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The topic of this paper will be evaluating the effectiveness of skin-to-skin (STS) between the mother and the newborn as a treatment for postpartum depression. The client present in this case study is client X, a 30-year-old woman who is 36 hours postpartum (Refer to Appendix A). Client X’s reason for admission to the hospital was spontaneous vaginal delivery. The client has been previously admitted to the hospital for the birth of her first child. She did not have any pregnancy complications during this pregnancy and gave birth at 39+1 gestation. Client X has a history of anxiety and suffered from postpartum depression after the birth of her first child. Her anxiety and postpartum depression were both treated by counseling. The client does not take any medications. During my postpartum assessment and time with client X, the clinical signs I experienced were that the client stayed in bed much of the time. She was withdrawn when talking with her, she did not talk very much and gave short answers to my questions. Her mood was low, and she did not eat any of the food provided by the hospital. When speaking with her, I learned that her husband purchased food from outside the hospital that she normally likes but she did not want it. When asked about sleeping, the client expressed that they were having trouble sleeping and were very fatigued. As well, when asking my client how they were progressing, I learned the client felt very down and sad but was unsure of the reason why. Postpartum depression not only affects the mother but also the newborn. STS was chosen as the nursing-focused intervention for this client because it could be performed right away, is accessible, and is also beneficial for the newborn.
The first article I have chosen that examines the effect of STS between mothers and newborns on decreasing postpartum depression symptoms is by Bigelow, Power, LacLellan-Peters, Alex, and McDonald (2012). In the study, the team considered how STS would affect the mother’s postpartum depressive symptoms over 3 months postpartum. The methods used to evaluate the subjects were the Edinburgh Postnatal Depression Scale (EPDS) and the Center for Epidemiological Studies Depression Scale (CES-D). According to Bigelow et al.(2012), these scales are self-evaluated, the most common, and used in postpartum studies (pg. 370, 373). On the scales, 0 means a presence of no postpartum depression risks while higher values (13 for EPDS and 16 for CES-D) show the presence of postpartum depression risk (Bigelow et al., 2012). The STS group averaged a score of 4 on the postpartum depression scales in the 1st week of evaluation while the control group averaged a 7 (Bigelow et al., 2012). This result was found to be statistically significant (Bigelow et al., 2012). At the 1-month timeframe, the STS group scored an average of three and the control group scored an average of 5 (Bigelow et al., 2012). This result was found to be moderately significant (Bigelow et al., 2012). From 2 months on, there was no statistical significance recorded between the STS and control groups (Bigelow et al., 2012). Overall, the main finding in this article is that STS was effective in reducing the risk of postpartum depression during the 1st week postpartum.
The strength of the research findings was the use of two postpartum depression risk screening tools. By having two evaluations, the study is reducing its room for error. For example, a client could score high on one evaluation method and low on the other. With these results, one evaluation method would suggest there are at risk for postpartum depression and the other would not. By utilizing two evaluation methods, the study is minimizing that error risk. Thus, if the client scores high on both evaluation methods, the results have been checked by more than one resource. However, the weakness of these research findings is that there was no statistical difference between the STS and control group from 2 months onward. This result suggests that STS may not be effective in reducing the risk of postpartum depression long term.
Secondly, an article by Herizchi, Hosseini, and Ghoreishizadeh (2017) examined the effectiveness of STS in reducing postpartum depression for mothers of premature newborns. The tool used to evaluate postpartum depression risk was EDPS. Postpartum depression risk was evaluated at 10, 20, and 30 days postpartum. On the 10th day, there was no significance between STS and the control as the STS group averaged a 13.3 score and the control a 15.3667 (Herizchi et al., 2017). However, the 20th and 30th days were found to be significant with p-values being 0.001 (Herizchi et al., 2017). On the 20th day, the STS group scored 9.16 and the control 16.56 while on the 30th day, the STS group scored 8.1 and the control 17.30 (Herizchi et al., 2017). Therefore, the main finding from this article is that STS was effective in reducing the risk of postpartum depression in clients after 10 days postpartum who had a presentation of postpartum depression risk.
A strength of the Herizchi et al. article is that their findings demonstrated that STS can remove the risk of postpartum depression. The evaluation method used in this study was EDPS, where a score of 13 or above means the client is at risk for postpartum depression (Herizchi et al., 2017). On the 10th day of evaluation, the STS group had an average of 13.3, meaning they were at risk for postpartum depression (Herizchi et al., 2017). By the 20th day of evaluation, the STS group’s score dropped significantly to 9.16, meaning according to EDPS, they no longer were at risk for postpartum depression (Herizchi et al., 2017). Thus, the STS intervention removed their risk for postpartum depression. However, a weakness in the article is that many of the newborns were in the NICU during the first few days postpartum, and STS time was affected. This may have influenced the results of the 10th-day evaluation. Even though the STS group hit their required hours per day, the stress of the NICU and time constraints could have affected the results of the 10th-day evaluation.
