The focus of this guideline is on the confirmation, prevention, and treatment of mothers with depressive symptoms in the first postpartum year. This guideline will benefit community, family practice, and hospital-based nurses, as well as other health professionals caring for postpartum women. Specific Practice Recommendations relate to the confirmation of mothers with depressive symptoms and include implementation of effective preventive and non-pharmacological treatment interventions. Education Recommendations are suggested to support clinical practice in the care of mothers experiencing depressive symptoms in the postpartum period. Finally, Organization and Policy Recommendations have been developed to address the importance of a supportive practice environment that enables the provision of effective care and includes strategies for ongoing evaluation of guideline implementation.
It is acknowledged that the individual competencies of nurses vary, across categories of nursing professionals, and depends upon their scope of practice. Knowledge, skills, attitudes, critical analysis and decision making are enhanced over time through education and experience. It is expected that individual nurses will perform only those assessments and interventions for which they have the appropriate knowledge and skill set. Furthermore, it is imperative that nursing professionals seek appropriate consultation in instances where the mother’s care needs require a multidisciplinary approach. It is also important to note that a diagnosis of postpartum depression can only be established by a clinical diagnostic interview completed by a trained mental health specialist. This guideline has been conceptualized within the scope of nursing practice. As the etiology of postpartum depression is multifactorial, diverse interventions provided by other health professionals may also be required. As such, it is acknowledged that effective healthcare depends on a coordinated interdisciplinary approach incorporating ongoing communication between health professionals and mothers while including maternal preferences and needs. Furthermore, postpartum care in Ontario varies across geographical locations and the provider of services. Currently, women who have given birth vaginally are typically discharged from hospital within 48-hours of delivery. Due to shorter length of stay, much of the responsibility of care in the postpartum period is delivered by community health providers in a variety of settings (e.g., clinics, family practice, community facilities, and client’s home) (Watt, Sword, Krueger & Sheehan, 2002).
In summary, no research studies to date have investigated the extent to which postpartum depression screening will ultimately improve the mental health of postpartum women. Research on men and women with depression outside of the postpartum period has shown limited results so far: screening has not consistently increased either the number of patients who are given treatment for depression or the number of patients who go on to recover from their depression. Given these findings, postpartum depression screening will not be addressed in this best practice guideline. In addition, although it is acknowledged that antenatal depression is also frequently experienced by many pregnant women, it requires a separate review and evaluation of evidence.
Given this scope, the clinical questions addressed by this guideline are:
- How can nurses accurately confirm depressive symptoms in postpartum women?
- What effective prevention interventions can nurses implement in practice?
- What effective treatment interventions can nurses implement in practice?