

Where to give birth: What constructs women’s choices about where to deliver?

7 out of 10 mothers initially wanted to give birth either at home or in their natal homes in villages. Women also mentioned that in an ideal scenario, they would chose to go into the clinic as late as possible, when they are in the final stages of labor. The reasons cited for this preference included: feeling stressed and anxious due to the environment at the clinic, facing greater emotional distress, or feeling uncomfortable staying there for long hours or distressed that they cannot move about freely like they can in their homes.

Aklima, 35, mother: “I never go to the hospital [for checkups] before my delivery… I only go during the last stage…I don’t like staying at hospitals much… I don’t like the use of medicines at all… They said there are risks at home… you don’t always get safe deliveries at home. I was scared… they said that if I face any problems then I will need to go to the clinic either ways. If there is any problem I could take immediate help (in the clinic).”

From observations during interviews, it is seen that the urban space in the Mirpur 1 and 2 areas is congested with structures both legal and illegal. Large apartments, half constructed building and small shanty houses have been developed side by side. Here, most families live in one room homes within these half constructed building or shanty areas and those who are more economically well off are able to rent two or three room flats where families live together. The space makes it increasingly difficult for women to opt for home births, even if they desire to. In this context, the issues of privacy, comfort and ease of delivery have a significant influence in shaping the expectations and decisions these women take on regarding their deliveries. Keeping the congested urban landscape of Mirpur in mind, many expectant mothers chose to give birth in the clinic- as they did not feel that giving birth at home was a feasible option for them. Further conversations revealed that this idea stemmed from – the lack of family members to support them even if they wanted to give birth at home or they faced problems of prolonged labor or their membrane was ruptured.

Nasima, 30, mother: No, no I didn’t think about home (the rented place in Mirpur). I would have gone back to my village. But going to the village means going through a lot of trouble. The doctors are far away in the village, aren’t they? It gets too late to reach to them when there’s problem with delivery. (Over here)If I feel pain I can go anytime (to the doctor), so I stayed in Dhaka…But I’m alone here if I do delivery at home who’s going to clean up and manage everything, who is here, you tell me? In Dhaka, where do I find a dai-matari? If I had an acquaintance I would not have had a problem because then if I did face a problem (during birth) they would have been there on standby and I could ask them for help. But I don’t know anybody here, it’s not like that for me.

Ranjin, 17, mother: “My water broke at home. My mother-in-law had wanted (me) to deliver at home. It was my first time so I didn’t understand a lot of things. She had told me to deliver at home. Then when she saw that there is no pain, she took me to BRAC. I could feel the water trickling down. I told [the baby’s] grandmother that, ‘Ma this is what is happening’. She didn’t say anything, just went and called her khala. Her Khala came and said that her water is broken. They saw that throughout the night, there was no pain. The day after at 12 noon, I went to the medical, the medical at Golartek, they took me over there to do an ultrasonography.”

Afsana and Rashid (2009) reported that when delivering at home in the village, women narrated that they were allowed to walk freely, change positions, and hold onto a rope or pole while giving birth upright. The TBA, the “dai-ni”, provide physical and emotional support, but try not to take over the birthing experience, allowing women family members to play a role by physically holding the woman or telling stories to keep her calm. In the current context of urban slums or low income households, Bangladeshi expectant mothers usually have less information on delivery, a decreased support network by living in a nuclear family (in slums), and because of cultural reasons, a spouse that might not be involved in the birth at all) (Edmond, Paul and Sibley, 2011; Amin 1988).

Furthermore, the social networks women reported that they have built in and around their homes are an important factor that shapes their understanding of their own childbirth, their knowledge regarding birthing beliefs and practices – which eventually leads to how their attitudes towards innovation in the birthing space are shaped:

Shamima, 30, mother: R: Yes I wanted to do it at home. I didn’t know I would be taken there, I wanted to try giving birth at home. I told the Apa, then she said no I will take you to the center….so that’s why we did not inform any dais. My mother wanted to call a dai, I did not want to go anywhere…my mother gave birth at home and I wanted to do the same. But then who would call a dai at late night…”

The networks that “Kormi” and “Shekbika” establish around their communities is the most effective way in which BRAC has been able to change health seeking behavior of pregnant women in the (Mirpur -1) area in the past decade:

Asma, 35, SK: People are more hospital leaning than before, even if they go somewhere else (other than BRAC) at least they are going, that is what i like. Wherever it is less expensive, they go, they don’t do it at home. One thing we have been able to make then understand is that it is not right to deliver at home, it isn’t safe. This is my believe, that even though I am not in office, so you can ask anyone at the office, in my area, the ones I work with, home births are very low.

Current community messaging about the chair is limited to meetings for pregnant mothers (who are in their last trimester):

Asma, 35, SK: You’ll need to understand one thing here apa, if I do talk about this when I go to their homes, it’s a matter of seeing it with their own eyes. Someone who has never seen the chair before in her life, even if I try to make her understand in a thousand ways she will not be able to understand. But when she comes to this place, then I can show it to her. When a mother comes in, and we are present there, we take her to the labour room and show it to her telling her that apa come and see the delivery room, this is where we do the deliveries. We do it like this, take a look would you be able to get this at your home?

Midwives are only able to communicate about the chair during fieldwork, which is limited scope because they’re approaching only one person at a time. Community messaging efforts could potentially make people aware of the chair and make their duties of counselling and information dissemination during deliveries or high stress delivery situations much easier.

Apart from notions of privacy, cleanliness was an important factor as explained by women when choosing where to give birth. Nasrin, a 22yrs old woman with three children we interviewed, mentioned opting for birthing at the clinic because of the lack of resources at hand in her home and neighborhood.

Nasrin, 22, mother: I mean we go to BRAC because the normal delivery happens there and you can leave everything behind and come home clean …it’s nearby so it’s easier and more people go there.

The lack of privacy, the need for cleaning up after birth and the fact that most of these women do not have a family network to rely on during births, leads them to opt for the clinic. This problem seems particular to women (those interviewed) who cannot commute to their villages, where they usually give birth at home with a dai/dai-ni in attendance. Nasima (30, mother) who narrated that her issues of back pain and postpartum issues were a result of using the chair during her delivery, mentioned that it would be easier for her to be able to deliver at her home, in her village, but she decided not to go since she has two other children to look after and her husband had been recently ill. Delivering in the clinic then, comes from the sense of not having enough resources at hands, which reduce the risk that they sense and that they have come to become aware of regarding deliveries at home: support of family members, easy access to transport in case of an emergency, enough space within homes.

Furthermore, pollution or uncleanliness has been shown to imply risk of attack by malevolent spirits or “kalo drishti” in researches on delivery practices in Bangladesh (Afsana and Rashid, 2001). The emphasis on pollution is found consistently in birth stories in Bangladesh, including the numerous studies carried out by researchers (Rozario, 1998; Blanchet, 1983). Rozario and Samuel’s (2002) paper state that the need for separation from others becomes critical for women during birth, since people who are perceived to be polluted will transmit their state of pollution to others, placing them at risk. So women who perceived to be in a state of pollution have to be kept apart from those who are not. In previous studies by the same author, it has also been noted that childbirth pollution is the most severe pollution of all, far greater than menstruation, sexual intercourse, defecation or death. Consequently, touching the amniotic sac, placenta/ umbilical cord and delivering the baby, cutting the cord and cleaning up the blood are considered “the most disgusting of tasks” in reproductive discourses of South Asia (Rozario, 1995). These ideas are present within the groups of women interviewed during this study, and that the removal of pollution is at least one of the major functions of the TBA (or in this MLC’s case, the support staff) assisting the births.

Support networks and birthing knowledge

Intimacy, friendship and social solidarity within one’s family are important dimensions to consider in understanding the motivations underlying women’s health-related actions or health seeking behaviors (Unnithan, 2002). They explain why, for example, for certain women their female neighbor rather than their mothers or mother-in-laws become more important influences in what they decide during deliveries. Or even, how they form expectations of and experience their own childbirths. Since most women interviewed in the study lived in urban spaces, in nuclear families away from their natal kin and often held less bargaining and decision making power within their nuclear household structures (unless they have some level of financial solvency). In this context, their networks are formed depending on their relationships with other women in the local neighborhood (Chowdhury et. al, 2009). As a consequence, there are varied forms of networks of support and a group of familiar, older and experienced women.

