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A Review of Postpartum Depression and Continued Post Birth Support Research Paper

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Updated: Jun 27th, 2021

Abstract

The paper is focused on the investigation of postpartum depression as the most severe psychological disorder women may experience after giving birth. It is noted that the problem has not received sufficient attention from psychiatrists and other healthcare specialists. Current methods of diagnosing postpartum depression are not effective. Many women start experiencing the disease’s symptoms upon being discharged from a hospital when there is no possibility to observe their behavior and condition. The project consists of two major parts. In the first chapter – the introduction – the problem statement, background, purpose, and nature of the project are mentioned. At the end of this section, research questions are defined. The second chapter – a review of literature – suggests the analysis of the existing scholarly literature focused on the problem. Both historical overview and current context are discussed. The review ends with a conclusion and a summary of the sources. At the end of the paper, recommendations for further research on postpartum depression are outlined.

Introduction

Postpartum depression is the most severe psychological complication of childbirth. Emotional distress and the loss of control experienced by women who have just given birth have a negative effect both on mothers’ and babies’ condition. Although postpartum depression has attracted the interest of many scholars, there is no unanimity in their opinion as to what the causes of the condition are and what solutions are the most effective. Chapter 1 aims at overviewing the project and formulating the project statement. In Chapter 2, the researcher has reviewed past and current literature focused on the topic. The final part of the paper includes a conclusion, a summary, and recommendations.

Problem Statement

The insufficient knowledge of postpartum depression among obstetricians frequently leads to their mistaking it for regular depression. Physicians mainly focus on new mothers’ physical appearance and condition, neglecting their emotional and psychological state. The proposed project is crucial and feasible since it aims at performing a thorough investigation of postpartum depression and suggesting solutions for this problem. The mixed-method approach will be used. Qualitative methods will be employed to collect the information from new mothers and healthcare specialists. Quantitative methods will be used to calculate the obtained data.

Background

Postpartum depression, along with prenatal depression, belongs to major depressive disorders affecting 12-20% of the population (Brummelte & Galea, 2016). Depressive disorders are reported to be the main reason for disability in the world, and they impact women more frequently the men (Brummelte & Galea, 2016). The problem is aggravated by the fact that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not acknowledge the possibility of depression’s development in four weeks after giving birth. More than that, DSM-5 does not differentiate between antenatal and postnatal depression symptoms, referring to them as “peripartum episodes” (American Psychiatric Association, 2013, p. 152). Therefore, it is crucial to dedicate more efforts to the investigation of postnatal depression since the analysis will make it possible to identify the causes and find solutions to the problem.

Purpose

The purpose of the project is to explain the significance of managing postpartum depression by interviewing new mothers and healthcare specialists. The research aims at identifying the major causes of postnatal depression as a severe complication of new mothers’ mental condition. A review of literature will offer approaches of various scholars to defining the problem and finding solutions to it.

The Nature of the Project

The chosen design for research is a descriptive study that will employ a convenience sample to obtain answers to survey questions. The sample population will complete questionnaires that will provide relevant information concerning depression and social support. The demographic peculiarities of the participants include being over 18 years old, being able to read and write, and being a new mother. Thus, the females participating in the project will have a birthing experience that they will be able to recollect and record.

Social support questionnaires addressing background and demographic characteristics constitute vital information tools for collecting data. The Edinburgh Postnatal Depression Scale will be employed as a method of generating relevant questions related to pre-and postnatal classes and postpartum visits (Alvarado-Esquivel, Sifuentes-Alvarez, & Salas-Martinez, 2014). The use of qualitative methods is explained through the necessity to capture the opinions and views of the participants. Such a methodology guarantees a high level of evaluative and experimental justification. Certified nurse-midwives and obstetricians will also be interviewed. The interviews will be coded by combining the themes and the survey instrument.

Research Questions

The project aims at answering the following research questions:

  • What are the major reasons for postpartum depression?
  • What are the most effective ways of overcoming the problem?
  • What interventions have been suggested so far, and what was their effect?

