The Role Of Child And Family Health Nurses In Dealing With Postpartum Depression

Parenthood is one of the most challenging and rewarding milestones in a couple’s lives. However, as idyllic as this scene might be, it is undeniable that several new mothers’ experience postnatal depression after giving birth to their offspring. To understand this pressing issue, this paper investigates various published research materials and reviews their findings about the subject. Specifically, this paper expounds on the relationship of postnatal depression and the role of child and family health nurses (CFHNs).

In assessing the risk factors for postnatal depression, Robertson and Stewart (2003), studied over 24,000 subjects for their research. The authors were able to determine that the following factors are the strongest indications of postnatal depression: depression and anxiety during the pregnancy itself, high stress levels during the pregnancy itself, a prior history of depression, and having little to no social support from other people during the aforementioned periods. In this regard, the topic of the Family Partnership Model (FPM) comes into play; this model essentially provides for the whole family’s role in combatting postnatal depression.

Family Partnership Model calls for the family’s utilization of the resources they have in solving their problems in the long term. It also calls for a more comprehensive and holistic approach in dealing with problems that occur in the family, among which are postnatal depression (Centre for Community Child Health, 2015). It is also important at this point to note how CFHNs also play an integral role in ensuring that the family can follow the FPM. How the CFHNs help the family is aptly referred to as working in partnership with the parent. That is, apart from physical examinations of a baby, such nurses also provide free information on breastfeeding, nutrition, immunization, and other parenting-related issues. Without a doubt, the responsibilities of CFHNs vary greatly from state to state. However, in most cases, the first appointments between a family and their CFHNS happen at home, because parents are still getting used to their new roles after labour.

In further looking for possible causes related to postnatal depression, Kahn, Wise, Kennedy, and Kawachi (2000) hypothesized that state income inequality and the household income also affects the health of mothers. Indeed, external factors greatly affect the wellbeing of a mother. As such, many experts call for a more proactive involvement of the community as well, in addition the roles played by the family members and the CFHNs. Community engagement is defined as the process in which the community is engaged in taking care of the mother and the baby in a more meaningful manner. Through this way, the mothers feel more at ease and comfortable with the new challenges she faces with her growing family.

Through the help of the community and CFHNs, postnatal depression symptoms such as maternal separation anxiety is lessened. Hock and Schirtzinger (1992) describe the same as the mother’s experience of anxiety during short-period separation from the child. Furthermore, the authors concluded that maternal separation anxiety is a serious medical condition that should not be left untreated.

In addition to the foregoing, Bailey, Jabeen, and Ali (2012) point out that postpartum depression is often left unrecognized and undiagnosed. A huge part of this ailment may be because of a prior history of depression of the woman. Truly, conquering postnatal depression should not just be left to the hands of the mother herself. Again, this points to how the help of the family, CFHNs, and the community is crucial in this mother’s journey.

Balaji, Claussen, Smith, Visser, and Morales (2007) found that social support groups of a mother greatly affect her maternal health. They found out that social networks provide a quality support much needed by the mother both during and after the pregnancy. These are seen to be avenues which can greatly aid the mother in her most trying times. This study points out that it is important for the mother to feel that she is supported by those closest to her.

Once the mother feels the support of people around her, her mental health and disposition vastly improves. The mother’s mental health is inextricably linked to the health of the baby. In a presentation to the World Health Organization, Bowlby (1952) emphasized that a mother’s care during the infanthood and early childhood of her offspring greatly affects the latter’s growth and development. This further supports the idea that there can be no holistic health if mental health is disregarded. Additionally, this emphasis on a holistic view of health is underscored by the more recent trend brought by FPM.

In addition to the foregoing, Patel, Rahman, Jacob, and Hughes (2004) also investigated the correlation between a child’s growth and development and the maternal care he receives. The study found that postnatal depression may be a significant cause in the severe malnutrition of the children in several South Asian regions. Indeed, postnatal depression should be treated from the very beginning so as not to affect the child further.

The abovementioned research has also been replicated in Ethiopia, India, Vietnam, and Peru. The authors found that there was a positive correlation between maternal care (or lack thereof) and the child’s overall health. They concluded that health programmes in Asia should seriously consider providing for the promotion and care of the mother’s mental health during and after the pregnancy. A mother’s health can no longer just be set aside.

As regards the medical professionals, Sit and Wisner (2010) reviewed the various criteria in the diagnosis of the ailment and other clinical risk factors as well. The authors found that the best time for a doctor to assess a mother for postnatal depression is during her first postnatal appointment with the doctor. This is because data suggest that most of the postpartum indicators occur within the first month after giving birth (Sit and Wisner, 2010). These findings indicate how time is a crucial factor and how medical professionals such as CFHNs are crucial people in the life of a mother from pregnancy to post-birth. Indeed, the diagnosis of postnatal depression must not stop at just the identification of the illness, Sharma and Sharma (2012) emphasizes. Instead, the treatment must also include the maintenance stages, in addition to the initial diagnosis.

Another factor that has a connection with postnatal depression is culture. To determine if culture plays a role in postnatal depression, Arifin, Cheyne, and Maxwell (2018) looked at instances of this ailment in Malaysia, as compared with Japan and America. In the authors’ conclusion, they said that the assessment of the symptoms may sometimes erroneously capture the common responses of a mother to childcare, whether physiological or emotional responses. This study affirms that culture plays a significant part in postnatal depression. As such, culture-specific methods must also be employed by CFHNs; the FPM must also be tweaked in order to fit these cultural specificities.