Rabbi, 16, mother: R: Yes I wanted to do it at home. I didn’t know I would be taken there, I wanted to try giving birth at home. I told the Apa about this (SS), but then she said no I will take you to the center….so that’s why we did not inform any dais. My mother had wanted to call a dai … I did not want to go anywhere…my mother gave birth at home and I wanted to do the same. But then who would call a dai at late night? Thinking about all of this, then also since Apa had advised against it… we went to the center.

The role and presence of health workers, in this case, BRAC SKs/SSs in the area are critical to their decisions as to where they seek care for delivery as well.

Shamima, 30, mother: “I knew about BRAC from those who had their deliveries there. Ujjol’s mother offered to take me there. After seeing me she informed them. The landlord’s granddaughter and Lovely Apa were called. They told Lovely Apa that there is a pregnant lady here and you should come and see her. I didn’t even know about it. 3-4 people came afterwards. Then they asked me a lot of questions, gave me advice. I told them I won’t do my delivery there but they told me to give it a try. They told me there would be a lot of advantages to using the chair. They told me to sit down in the chair and try it out for myself. Otherwise I would have gone back to my village. I just stayed due to Lovely Apu’s insistence. She was adamant about me staying at the clinic. She told me she will take care of me, even if (worst case scenario) I have to do a C- section… See I didn’t know anything but those who had gone before me told me, “Bhabi there is a Dai [midwife] there who is very good. Everybody in that clinic is good. You stay here instead of going to the village, you will have a good experience. If you don’t trust me try it yourself once”. So yeah I think they were right’.

It is evident from informal discussions with women and observations around the MLC’s area, that it is particularly middle-aged and elderly women (usually aged 50 – 65 and have migrated from rural communities in the past few decades) and Shastho Kormi/Shebika within the community are deemed to have the most knowledge (attained from their own experience of birthing, delivering or their knowledge and positions as BRAC employees, respectively).

As other research on birthing practices in India and Bangladesh show, woman’s kin-peer group is possibly the most influential when it comes to decisions about whom to consult for reproductive ailments – and in this case, childbirth (Unnithan, 2002; Chowdhury et. al, 2009).

Bithi, 27, mother: I go to drop my child to a private tuition, over there. A khala (aunt) had faced this situation – her placenta was stuck, she was taken to Dhaka Medical and they didn’t give the injection at first. They used their hands and it was torturous. Then they gave an injection. She said that it was more painful than her delivery, because they put their hands inside and pulled too much. They took her to Dhaka Medical and her placenta was half out, and they wrapped it around their hands and went to the hospital. She told me that if you have the delivery, tell them to take the placenta out as soon as they can. She had told me this.”

Later during delivery, Bithi narrates, that she had asked the ‘khala’ to give her an injection before they proceeded with her placenta delivery. While this is a normal medical procedure that they would have done regardless of her request, for most women it is not common knowledge that injections are given to help with the placenta delivery. Bithi’s conversation with her neighboring women had shaped her understandings of the possible dangers and risks of her second childbirth and its associated precautions from the stories of other women that were relayed onto her.

Literature reports that support networks within women’s communities provide access to birthing knowledge for young women and young expectant mothers. Birth in South Asian countries is typically seen as ‘women’s business’ and is generally not discussed outside the networks of birthing women. Knowledge is passed on verbally to those who ‘have a right to know’ (Davids and Chesney, n.d). Previous studies on social networks for new mothers found that only a small percentage living in the urban slum areas had post-partum and delivery support systems beyond the poor settlement in which they resided (8%), or outside of Dhaka (3%). Their primary support network included family members, friends, husbands and the community health workers (CHWs), who became the main source of information and a noted source of emotional support when available (Adams et. al, 2015). These networks have to be regarded in terms of the shifting power and politics among members of the women’s household, their landladies, among their neighborhood women, their peers and in some cases – their natal households. Whether these networks are successful or unsuccessful, depends on various factors.

Birthing at the center or at home?

During our interviews and observations at the clinic, we came across preconceived notions about delivery practices (this encompasses hygiene, medication, support from the MLC staff, among other things), which create gaps in how the center runs versus how mothers in labor expect it to run.

Afrin, 24, Midwife: The challenging part is, not all the patients and their attendants have the same mentality. Many (mothers and their relatives) come with a preconceived notion that giving an “injection and saline” (oxytocin to induce labor) are critical in order for a woman to be able to go through a normal delivery. That’s what the mentality is and it’s not new founded either. It’s been long since it has been around and this often comes up as a challenge for us. As part of our knowledge of normal physiology, we understand that there is no need to do conduct a delivery with an induction. A mother’s body has hormones which is enough to do a normal delivery. But in order to clear this misconception, we have to do a lot of counseling. So this is a challenging issue for us, as patient attendants create a ruckus if we try to do a normal delivery without any induction. Some understand after we explain to them, some don’t. Then we have to really give them proper counselling, still we don’t opt for induction. We want to improve our care that’s why we don’t do induction. After I joined here, the deliveries that have taken place have been completely without induction, just simple normal deliveries in the normal process. So this is a challenging aspect for us, since the attendants and even the patients at times scream and shout about this. Some patients even leave, when they see we are not giving them any injection or saline, after creating a big scene. We allow those who want to go, to leave, we don’t create a fuss.

In the case of women we interviewed living in Mirpur, they go into the MLC with the expectation being met with a specific series of experiences of which they have gained some knowledge (from community and kin-groups) and also what those experiences would do to their bodies and the extent to which they can control the events of their own delivery. Women shared that when were first introduced to the birthing chair at the onset of their deliveries, they experienced gaps in their expectations and the actual experience, with many resisting the chair. Which is because they went into the delivery center with completely no knowledge of the birthing chair and the clinic’s shift to more normal delivery focused midwifery practices. Thus, most women initial resisted the chair out of fear.

Unnithan’s (2002) work on childbirth experiences in rural Rajisthan had critically looked into the motivations of women (and the community) to prefer home births over hospital births. She suggested that resort to home births is more a result of helplessness and an inability to command the resources (finances, transport, and company) which would be needed for birth in clinics and hospitals

However, the longer the birthing chair is utilized by women and remains as the main option for delivery at the clinic, the more it can become a part of the community knowledge through the midwives’ monthly door to door community activities.

Afrin, 24, midwife: (I: So when you visit the expectant mothers to counsel them, what kind of advice do you give them?) Then, we tell them “Apa, your delivery date is near, the date is this week or this month, so if you get labor pain do not try anything at home. If you try at home, there might be unnecessary complications for both the mother and the child. There can be a life risk”. Somebody at home might unknowingly give you an injection or an IV saline, which is bad for the child as it can affect the heartbeat of the child or the child may die inside the womb. Obviously we can’t say that directly, so we say the baby might become sick inside. For the child as well as for one’s own life, she must come to the hospital. It is my life and my child’s life, it needs to be saved. So like this we do counseling to not do home delivery. She might have relatives or elders who prefer home delivery, who say that you already did checkup so you don’t need to go the hospital anymore, the delivery will be done at home. Then if there are elders at home we try to make them understand that during home delivery if the mother starts bleeding then she might die and you won’t be able to do anything, you can’t take her to the hospital from home. During delivery if you need immediate help, example if the baby’s head gets stuck or the placenta gets stuck, then if they are in the hospital we can immediately manage the situation. There will be less problems in the hospitals. We try to make them understand how risky home deliveries can be. They might not come to us, they might go someplace else but they should at least go to a hospital for delivery. That is how you have to do counselling. Majority of the times, the mothers plan on doing a normal delivery by coming here and they are ready about it. Those who are a previous case of CS [cesarean] also want to do a normal delivery here but then we get afraid since they have previously done a cesarean and how can we manage if something happens, we don’t have proper management here… We talk very openly about the services we provide for a normal delivery (during fieldwork), we talk about the chair, the birthing ball. Due to exercise with these [equipment/apparatus], delivery without induction is possible. If there is [labor] pain then there is no need for induction. The mothers have to be coached like this, otherwise they ask for injections. So if we tell them from before then they have a concept that if they come here to the clinic, the Apas can do a normal delivery and the baby will stay healthy.