The main research question incorporates all these issues, and it can be formulated as the following PICO question: In new mothers, does the use of a medical intervention reduce the future risk of postpartum depression compared to mothers not receiving the same intervention after delivery?

  • P (population): new mothers
  • I (intervention): a medical intervention
  • C (comparison): mothers not receiving support
  • O (outcome): a reduced risk of postpartum depression

Literature Review

Introduction

The intent of Chapter 2 is to provide a review of the literature that will guide the capstone project. The chapter suggests a historical overview of the research problem and discusses current findings on the topic. The issue of postpartum depression is investigated with the help of scholarly sources focused on the causes and consequences of the disorder.

Historical Overview

Research on postpartum depression has not altered much in several latest decades. As O’Hara and Swain (1996) note, the majority of research articles focused on postpartum depression published in the 1980s-1990s had one common limitation. These studies were “susceptible to overweighing” of individual research projects and the “difficulty in integrating” the outcomes of multiple studies (O’Hara & Swain, 1996, p. 37). Thus, in the second half of the 1990s, the strongest predictors of postpartum depression were such factors as inadequate social support, stressful living conditions and events, poor marital relationships, and psychological disorders during pregnancy (O’Hara & Swain, 1996). Similar opinions were favored by scholars at the beginning of the 2000s.

Besides the previously identified causes of postpartum depression, the following ones were established: low self-esteem, childcare stress, infant temperament, maternal blues, and unplanned or unwanted pregnancy (Beck, 2001). In 2010, the analysis problem continued attracting scholars’ concern, leading to the investigation of issues leading to postpartum depression and its consequences. Findings of the study performed by Field (2010) suggest that postpartum depression has a universal nature irrespective of cultural or socioeconomic peculiarities. Field (2010) notes that the disease harms such caregiving activities as sleep routines, breastfeeding, vaccinations, and safety practices. In this period, scholars started developing interventions aimed at relieving the symptoms of postpartum depression, such as interaction coaching and psychotherapy for mothers and massage for babies.

Current Findings

Recent articles view postpartum depression from a variety of angles of scholarly interest. Some researchers focus on the analysis of the condition and screening for it (O’Connor, Rossom, Henninger, Groom, & Burda, 2016; O’Hara & McCabe, 2013; Vliegen, Casalin, & Luyten, 2014). Other authors investigate interventions aimed at reducing symptoms (Danaher et al., 2013; Khazaie, Ghadami, Knight, Emamian, & Tahmasian, 2013). Particular attention in this respect is paid to the issue of breastfeeding as a factor having a positive effect on depression (Borra, Iacovou, & Sevilla, 2014; Figueiredo, Canário, & Field, 2014). Scholars consider breastfeeding as a productive method of alleviating the symptoms of postpartum depression.

Techniques of preventing postpartum depression are investigated in studies by Dennis and Dowswell (2013) and Werner, Miller, Osborne, Kuzava, and Monk (2015). Finally, a significant part of studies is dedicated to the analysis of the condition’s predictors (Gaillard, Le Strat, Mandelbrot, Keïta, & Dubertret, 2014; Räisänen et al., 2013; Yim, Tanner Stapleton, Guardino, Hahn-Holbrook, & Dunkel Schetter, 2015). The majority of scholars agree that the issue of postpartum depression has not been investigated at a sufficient level, which leads to the absence of productive preventive measures. The benefits of the reviewed articles include the investigation of postpartum depression and the emphasis on the problem. The limitations are concerned with the absence of a single approach and the inability to propose an effective intervention that could help new mothers cope with psychological difficulties.

The theoretical framework of the project includes the premises of postmodern feminist theory, critical constructionism, and Foucault’s theory of governing the disability (Frug, 2013; Heiner, 2016; Tremain, 2018). The theories of postmodern feminism and constructionism are relevant to the study due to covering the medicalization of postpartum depression. Foucault’s ideas are relevant because he considers that the present-day social experience has shifted from psychical control to moral government. Moral control enables the subjugation of individuals, which leads to them becoming submissive and manageable.