In the improvement of mental health programs in pursuit of holistic growth, Honikman, Heyningen, Field, Baron, and Tomlinson (2012) concluded that maternal mental health is severely disregarded in underdeveloped and developing countries. In looking out for the mental wellbeing of mothers, there is a need to develop various appropriate interventions in order to effectively combat these ailments (Prince, Patel, Saxena, Maj, Maselsko, Phillips, and Rahman, 2007). Health care should be improved in order to take account serious mental ailments, especially that of mothers. This situation calls for a more proactive approach in battling the issue of postnatal depression and other maternal mental health problems. Focus must also be given in training CFHNs and information dissemination about FPM.

Focusing on the totality of the mothers, Oates (2008) posed the question of whether all women should be assessed for postnatal mood disorders. The author, although not explicitly answering the question, emphasized how all medical professionals should be well-versed in assessing the possible symptoms for postnatal disorder. There should be emphasis on being more vigilant in looking out for symptoms of postnatal depression.

Following the emphasis on the integration of maternal health in the prenatal and postnatal care regimen of a mother, Rahman, Surkan, Cayateno, and Rwagatare, and Dickson (2013) concluded that doing the same would increase the overall health of both the mother and the child. In doing this, health programmes must be able to hurdle the challenge of vanquishing the various misconceptions as regards postnatal depression; this include the belief that depression is rare. This should be the first step in improving maternal health care.

With all the above-mentioned studies, one fact can no longer be contested: maternal mental health care should be a priority program of countries. As such, there should be focus on maintaining and sustaining the mental health of the mother not only during the pregnancy but also after childbirth. This can be done by renewed efforts for the effective utilization of the expertise of CFHNs as well as information dissemination about FPM.

Reference List

1. Arifin, R., Cheyne, H., and Maxwell, M. (2018). Review of the prevalence of postnatal depression across cultures. AIMS Public Heal th. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6141558/
2. Bailey, R., Jabeen, S., and Ali, Shaid. (2012) Postpartum depression: a review. Journal of Health Care for the Poor and Underserved. Available at: https://www.researchgate.net/publication/225072971_Postpartum_Depression_A_Review
3. Balaji, A., Claussen, A., Smith, C., Visser, S., Morales, M., Perou, R. Social support networks and maternal mental health and well-being. Journal of Women’s Health. Available at: https://www.liebertpub.com/doi/abs/10.1089/jwh.2007.CDC10
4. Bowlby, J. (1952). Maternal care and mental health. Available at: https://pages.uoregon.edu/eherman/teaching/texts/Bowlby%20Maternal%20Care%20and%20Mental%20Health.pdf
5. Centre for Community Child Health. (2015). Using the family partnership model to engage communities: lessons from Tasmanian child and family centres. Murdoch Children’s Research Institute.
6. Harpham, T., Huttly, S., De Silva, M., and Abramsky, T. (2005). Maternal mental health and child nutritional status in four developing countries. Journal of Epidemiology and Community Health. Available at: https://jech.bmj.com/content/59/12/1060.short
7. Hock, E. and Schitzinger, M. (1992). Maternal separation anxiety: its developmental course and relation to maternal mental health. Child Development. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-8624.1992.tb03598.x
8. Honikman, S., Heyningen, T., Field, S., Baron, E., and Tomlinson, M. (2012). Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa. PLOS Medicine. Available at: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001222
9. Kahn, R., Wise, P., Kennedy, B., and Kawachi, I. (2000). Papers
10. State income inequality, household income, and maternal mental and physical health: cross sectional national survey. BMJ. Available at: https://www.bmj.com/content/321/7272/1311.short
11. Oates, M. (2008). Postnatal affective disorders. Part 1: an introduction. The Obstetrician & Gynaecologist. Available at: https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1576/toag.10.3.145.27416
12. Patel, V., Rahman, A., Jacob, K., and Hughes, M. (2004). Effect of maternal mental health on infant growth in low income countries: new evidence from South Asia. BMJ. Available at: https://www.bmj.com/content/328/7443/820.full
13. Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, R., Rahman, A. (2007). No health without mental health. The Lancet. Available at:
14. https://www.sciencedirect.com/science/article/pii/S0140673607612380
15. Rahman, A., Surkan, P., Cayetano, Cl., Rwagatare, P., and Dickson, K. (2013). Grand challenges: integrating maternal mental health into maternal and child health programmes. PLOS Med. Available at: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001442
16. Robertson, E., Celasun, N., and Stewart, D.E. (2003). Risk factors for postpartum depression. Postpartum depression: Literature review of risk factors and interventions. Available at: https://www.who.int/mental_health/prevention/suicide/lit_review_postpartum_depression.pdf
17. Sharma, V., and Sharma, P. (2012). Postpartum depression: diagnostic and treatment issues. J Obstet Gynaecol Can. Available at: https://www.jogc.com/article/S1701-2163(16)35240-9/pdf
18. Sit, D., and Wisner, K. (2010). The identification of postpartum depression. Clin Obstet Gynecol. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736559/