But acceptance is critical to the birthing chair’s success in Mirpur and other nearby neighborhoods. As literature finds, when other women deliver in a facility, they diffuse their experiences to the greater community (Afsana and Rashid, 2011). As urbanization spreads and changes the landscape of these women’s lives, delivering in their natal home becomes only a distant possibility for most. Yet the feeling and idea that hospitals in general are not to be trusted with something as intimate to these women as childbirth, remains. A study of practices of childbirth in urban slums in Dhaka in 2007 found that 84% of respondents, married women aged 15-29, preferred to give birth at home with most choosing an untrained TBA (Choudhury et. al, 2012). This paper was the baseline survey for the MANOSHI program of BRAC, another paper that analyzed the situation of urban slum births noted that “women were found to have no clear idea about the delivery process until they experienced it themselves,” relying on TBAs, other women and landladies for advice (Ahmed et. al, 2010).

Childbirth: Pain, endurance and “feels like death’

Nasrin, 22, mother: It is like a searing pain which starts from your spine… when it settles on to the lower abdomen the pain increases a lot. It stays for a minute and then it subsides, and so it continues like that… The pain you have when it is a girl is different than a boy’s. The people who stay here as tenants, they told me as well that the pain differs. They say when you have a girl, the abdomen becomes round and you have a lot of hair fall, become thin, etc. When I was having my son, I became dark but when I was pregnant with my girls I became fairer and was healthy since I could eat properly…during his time I couldn’t even eat. When you have a son, your body becomes dark and thin…

The majority of women experience pain during labor and childbirth. For many women, they shared that it is the most significant pain they experienced in their life. However, despite it being associated with the same fundamental physiological process, not all women experience labor pain in the same way. Women’s evaluations of labor pain can range from excruciating to pleasurable in different individuals or on different occasions. Some women manage the pain well, requiring minimal assistance and reporting positive experiences, whilst others do not cope well and request intervention in order to avoid or alleviate the pain. Curiously, women have reported labor pain as a paradoxical experience of pain – one that is both excruciating but also desirable because of its positive outcome of the birth of their child. It is thus clear that labor pain is a complex and unique experience of pain and, consequently, is challenging to manage.

The 10 women interviewed constructed their notions of pain, endurance and the threat of birthing mainly through the knowledge they found from mothers, mother in laws, and their neighbors. Women’s ideas of pain, endurance and beliefs of birthing to be a risky, life threatening process has been explored in past and existing researches on maternal health and well-being. Representations of birthing that these women see and experience around themselves, reflect and construct the regimes of truths and beliefs that they carry with them to their own experiences of childbirth (and pregnancy) (based on arguments of body policing; Ussher, 2006). Women interviewed similarly based it on what they saw around them in their neighborhood and stories they heard of women nearly dying during delivery.

Bithi, 28, Mirpur: Well you see sometimes your placenta could get stuck. If it gets stuck inside you, the person will die. Or if you have low blood pressure or there is too much blood loss or mistreatment. If they handle it improperly, the placenta goes up. My mother had told me this. I was tensed about that but also about other things. I have heard that the delivery goes well and even then people die. A neighborhood woman’s baby had been delivered 10 days ago, the woman still has very low pressure. And then the child survived and mother died. But after a few days the baby also died. Her pressure was low that’s why. The baby didn’t get enough milk. Mother’s care is critical…I heard the news a few days before my delivery date. I had taken a walk along that house, that’s when I heard it. I’ve seen it in many places. I know of home births, sometimes they couldn’t get a hold of the placenta properly, and that’s why the placenta rides up their organs. And they die because of it. I’ve heard from two people, they were neighbors, that’s why.

Fear formed in the women interviewed were very specific and contextual, derived from stories of ill managed births, accidents during deliveries and ill-managed pregnancies around their network of women. However, the context of the fears around death during childbirth have a more underlying, national narrative.

Inductive Essay on the Role of Midwife

The following assignment will examine the role of the midwife within antenatal care. Firstly, looking at the changes that may affect pregnancy which could then impact on the midwives role, for example, conditions such as breech or gestational diabetes. To then continue to discuss the process of risk assessment and the importance of protecting pregnant women.

Next, the impact of the midwife meeting the needs of the pregnant woman and her family: physically, socially and psychologically will be discussed.

Moving onto exploring the role of the Nursing and Midwifery Council with regards to the midwives role, and then to analyse The Code with regards to antenatal care.

Finally, to discuss the role of the supervisor of midwives in supporting maternity services, examing the changes throughout time and the reasons behind these changes. With the role recently being removed from regulation, the supervisor role still has a part to play in supporting midwives in carrying out their duties of care this is to be discussed.

Pregnancy occurs over three periods, known as trimesters. The first trimester sees both the baby (foetus) and mother go through rapid changes. For the foetus, this period is when it is most vulnerable yet sees all the major organs and systems develop, fully formed at the end of this trimester. For the mother, the changes which can occur to name a few are; the breasts enlarge, becoming tender and veins more prominent, an increase in hormones potentially cause mood swings, irritability and morning sickness (Summa Health, 2018).

The attendance of the first midwife appointment (booking appointment), ideally takes place by week 10 of pregnancy in the first trimester. At this appointment the midwife will ask questions to assess the needs of the expecting mother; discussing physical and mental health, health issues within the family, whether family support is available and also whether any substances are consumed such as drugs, smoking or alcohol. This appointment also sees tests take place for the monitoring of both the mother and baby, blood is taken to measure whether HIV, syphilis or hepatitis B are present as these pose a risk to the baby. Further discussion may take place to determine whether there is a need for another blood test to see if blood disorders sickle cell or thalassaemia are present. The height, weight and BMI of the mother will be measured as will their blood pressure and urine, for any signs of pre-eclampsia. The midwife will discuss and pass on information with regards to; nutrition and diet (as there are certain foods to be avoided) and the recommendation of vitamins folic acid and vitamin D, the development of the baby throughout the pregnancy, the tests and scans to be offered during pregnancy, exercise and pelvic floor exercises, breastfeeding and information on antenatal classes. The appointments with the midwife are the opportunities to discuss any worries or concerns, issues which could affect the pregnancy: domestic violence, abuse or female genital mutation (FGM), the midwife is there to provide guidance, advice and support. By the end of the first appointment, the midwife will have created a handheld book of notes, necessary for the recording appointments, test results and health. The pregnant woman is to carry around this book with her at all times should urgent care be needed at any point during pregnancy (NHS, 2018).

From the moment the woman discovers she is pregnant, from the first booking appointment through to the day the baby is born plus a few weeks beyond, the midwife is there to support the woman. A wide range of information and support from nutrition, antenatal classes, child care and preparing for the birth itself, is covered by the midwife. Meeting the physical needs of the woman, the midwife will discuss nutrition advice, recommendations for exercise and discuss the importance of rest and sleep. Physically the pregnant woman may experience symptoms such as heartburn, constipation and morning sickness and the midwife can provide advice for such conditions, for example, the suggestion of the use of Gavison for heartburn as is this safe during pregnancy.

Why Does Postpartum Depression Happen: Essay

The adverse effects societal changes such as urbanization have on the incidence of Postpartum Depression and measures taken to support women.

Abstract

With the incidence of Postpartum depression (PPD) at around 20%, this paper aims to explore how a current stressor such as urban upbringing (a factor that has not yet been studied about PPD could affect the incidence of PPD). It expands on the hypothesis that urban upbringing is linked to increasing stress hence a potential increase in PPD incidence. Moreover, the paper provides evidence-based methods to support women suffering from PPD such as hardiness training. Furthermore, solutions such as management of PPD and ways to overcome limitations when carrying out studies are also provided. Due to these limitations, when studying the effect of different risk factors on PPD, more research has to be done which includes multivariate and multifactorial models.