The selected research articles suggest that STS is effective at reducing postpartum depression during the 1st month postpartum. The 1st month postpartum is critical for mothers as it involves their transition from pregnancy to the mother role. This information is valuable to nursing care as the intervention can be used with a client who is experiencing postpartum depression symptoms. In the case study presented at the beginning of this paper, the client was expressing symptoms of postpartum depression. In this case, the nurse can perform an informed nursing care intervention in which they suggest the client perform STS with their newborn for prolonged periods throughout the day to help reduce the client’s postpartum depression symptoms. My client was in her 1st week postpartum. As the first article I presented by Bigelow et al. shows, STS significantly reduced postpartum depression symptoms during the 1st week postpartum. Because of this, nurses can suggest STS to the client to help reduce her symptoms.
Furthermore, in the second article presented by Herizchi et al., the subjects presented were already at risk for postpartum depression. This meant they scored an average above 13. During that study, those subjects that were at risk for postpartum depression, upon the intervention of STS, decreased their scores and were no longer classified as at risk for postpartum depression. These results are also beneficial to my case study as it shows that STS can reduce the risk of postpartum depression. In terms of my client, she has a history of postpartum depression with her previous pregnancy. Because of this, her risk of developing postpartum depression was high. Since she is already considered at risk for postpartum depression like the subjects in the Herizchi et al. study, it suggests that STS can reduce her risk as well from the results of Herizchi et al.’s study.
One facilitator that can help implement the use of STS in a practice setting is parental education. Upon admission to the postpartum unit, nurses can provide teaching on postpartum depression and the usefulness of STS in reducing the client’s risk for it. Nurses can perform this teaching along with their other teaching points, such as breastfeeding and perineal care. By teaching parents about postpartum depression symptoms, parents will know what to look for and will be able to recognize signs of postpartum depression development. Also, by teaching parents about the benefits of STS in reducing postpartum depression risk, parents will be able to begin performing STS hours postpartum as a preventative treatment. Also, since they know what symptoms of postpartum depression appear like, they will have some knowledge of how to help reduce it if it presents. The teaching of both parents is important as the mother may not always acknowledge their postpartum depression risk or symptoms. Having their partner understand the risks and symptoms will help them recognize them so it does not get missed. As well, the partner can suggest STS use if the mother is too busy and accidentally overlooks it. Thus, parental education can facilitate the implementation of the informed nursing-focused intervention of STS into practice.
Furthermore, the promotion of STS after routine events can facilitate the implementation of STS into practice. When a nurse goes into the client’s room to take vitals or perform an assessment, the nurse can suggest STS to the mother. Constant reminders like this can happen throughout the client’s postpartum stay. Reminding the client frequently will facilitate more STS because it puts STS on the client’s mind. The postpartum stay in the hospital is overwhelming for the client. They are tired and have many things on their mind. They may lose track of time or even forget about STS. Thus, promoting STS after interaction with the client can improve the use of STS in practice because it reminds the client to perform it.
Some barriers to implementing STS in practice are visitors and people wanting to hold the baby. The birth of a baby is exciting for the parents and their family. When family or friends come to visit, it creates a distraction for the client and their family. Visitors may be with the client for hours throughout the day and many people may come to visit. With the client preoccupied with talking with their visitors as well as caring for the newborn, they might not find the time or even forget about STS. As well, when people come to visit, they may want to hold the baby. This reduces the amount of time the client has to perform STS with their newborn. However, these barriers can be mitigated by encouraging the client to perform STS while in the presence of the visitors. As well, the nurse can educate the visitors on the benefits of STS, suggest they help encourage the client to perform it while they are there and reduce their newborn holding time. Therefore, education can be used to mitigate the barriers of visitors and people wanting to hold the baby.
Coming into this assignment, I was educated about the benefits of STS for the newborn, however, I learned there could be benefits for the mother as well. I learned that STS is easily accessible, it is free, and it does not take much effort to initiate. I learned that STS can greatly reduce the client’s risk for postpartum depression, especially in the 1st week postpartum. These insights I gained will influence my future nursing practice as I now have a new intervention, I can apply in postpartum depression scenarios. I will not only educate my clients on STS for the benefit of the newborn, but I will also educate my clients on the benefit of STS for themselves. As well, I can recognize the barriers to the implementation of STS and use my mitigation techniques and facilitators to work around the barriers. In conclusion, my future nursing role will be adjusted to fit the knowledge I gained about STS to treat postpartum depression symptoms.
References
- Bigelow, A., Power, M., MacLellan-Peters, J., Alex, M., McDonald, C. (2012). Effect of mother/infant skin-to-skin contact on postpartum depressive symptoms and maternal physiological stress. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41(3), 369-382.
- Herizchi, S., Hosseini, M.B., Ghoreishizadeh, M. (2017). The impact of kangaroo-mother care on postpartum depression in mothers of premature infants. International Journal of Women’s Health and Reproduction Sciences, 5(4), 312-317.
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