Introduction

In a world that’s rapidly developing it is evident that human lifestyle has changed among several cultures (Lambert, 2006). These lifestyle changes have undoubtedly improved the quality of life of so many, yet there seem to be some adverse effects -stressors- arising amongst today’s society that previously weren’t considered aggravators. Despite the major medical advancements that have occurred in pharmaceutical companies that produce antidepressants, why is it that according to WHO ma depression and anxiety make up 25% of reported cases of mental illness globally (Who. int, 2005). Specifically, with postpartum depression occurring universally with incidence rates being maintained at around 20% (Centre of Health Statistics, 2008), stress and its relationship with PPD is certainly an important topic to study. Looking at the effects PPD has on so many women such as appetite loss, weight fluctuations, insomnia, fatigue, suicidal thoughts, and feelings of worthlessness (Sadock and Sadock 2005). Having these effects in mind, when pregnancy should ideally be seen as a delightful period for women, highlights the importance of understanding and managing PPD. Although there has been research on both direct and indirect stressors on PPD, one rising stressor nowadays -rise in urban upbringing and urbanization- has not yet been studied about PPD. Hence this essay aims to explore the link between the two, but also explore management methods for women suffering from PPD. Also, the limitations of coming to conclusions about causal relationships between different stressors and PPD will be outlined.

Methods:

The primary search was through Primo and Google Scholar with general search terms for example ‘stressors of the 21st century’ and ‘postpartum depression’. When I found that urban upbringing is considered a stressor, I then searched specifically using terms such as ‘urban upbringing stress and postpartum depression’, which didn’t have any relevant outcomes. I then found links between urban upbringing and stress, and stress and PPD to make a hypothesis for what I considered a gap in the literature. I also searched for ‘factors affecting postpartum depression’ to get an idea of what is already known and how research studies are carried out for PPD to explore limitations.

Urban upbringing related to PPD?

With more than 50% of the world’s population now living in urban areas -cities and towns- for the first time in history, the potential impact this has on people is concerning. Although urban upbringing comes with many privileges such as more job opportunities, better hygiene, and access to healthcare there are some health risks associated with it (Pezawas et al., 2005). Research suggests that due to the challenging city environment, there is higher amygdala activity which in turn increases stress amongst the population (Pezawas et al., 2005). In a generation where the population living in cities is predicted to increase up to 69% in the next 30 years (Dye, 2008), knowing that anxiety and stress are some of the greatest effects of urbanization makes me question how it may impact women and the incidence rates of PPD. Research suggests that stress is strongly linked to increased risk of PPD occurring (Swendsen and Mazure, 2006). In addition, other findings suggest that some variables linked to PPD are similar to those linked to general depression (Bernazzani et al., 1997) and ‘life stressors precede depression in over 80% of cases’ (Swendsen and Mazure, 2006). Thus, a hypothesis can be made that stressors in daily life such as urban upbringing could be linked to PPD. Moreover, a woman’s general stress levels could also impact the way new mothers cope with the challenges motherhood brings and change how they perceive stressful experiences (Arizmendi and Affonso, 1987). Dissatisfaction due to not having any control over events during motherhood is also a risk factor for PPD thus stress could have both direct and indirect effects on PPD. Hence, if urban upbringing is proven to increase stress, and stress can cause PPD, urbanization may pave the way for the high incidence of PPD. Living in the city, due to the increased demands women have to face nowadays such as heavy workload and stress in business settings may be the reason behind this. This hypothesis, if true, may have more apparent consequences as the population in cities rise

Another hypothesis that could be further investigated is the lower support provided by extended families, due to urban upbringing and its effects within families. Due to the fast-paced lifestyle as well as large distances in cities, nuclear families will likely be isolated from extended families and hence receive less support (Jack and Paschalis 1974). Terry et al. (1996) emphasize that when new parents are going through stressful situations, support from extended family is extremely important as they can provide both mental and physical support which decreases the chances of developing PPD. Also, isolated parents won’t have the ‘stress-buffering’ effects provided by a supportive extended family that could help them cope with stressors (Collins et al., 1993).

Limitations

Coming to causal relationships about different variables linked to PPD has many limitations. Firstly, although there is evidence indicating that living in the 21st century is stressful, that may only apply to certain aspects such as urban upbringing. Factors such as diseases of the newborn, also risk factors for PPD, aren’t as apparent today as they were in the past (Hahn-Holbrook and Haselton, 2014). Consequently, although there may be a general trend suggesting a more stressful society, certain variables do not suggest that and this should be taken into consideration when coming to conclusions.

Moreover, when conducting studies, controlling all variables that could affect the development of PPD is very difficult as there are many risk factors. Some of these include not breast-feeding, undernourishment, lack of exercise (Hahn-Holbrook and Haselton, 2014), pregnancy hormones, poor family and spousal relationships, and stress regarding the newborn’s upbringing (Goyal, Gay, and Lee, 2010), and certainly prior mental illness history (Swendsen and Mazure, 2006). This list is not exhaustive, thus not finding a large enough sample size with the same confounding variables means that it is hard to reliably say when there is a significant causal relationship between any variable and PPD. Some variables such as socioeconomic (SES) factors have controversial results. Goyal, Gay, and Lee (2010) suggest low SES factors are linked to PPD. Similarly, Broussard, Joseph, and Thompson (2012) claim that ‘poverty-related stress accumulates and can lead to various stress responses that extend over time.’ On the contrary, others suggest no relationship between PPD and social and demographic factors such as education and income (Clout and Brown, 2015). Likewise, many previous studies have not found any link between age (McMahon et al., 2011), education (Smith and Howard, 2008) and PPD. However, this result was based on a study where participants didn’t have a low mean income, hence the important variable of low income was not a risk factor.

Risk factors vary between countries due to differences in traditions and lifestyle (Hahn-Holbrook and Haselton, 2014) so when carrying out studies, results should not be generalized. Undoubtedly, each person is unique and copes with stress and challenges differently, hence perception of stressful situations and the effect these have on women is subjective which is a limitation (Broussard, Joseph, and Thompson, 2012). Lastly, the frequency of stressful events as well as the timing of they occur could affect the extent to which each woman results in varying outcomes.

Managing these adverse effects

Due to the various limitations mentioned above, conducting studies and coming to causal relationships between risk factors and PPD requires numerous studies to be carried out considering many variables. However, with so many women suffering from PPD, having an understanding and managing the consequences that come with it is a priority.

Although reducing 21st-century stressors would be ideal, preparing women to face them is a more realistic approach. As stress is a major risk factor for PPD, hardiness training -hardiness referring to one’s ability to cope with stress- has proven to be effective against PPD. The reason behind these results is how new mothers are trained to tackle problems and dilemmas that come their way either related to motherhood or not. They set targets and gain control over their lives while receiving support throughout their training to stay motivated. This indicates that when the root cause which is stress in this situation, is located and tackled, the quality of life of these mothers can be drastically improved (Bakhshizadeh, Shiroudi, and Khalatbari, 2013).

Moreover, educating clinicians about stressors that women could be exposed to, should enable them to know when a woman is at risk and when a referral is necessary (Liu and Tronick, 2013). This screening, both prenatally and postnatally up to one year after birth, should allow women to have a more personal relationship with healthcare professionals. Although the biological changes of pregnancy are similar amongst women, the SES factors such as housing, work, education, and income vary from woman to woman. With healthcare professionals having a more personal approach to patients, they have an insight into these factors, as well as cultural differences (Hung and Chung, 2001; Chan and Levy, 2004; Templeton et al., 2003) relationship satisfaction and fears and expectations each woman may have. Approaching each woman and her pregnancy as a unique case will provide the mother with the physical and mental support she requires going through this major phase in her life.

Raising awareness about PPD could help women understand that what they feel may not just be due to natural hormonal changes, but instead symptoms of PPD. Hence, educating the mothers themselves and society about PPD, about difficulties motherhood may have, how to tackle them, and where, when, and how to seek help is vital.

Nevertheless, ‘researchers have noted that even 1 year of college reduces the poverty rate for minority women by half’ (Rice, 2001) thus stress due to financial burden could be tackled via education.

Conclusion

Although there is a general trend suggesting an increase in stressors nowadays, risk factors differ amongst cultures and individuals. Several advancements have limited the stressors of our ancestral past while new ones arise. Further research should be done to establish whether there is a relationship – either direct or indirect – between PPD and urban upbringing, exploring the reasons around it such as lack of support from extended family. Moreover, ‘multivariate models are necessary because of the large number of risk factors implicated in the onset of PPD’ (Swendsen and Mazure, 2006) as well as a ‘multifactorial model assessing direct and indirect effects’ (Bernazzani et al., 1997). All risk factors should be taken into account when studying their effects and the current stress level of each participant should be established ‘to obtain a baseline level’ to understand the degree each risk factor contributes to PPD (Arizmendi and Affonso, 1987). Nonetheless, women participating in studies should be treated with respect and dignity and their information should remain confidential. Most importantly, no woman should have to go through such a tough battle with her self, therefore each woman must be provided with support throughout her pregnancy as well as postpartum. This should be the duty of all healthcare professionals involved.

References:

    1. Arizmendi, T. and Affonso, D. (1987). Stressful events related to pregnancy and postpartum. Journal of Psychosomatic Research, 31(6), pp.743-756.
    2. Bakhshizadeh, A., Shiroudi, S. and Khalatbari, J. (2013). Effect of Hardiness Training on Stress and Post Partum Depression. Procedia – Social and Behavioral Sciences, 84, pp.1790-1794.
    3. Balswick, Jack O., and C. Paschalis. “THE EFFECT OF URBANIZATION UPON HOUSEHOLD STRUCTURES IN CYPRUS.” International Journal of Sociology of the Family, vol. 4, no. 1, 1974, pp. 101–108., www.jstor.org/stable/23027129.
    4. Bernazzani, O., Saucier, J., David, H. and Borgeat, F. (1997). Psychosocial predictors of depressive symptomatology level in postpartum women. Journal of Affective Disorders, 46(1), pp.39-49.
    5. Broussard, C., Joseph, A. and Thompson, M. (2012). Stressors and Coping Strategies Used by Single Mothers Living in Poverty. Affilia, 27(2), pp.190-204.
    6. Center for Health Statistics. Live births by race/ethnic group of mother, 2004. 2008. Retrieved February 3, 2008, from http://www.dhs.ca.gov/hisp/chs/OHIR/tables/birth/race.htm#resources.
    7. Chan, S. and Levy, V. (2004). Postnatal depression: a qualitative study of the experiences of a group of Hong Kong Chinese women. Journal of Clinical Nursing, 13(1), pp.120-123.
    8. Clout, D. and Brown, R. (2015). Sociodemographic, pregnancy, obstetric, and postnatal predictors of postpartum stress, anxiety, and depression in new mothers. Journal of Affective Disorders, 188, pp.60-67.
    9. Collins, N. L., Dunkel‐Schetter, C., Lobel, M., & Scrimshaw, S. C. M. (1993). Social support in pregnancy: Psychosocial correlates of birth outcomes and postpartum depression. Journal of Personality and Social Psychology, 65, 1243–1258.
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    12. Goyal, D., Gay, C. and Lee, K. (2010). How Much Does Low Socioeconomic Status Increase the Risk of Prenatal and Postpartum Depressive Symptoms in First-Time Mothers? Women’s Health Issues, 20(2), pp.96-104.
    13. Hahn-Holbrook, J. and Haselton, M. (2014). Is Postpartum Depression a Disease of Modern Civilization? Current Directions in Psychological Science, 23(6), pp.395-400.
    14. Hung, C. and Chung, H. (2001). The effects of postpartum stress and social support on postpartum women’s health status. Journal of Advanced Nursing, 36(5), pp.676-684.
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Essay on Postpartum Blues Vs Depression

Introduction

Post-partum depression is commonly known to be one of the main difficulties with maternity and childbirth (Jones, 2017). Many women commonly do not realize they suffer from this debilitating illness and can often go months even years without seeking treatment. This illness can be viewed with extreme variations, ranging from ‘baby blues’ to psychosis (Degner, 2017). Understanding the different symptoms and the severity of each symptom plays an important role in recognizing and treating each woman and in turn encouraging a positive and healthy relationship between mother and child (Andersson et al., 2016). This study will discuss, in part, the signs and symptoms of ‘Baby Blues and Postpartum depression and how they can be assessed.

Discussion

Nearly half of all women will experience some form of ‘baby blues’ after giving birth (Bass and Bauer, 2018). According to (Stewart and Vigod, 2019), postpartum depression often shares some of its symptoms with non-perinatal depression. These symptoms may include a single or a combination of the following, general depressed mood, loss of interest in daily activities, loss of concentration, fatigue, and feelings of guilt and worthlessness (Stewart and Vigod, 2019). Postpartum depression, symptoms may influence the mother’s mental and physical health and can pose a threat to the child’s health.

(Steward and Simone, 2016) states that the mood disorder known as ‘Baby Blues’ does not have a serious impact on the mother’s health and does not have any manic or psychotic symptoms. Because there are no severe symptoms, it can often be referred to as a result of hormonal changes that the mother experiences after childbirth (Rosenberg, Greening, and Windell, 2003). In most cases, these symptoms begin to dissipate on their own within a 2-3 week period, although in rare cases, it may begin to develop into postpartum depression (Steward and Simone, 2016). Even though this illness poses a significant threat to life, there is no definitive way to test for postpartum depression, though there is an assessment tool that some healthcare professionals use to detect this illness (Howard et al., 2014). This 10-item self-report scale is known as the ‘(EPDS) Edinburgh Postnatal Depression Scale’ (Cox, 1987), as referenced by (Howard et al., 2014). This report allows the assessor to evaluate the mother sensitively and also assess the severity of the symptoms. Because this tool is not 100% accurate in diagnosing postpartum depression, misdiagnoses can still occur (Parker et al., 2014).

Conclusion

Although the condition ‘Baby Blues’ can be seen as a hormonal condition, it can develop into a more serious mental illness. It is also evident that all new mothers should be aware of their thoughts and feelings and express them freely. In addition, even though there is no clear way of determining if a woman is suffering from postpartum depression, the (EPDS) is a useful tool for healthcare professionals to assess the woman before her condition worsens and affects her relationship with her baby and her life.

References

    1. Andersson, E., Hildingsson, I., Mittuniversitetet, Fakulteten för, h. and Avdelningen för, o. (2016) ‘Mother’s postnatal stress: an investigation of links to various factors during pregnancy and post‐partum’, Scandinavian Journal of Caring Sciences, 30(4), pp. 782-789.
    2. Bass, P. F. and Bauer, N. S. (2018) ‘Parental postpartum depression: More than ‘baby blues”, Contemporary Pediatrics, 35(9), pp. 35-38.
    3. Cox, J.L., Holden, J.M. and Sagovsky, R. (1987). Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), pp.782-786.
    4. Degner, D. (2017) ‘Differentiating between ‘baby blues,’ severe depression, and psychosis’, BMJ (Clinical research ed.), Journal Article, 359, pp. j4692.
    5. Howard, L. M. P., Molyneaux, E. M., Dennis, C.-L. P., Rochat, T. P., Stein, A. P. and Milgrom, J. P. (2014) ‘Non-psychotic mental disorders in the perinatal period’, Lancet, The, 384(9956), pp. 1775-1788.
    6. Jones, I. (2017) ‘Post-partum depression—a glimpse of light in the darkness?’, Lancet, The, 390(10093), pp. 434-435.
    7. Parker, G. B., Hegarty, B., Paterson, A., Hadzi-Pavlovic, D., Granville-Smith, I. and Gokiert, A. (2014) ‘Predictors of post-natal depression are shaped distinctly by the measure of ‘depression’’, Journal of Affective Disorders, 173, pp. 239-244.
    8. Rosenberg, R., Greening, D. E. and Windell, J. (2003) Conquering postpartum depression: a proven plan for recovery. 1st Da Capo Press pbk. ed. Cambridge, MA: Da Capo Press.
    9. Stewart, D.E. and Simone, V. (2016). Postpartum Depression. The New England Journal of Medicine, 375(22), pp. 2177-2186.
    10. Stewart, D. E. and Vigod, S. N. (2019) ‘Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics’, Annual Review of Medicine, 70(1), pp. 183-196.

Essay on Stages of Postpartum Depression

Postnatal disorder is a type of mood disorder associated with childbirth that can affect both sexes. The postnatal disorder is more likely towards mothers than fathers but it does not mean the father is not affected at all. Postnatal depression is usually affected by new fathers because they will feel stress becoming a new role as the head of the family (Coyne, 2019, October 10). The stress comes when they need to do something unusual like they need to have extra finances for their child, they need to take care of their baby at midnight and many more and it can lead to depression regarding the unusual. In contrast, every mother will experience postnatal depression after giving birth (NHS, 2017, October 23) but it depends on the person itself whether they already have a history of depression or not. This is because someone who has depression will have a high tendency to have postnatal depression.

Postnatal disorder can be divided into 3 stages which are baby blues, postpartum depression, and postpartum psychosis. The meaning of baby blues is a transient postpartum mood disorder characterized by milder depressive symptoms than postpartum depression. About 70% to 80% of all new mothers will experience baby blues with some negative feelings or mood swings after giving birth (‘Baby Blues: Causes, Symptoms and Treatment,’ 2019, October 14). Usually, the mother will suffer from baby blues disorder within 3 days until a week after childbirth. The causes of the baby blues phase are unclear at this time because they only can be detected when they have hormone changes. These hormonal changes can lead to chemical changes in the brain which will turn to depression (‘Baby Blues: Causes, Symptoms and Treatment,’ 2019, October 14).

The second stage of postnatal disorder is postpartum depression which can be defined as if your symptoms from baby blues do not fade away after a few weeks or the symptoms are getting worse (Smith, 2019, November 5). Postpartum depression in the beginning will look normally like baby blues disorder. Postpartum depression and baby blues have the same symptoms but to differentiate, postpartum depression’s symptoms are more detailed such as suicidal thoughts or an inability to care for your baby, and this disorder is longer lasting (Smith, 2019, November 5). Those who have experienced baby blues have a high chance of getting postpartum depression.

The last stage of postnatal disorder is postpartum psychosis. Postpartum psychosis rarely happens but it is an extremely serious disorder that can develop after childbirth and it is characterized by a loss of contact with reality (Smith, 2019, November 5). Postpartum psychosis is different from baby blues and postpartum depression because it has a high risk for suicide or infanticide (Smith, 2019, November 5). Normally, new mothers have a low tendency to diagnose postpartum psychosis because this disorder will happen to someone who has an episode of postpartum depression due to previous pregnancies.

Inductive Essay on the Role of Midwife

The following assignment will examine the role of the midwife within antenatal care. Firstly, looking at the changes that may affect pregnancy which could then impact on the midwives role, for example, conditions such as breech or gestational diabetes. To then continue to discuss the process of risk assessment and the importance of protecting pregnant women.

Next, the impact of the midwife meeting the needs of the pregnant woman and her family: physically, socially and psychologically will be discussed.

Moving onto exploring the role of the Nursing and Midwifery Council with regards to the midwives role, and then to analyse The Code with regards to antenatal care.

Finally, to discuss the role of the supervisor of midwives in supporting maternity services, examing the changes throughout time and the reasons behind these changes. With the role recently being removed from regulation, the supervisor role still has a part to play in supporting midwives in carrying out their duties of care this is to be discussed.

Pregnancy occurs over three periods, known as trimesters. The first trimester sees both the baby (foetus) and mother go through rapid changes. For the foetus, this period is when it is most vulnerable yet sees all the major organs and systems develop, fully formed at the end of this trimester. For the mother, the changes which can occur to name a few are; the breasts enlarge, becoming tender and veins more prominent, an increase in hormones potentially cause mood swings, irritability and morning sickness (Summa Health, 2018).

The attendance of the first midwife appointment (booking appointment), ideally takes place by week 10 of pregnancy in the first trimester. At this appointment the midwife will ask questions to assess the needs of the expecting mother; discussing physical and mental health, health issues within the family, whether family support is available and also whether any substances are consumed such as drugs, smoking or alcohol. This appointment also sees tests take place for the monitoring of both the mother and baby, blood is taken to measure whether HIV, syphilis or hepatitis B are present as these pose a risk to the baby. Further discussion may take place to determine whether there is a need for another blood test to see if blood disorders sickle cell or thalassaemia are present. The height, weight and BMI of the mother will be measured as will their blood pressure and urine, for any signs of pre-eclampsia. The midwife will discuss and pass on information with regards to; nutrition and diet (as there are certain foods to be avoided) and the recommendation of vitamins folic acid and vitamin D, the development of the baby throughout the pregnancy, the tests and scans to be offered during pregnancy, exercise and pelvic floor exercises, breastfeeding and information on antenatal classes. The appointments with the midwife are the opportunities to discuss any worries or concerns, issues which could affect the pregnancy: domestic violence, abuse or female genital mutation (FGM), the midwife is there to provide guidance, advice and support. By the end of the first appointment, the midwife will have created a handheld book of notes, necessary for the recording appointments, test results and health. The pregnant woman is to carry around this book with her at all times should urgent care be needed at any point during pregnancy (NHS, 2018).

From the moment the woman discovers she is pregnant, from the first booking appointment through to the day the baby is born plus a few weeks beyond, the midwife is there to support the woman. A wide range of information and support from nutrition, antenatal classes, child care and preparing for the birth itself, is covered by the midwife. Meeting the physical needs of the woman, the midwife will discuss nutrition advice, recommendations for exercise and discuss the importance of rest and sleep. Physically the pregnant woman may experience symptoms such as heartburn, constipation and morning sickness and the midwife can provide advice for such conditions, for example, the suggestion of the use of Gavison for heartburn as is this safe during pregnancy.

Why Does Postpartum Depression Happen: Essay

The adverse effects societal changes such as urbanization have on the incidence of Postpartum Depression and measures taken to support women.

Abstract

With the incidence of Postpartum depression (PPD) at around 20%, this paper aims to explore how a current stressor such as urban upbringing (a factor that has not yet been studied about PPD could affect the incidence of PPD). It expands on the hypothesis that urban upbringing is linked to increasing stress hence a potential increase in PPD incidence. Moreover, the paper provides evidence-based methods to support women suffering from PPD such as hardiness training. Furthermore, solutions such as management of PPD and ways to overcome limitations when carrying out studies are also provided. Due to these limitations, when studying the effect of different risk factors on PPD, more research has to be done which includes multivariate and multifactorial models.

Introduction

In a world that’s rapidly developing it is evident that human lifestyle has changed among several cultures (Lambert, 2006). These lifestyle changes have undoubtedly improved the quality of life of so many, yet there seem to be some adverse effects -stressors- arising amongst today’s society that previously weren’t considered aggravators. Despite the major medical advancements that have occurred in pharmaceutical companies that produce antidepressants, why is it that according to WHO ma depression and anxiety make up 25% of reported cases of mental illness globally (Who. int, 2005). Specifically, with postpartum depression occurring universally with incidence rates being maintained at around 20% (Centre of Health Statistics, 2008), stress and its relationship with PPD is certainly an important topic to study. Looking at the effects PPD has on so many women such as appetite loss, weight fluctuations, insomnia, fatigue, suicidal thoughts, and feelings of worthlessness (Sadock and Sadock 2005). Having these effects in mind, when pregnancy should ideally be seen as a delightful period for women, highlights the importance of understanding and managing PPD. Although there has been research on both direct and indirect stressors on PPD, one rising stressor nowadays -rise in urban upbringing and urbanization- has not yet been studied about PPD. Hence this essay aims to explore the link between the two, but also explore management methods for women suffering from PPD. Also, the limitations of coming to conclusions about causal relationships between different stressors and PPD will be outlined.

Methods:

The primary search was through Primo and Google Scholar with general search terms for example ‘stressors of the 21st century’ and ‘postpartum depression’. When I found that urban upbringing is considered a stressor, I then searched specifically using terms such as ‘urban upbringing stress and postpartum depression’, which didn’t have any relevant outcomes. I then found links between urban upbringing and stress, and stress and PPD to make a hypothesis for what I considered a gap in the literature. I also searched for ‘factors affecting postpartum depression’ to get an idea of what is already known and how research studies are carried out for PPD to explore limitations.

Urban upbringing related to PPD?

With more than 50% of the world’s population now living in urban areas -cities and towns- for the first time in history, the potential impact this has on people is concerning. Although urban upbringing comes with many privileges such as more job opportunities, better hygiene, and access to healthcare there are some health risks associated with it (Pezawas et al., 2005). Research suggests that due to the challenging city environment, there is higher amygdala activity which in turn increases stress amongst the population (Pezawas et al., 2005). In a generation where the population living in cities is predicted to increase up to 69% in the next 30 years (Dye, 2008), knowing that anxiety and stress are some of the greatest effects of urbanization makes me question how it may impact women and the incidence rates of PPD. Research suggests that stress is strongly linked to increased risk of PPD occurring (Swendsen and Mazure, 2006). In addition, other findings suggest that some variables linked to PPD are similar to those linked to general depression (Bernazzani et al., 1997) and ‘life stressors precede depression in over 80% of cases’ (Swendsen and Mazure, 2006). Thus, a hypothesis can be made that stressors in daily life such as urban upbringing could be linked to PPD. Moreover, a woman’s general stress levels could also impact the way new mothers cope with the challenges motherhood brings and change how they perceive stressful experiences (Arizmendi and Affonso, 1987). Dissatisfaction due to not having any control over events during motherhood is also a risk factor for PPD thus stress could have both direct and indirect effects on PPD. Hence, if urban upbringing is proven to increase stress, and stress can cause PPD, urbanization may pave the way for the high incidence of PPD. Living in the city, due to the increased demands women have to face nowadays such as heavy workload and stress in business settings may be the reason behind this. This hypothesis, if true, may have more apparent consequences as the population in cities rise

Another hypothesis that could be further investigated is the lower support provided by extended families, due to urban upbringing and its effects within families. Due to the fast-paced lifestyle as well as large distances in cities, nuclear families will likely be isolated from extended families and hence receive less support (Jack and Paschalis 1974). Terry et al. (1996) emphasize that when new parents are going through stressful situations, support from extended family is extremely important as they can provide both mental and physical support which decreases the chances of developing PPD. Also, isolated parents won’t have the ‘stress-buffering’ effects provided by a supportive extended family that could help them cope with stressors (Collins et al., 1993).

Limitations

Coming to causal relationships about different variables linked to PPD has many limitations. Firstly, although there is evidence indicating that living in the 21st century is stressful, that may only apply to certain aspects such as urban upbringing. Factors such as diseases of the newborn, also risk factors for PPD, aren’t as apparent today as they were in the past (Hahn-Holbrook and Haselton, 2014). Consequently, although there may be a general trend suggesting a more stressful society, certain variables do not suggest that and this should be taken into consideration when coming to conclusions.

Moreover, when conducting studies, controlling all variables that could affect the development of PPD is very difficult as there are many risk factors. Some of these include not breast-feeding, undernourishment, lack of exercise (Hahn-Holbrook and Haselton, 2014), pregnancy hormones, poor family and spousal relationships, and stress regarding the newborn’s upbringing (Goyal, Gay, and Lee, 2010), and certainly prior mental illness history (Swendsen and Mazure, 2006). This list is not exhaustive, thus not finding a large enough sample size with the same confounding variables means that it is hard to reliably say when there is a significant causal relationship between any variable and PPD. Some variables such as socioeconomic (SES) factors have controversial results. Goyal, Gay, and Lee (2010) suggest low SES factors are linked to PPD. Similarly, Broussard, Joseph, and Thompson (2012) claim that ‘poverty-related stress accumulates and can lead to various stress responses that extend over time.’ On the contrary, others suggest no relationship between PPD and social and demographic factors such as education and income (Clout and Brown, 2015). Likewise, many previous studies have not found any link between age (McMahon et al., 2011), education (Smith and Howard, 2008) and PPD. However, this result was based on a study where participants didn’t have a low mean income, hence the important variable of low income was not a risk factor.

Risk factors vary between countries due to differences in traditions and lifestyle (Hahn-Holbrook and Haselton, 2014) so when carrying out studies, results should not be generalized. Undoubtedly, each person is unique and copes with stress and challenges differently, hence perception of stressful situations and the effect these have on women is subjective which is a limitation (Broussard, Joseph, and Thompson, 2012). Lastly, the frequency of stressful events as well as the timing of they occur could affect the extent to which each woman results in varying outcomes.

Managing these adverse effects

Due to the various limitations mentioned above, conducting studies and coming to causal relationships between risk factors and PPD requires numerous studies to be carried out considering many variables. However, with so many women suffering from PPD, having an understanding and managing the consequences that come with it is a priority.

Although reducing 21st-century stressors would be ideal, preparing women to face them is a more realistic approach. As stress is a major risk factor for PPD, hardiness training -hardiness referring to one’s ability to cope with stress- has proven to be effective against PPD. The reason behind these results is how new mothers are trained to tackle problems and dilemmas that come their way either related to motherhood or not. They set targets and gain control over their lives while receiving support throughout their training to stay motivated. This indicates that when the root cause which is stress in this situation, is located and tackled, the quality of life of these mothers can be drastically improved (Bakhshizadeh, Shiroudi, and Khalatbari, 2013).

Moreover, educating clinicians about stressors that women could be exposed to, should enable them to know when a woman is at risk and when a referral is necessary (Liu and Tronick, 2013). This screening, both prenatally and postnatally up to one year after birth, should allow women to have a more personal relationship with healthcare professionals. Although the biological changes of pregnancy are similar amongst women, the SES factors such as housing, work, education, and income vary from woman to woman. With healthcare professionals having a more personal approach to patients, they have an insight into these factors, as well as cultural differences (Hung and Chung, 2001; Chan and Levy, 2004; Templeton et al., 2003) relationship satisfaction and fears and expectations each woman may have. Approaching each woman and her pregnancy as a unique case will provide the mother with the physical and mental support she requires going through this major phase in her life.

Raising awareness about PPD could help women understand that what they feel may not just be due to natural hormonal changes, but instead symptoms of PPD. Hence, educating the mothers themselves and society about PPD, about difficulties motherhood may have, how to tackle them, and where, when, and how to seek help is vital.

Nevertheless, ‘researchers have noted that even 1 year of college reduces the poverty rate for minority women by half’ (Rice, 2001) thus stress due to financial burden could be tackled via education.

Conclusion

Although there is a general trend suggesting an increase in stressors nowadays, risk factors differ amongst cultures and individuals. Several advancements have limited the stressors of our ancestral past while new ones arise. Further research should be done to establish whether there is a relationship – either direct or indirect – between PPD and urban upbringing, exploring the reasons around it such as lack of support from extended family. Moreover, ‘multivariate models are necessary because of the large number of risk factors implicated in the onset of PPD’ (Swendsen and Mazure, 2006) as well as a ‘multifactorial model assessing direct and indirect effects’ (Bernazzani et al., 1997). All risk factors should be taken into account when studying their effects and the current stress level of each participant should be established ‘to obtain a baseline level’ to understand the degree each risk factor contributes to PPD (Arizmendi and Affonso, 1987). Nonetheless, women participating in studies should be treated with respect and dignity and their information should remain confidential. Most importantly, no woman should have to go through such a tough battle with her self, therefore each woman must be provided with support throughout her pregnancy as well as postpartum. This should be the duty of all healthcare professionals involved.

References:

    1. Arizmendi, T. and Affonso, D. (1987). Stressful events related to pregnancy and postpartum. Journal of Psychosomatic Research, 31(6), pp.743-756.
    2. Bakhshizadeh, A., Shiroudi, S. and Khalatbari, J. (2013). Effect of Hardiness Training on Stress and Post Partum Depression. Procedia – Social and Behavioral Sciences, 84, pp.1790-1794.
    3. Balswick, Jack O., and C. Paschalis. “THE EFFECT OF URBANIZATION UPON HOUSEHOLD STRUCTURES IN CYPRUS.” International Journal of Sociology of the Family, vol. 4, no. 1, 1974, pp. 101–108., www.jstor.org/stable/23027129.
    4. Bernazzani, O., Saucier, J., David, H. and Borgeat, F. (1997). Psychosocial predictors of depressive symptomatology level in postpartum women. Journal of Affective Disorders, 46(1), pp.39-49.
    5. Broussard, C., Joseph, A. and Thompson, M. (2012). Stressors and Coping Strategies Used by Single Mothers Living in Poverty. Affilia, 27(2), pp.190-204.
    6. Center for Health Statistics. Live births by race/ethnic group of mother, 2004. 2008. Retrieved February 3, 2008, from http://www.dhs.ca.gov/hisp/chs/OHIR/tables/birth/race.htm#resources.
    7. Chan, S. and Levy, V. (2004). Postnatal depression: a qualitative study of the experiences of a group of Hong Kong Chinese women. Journal of Clinical Nursing, 13(1), pp.120-123.
    8. Clout, D. and Brown, R. (2015). Sociodemographic, pregnancy, obstetric, and postnatal predictors of postpartum stress, anxiety, and depression in new mothers. Journal of Affective Disorders, 188, pp.60-67.
    9. Collins, N. L., Dunkel‐Schetter, C., Lobel, M., & Scrimshaw, S. C. M. (1993). Social support in pregnancy: Psychosocial correlates of birth outcomes and postpartum depression. Journal of Personality and Social Psychology, 65, 1243–1258.
    10. Who. int. (2020). Depression. [online] Available at: https://www.who.int/health-topics/depression#tab=tab_1 [Accessed 2 Jan. 2020].
    11. Dye, C. (2008). Health and Urban Living. Science, 319(5864), pp.766-769.
    12. Goyal, D., Gay, C. and Lee, K. (2010). How Much Does Low Socioeconomic Status Increase the Risk of Prenatal and Postpartum Depressive Symptoms in First-Time Mothers? Women’s Health Issues, 20(2), pp.96-104.
    13. Hahn-Holbrook, J. and Haselton, M. (2014). Is Postpartum Depression a Disease of Modern Civilization? Current Directions in Psychological Science, 23(6), pp.395-400.
    14. Hung, C. and Chung, H. (2001). The effects of postpartum stress and social support on postpartum women’s health status. Journal of Advanced Nursing, 36(5), pp.676-684.
    15. Liu, C. and Tronick, E. (2013). Re-conceptualizing Prenatal Life Stressors in Predicting Post-partum Depression: Cumulative-, Specific-, and Domain-specific Approaches to Calculating Risk. Pediatric and Perinatal Epidemiology, 27(5), pp.481-490.
    16. McMahon, C., Boivin, J., Gibson, F., Hammarberg, K., Wynter, K., Saunders, D. and Fisher, J. (2011). Age at first birth, mode of conception and psychological wellbeing in pregnancy: findings from the parental age and transition to parenthood Australia (PATPA) study. Human Reproduction, 26(6), pp.1389-1398.
    17. Lambert, K. (2006). Rising rates of depression in today’s society: Consideration of the roles of effort-based rewards and enhanced resilience in day-to-day functioning. Neuroscience & Biobehavioral Reviews, 30(4), pp.497-510.
    18. Pezawas, L., Meyer-Lindenberg, A., Drabant, E., Verchinski, B., Munoz, K., Kolachana, B., Egan, M., Mattay, V., Hariri, A. and Weinberger, D. (2005). 5-HTTLPR polymorphism impacts human cingulate-amygdala interactions: a genetic susceptibility mechanism for depression. Nature Neuroscience, 8(6), pp.828-834.
    19. Rice, J. (2001). Poverty, Welfare, and Patriarchy: How Macro-Level Changes in Social Policy Can Help Low-Income Women. Journal of Social Issues, 57(2), pp.355-374.
    20. Sadock, B. J., & Sadock, V. A. (2005). Kaplan & Sadock’s Comprehensive Textbook of Psychiatry Lippincott Williams & Wilkins; Eighth edition (November 15, 2004). 4480 p
    21. Smith, L. and Howard, K. (2008). Continuity of paternal social support and depressive symptoms among new mothers. Journal of Family Psychology, 22(5), pp.763-773.
    22. Swendsen, J. and Mazure, C. (2006). Life Stress as a Risk Factor for Postpartum Depression: Current Research and Methodological Issues. Clinical Psychology: Science and Practice, 7(1), pp.17-31.
    23. Templeton, L., Velleman, R., Persaud, A. and Milner, P. (2003). The experiences of postnatal depression in women from black and minority ethnic communities in Wiltshire, UK. Ethnicity & Health, 8(3), pp.207-221.
    24. Terry, D., Mayocchi, L. and Hynes, G. (1996). Depressive symptomatology in new mothers: A stress and coping perspective. Journal of Abnormal Psychology, 105(2), pp.220-231.

 

Essay on Postpartum Blues Vs Depression

Introduction

Post-partum depression is commonly known to be one of the main difficulties with maternity and childbirth (Jones, 2017). Many women commonly do not realize they suffer from this debilitating illness and can often go months even years without seeking treatment. This illness can be viewed with extreme variations, ranging from ‘baby blues’ to psychosis (Degner, 2017). Understanding the different symptoms and the severity of each symptom plays an important role in recognizing and treating each woman and in turn encouraging a positive and healthy relationship between mother and child (Andersson et al., 2016). This study will discuss, in part, the signs and symptoms of ‘Baby Blues and Postpartum depression and how they can be assessed.

Discussion

Nearly half of all women will experience some form of ‘baby blues’ after giving birth (Bass and Bauer, 2018). According to (Stewart and Vigod, 2019), postpartum depression often shares some of its symptoms with non-perinatal depression. These symptoms may include a single or a combination of the following, general depressed mood, loss of interest in daily activities, loss of concentration, fatigue, and feelings of guilt and worthlessness (Stewart and Vigod, 2019). Postpartum depression, symptoms may influence the mother’s mental and physical health and can pose a threat to the child’s health.

(Steward and Simone, 2016) states that the mood disorder known as ‘Baby Blues’ does not have a serious impact on the mother’s health and does not have any manic or psychotic symptoms. Because there are no severe symptoms, it can often be referred to as a result of hormonal changes that the mother experiences after childbirth (Rosenberg, Greening, and Windell, 2003). In most cases, these symptoms begin to dissipate on their own within a 2-3 week period, although in rare cases, it may begin to develop into postpartum depression (Steward and Simone, 2016). Even though this illness poses a significant threat to life, there is no definitive way to test for postpartum depression, though there is an assessment tool that some healthcare professionals use to detect this illness (Howard et al., 2014). This 10-item self-report scale is known as the ‘(EPDS) Edinburgh Postnatal Depression Scale’ (Cox, 1987), as referenced by (Howard et al., 2014). This report allows the assessor to evaluate the mother sensitively and also assess the severity of the symptoms. Because this tool is not 100% accurate in diagnosing postpartum depression, misdiagnoses can still occur (Parker et al., 2014).

Conclusion

Although the condition ‘Baby Blues’ can be seen as a hormonal condition, it can develop into a more serious mental illness. It is also evident that all new mothers should be aware of their thoughts and feelings and express them freely. In addition, even though there is no clear way of determining if a woman is suffering from postpartum depression, the (EPDS) is a useful tool for healthcare professionals to assess the woman before her condition worsens and affects her relationship with her baby and her life.

References

    1. Andersson, E., Hildingsson, I., Mittuniversitetet, Fakulteten för, h. and Avdelningen för, o. (2016) ‘Mother’s postnatal stress: an investigation of links to various factors during pregnancy and post‐partum’, Scandinavian Journal of Caring Sciences, 30(4), pp. 782-789.
    2. Bass, P. F. and Bauer, N. S. (2018) ‘Parental postpartum depression: More than ‘baby blues”, Contemporary Pediatrics, 35(9), pp. 35-38.
    3. Cox, J.L., Holden, J.M. and Sagovsky, R. (1987). Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), pp.782-786.
    4. Degner, D. (2017) ‘Differentiating between ‘baby blues,’ severe depression, and psychosis’, BMJ (Clinical research ed.), Journal Article, 359, pp. j4692.
    5. Howard, L. M. P., Molyneaux, E. M., Dennis, C.-L. P., Rochat, T. P., Stein, A. P. and Milgrom, J. P. (2014) ‘Non-psychotic mental disorders in the perinatal period’, Lancet, The, 384(9956), pp. 1775-1788.
    6. Jones, I. (2017) ‘Post-partum depression—a glimpse of light in the darkness?’, Lancet, The, 390(10093), pp. 434-435.
    7. Parker, G. B., Hegarty, B., Paterson, A., Hadzi-Pavlovic, D., Granville-Smith, I. and Gokiert, A. (2014) ‘Predictors of post-natal depression are shaped distinctly by the measure of ‘depression’’, Journal of Affective Disorders, 173, pp. 239-244.
    8. Rosenberg, R., Greening, D. E. and Windell, J. (2003) Conquering postpartum depression: a proven plan for recovery. 1st Da Capo Press pbk. ed. Cambridge, MA: Da Capo Press.
    9. Stewart, D.E. and Simone, V. (2016). Postpartum Depression. The New England Journal of Medicine, 375(22), pp. 2177-2186.
    10. Stewart, D. E. and Vigod, S. N. (2019) ‘Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics’, Annual Review of Medicine, 70(1), pp. 183-196.