Conclusion

Findings of the literature review contribute to the project in that they outline the main aspects of the analyzed problem and indicate the urgent need for further investigations. Some of the reviewed articles focus on research questions such as the investigation of the causes of postpartum depression and the analysis of the solutions to the problem. However, only a few of the studies deal with the major research question that aims at investigating whether the use of medical interventions in new mothers can reduce the future risk of postpartum depression compared to those not receiving the intervention. The positive findings related to the topic are that some scholars outline the causes of postpartum depression and suggest solutions for them. The negative findings are concerned with the fact that almost none of the studies suggest effective interventions.

Summary

The review of literature has covered the following major points: the analysis of postpartum depression and its causes, screening for depression, interventions aimed at reducing the condition’s symptoms, the positive impact of breastfeeding, techniques preventing postpartum depression, and predictors of depression. The theoretical framework of the review is associated with such theories as critical constructionism, postmodern feminism, and Foucault’s theory.

Scholars agree that postpartum depression presents a serious risk to new mothers and their children due to weakening the family ties and increasing mothers’ irritation and disability to cope with the situation. The most reasonable and effective intervention among the analyzed ones was introduced by Danaher et al. (2013). However, the overall impression of the review of literature is that the problems caused by postpartum depression have not found a sufficient reflection in scholarly research. Further analysis is needed to investigate the possible solutions to this disease.

Recommendations

  1. To implement a second review of the Edinburgh Postpartum Depression Scale as opposed to the currently practiced single review. The existing norms presuppose inspecting women on the second day after giving birth. However, postpartum depression symptoms may not be revealed so quickly. Thus, it is recommended to perform the additional review after a few days of home adjustment.
  2. To create a condensed form of reference to support groups or hotlines that will be provided at discharge. With the help of this information, new mothers will be able to find the necessary support as soon as they feel the need for it, and they will achieve the necessary socialization and acceptance.
  3. To include in the recommendations the theoretical base presented in Ramona Mercer’s theory (Husmillo, 2013). The theory is based on the premise that the attainment of a mother’s role does not appear automatically upon becoming a mother. The scholar defends the need for new mothers to receive substantial support and help to eliminate the possibility of developing postpartum depression.

References

Alvarado-Esquivel, C., Sifuentes-Alvarez, A., & Salas-Martinez, C. (2014). Validation of the Edinburgh postpartum depression scale in a population of adult pregnant women in Mexico. Journal of Clinical Medicine Research, 6(5), 374-378.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.

Beck, C. T. (2001). Predictors of postpartum depression: Update. Nursing Research, 50(5), 275-285.

Borra, C., Iacovou, M., & Sevilla, A. (2014). New evidence on breastfeeding and postpartum depression: The importance of understanding women’s intentions. Maternal and Child Health Journal, 19(4), 897-907.

Brummelte, S., & Galea, L. A. M. (2016). Postpartum depression: Etiology, treatment and consequences for maternal care. Hormones and Behavior, 77, 153-166.

Danaher, B. G., Milgrom, J., Seeley, J. R., Stuart, S., Schembri, C., Tyler, M. S., … Lewinsohn, P. (2013). MomMoodBooster web-based intervention for postpartum depression: Feasibility trial results. Journal of Medical Internet Research, 15(11), e242.

Dennis, C. L., & Dowswell, T. (2013). Psychosocial and psychological interventions for preventing postpartum depression (Review). Cochrane Database of Systematic Reviews, 2, 1-206.

Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior and Development, 33, 1-6.

Figueiredo, B., Canário, C., & Field, T. (2014). Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychological Medicine, 44, 927-936.

Frug, M. J. (2013). Postmodern legal feminism. New York, NY: Routledge.

Gaillard, A., Le Strat, Y., Mandelbrot, L., Keïta, H., & Dubertret, C. (2014). Predictors of postpartum depression: Prospective study of 264 women followed during pregnancy and postpartum. Psychiatry Research, 215, 341-346.

Heiner, R. (2016). Social problems: An introduction to critical constructionism (5th ed.). New York, NY: Oxford University Press.

Husmillo, M. (2013). Maternal role attainment theory. International Journal of Childbirth Education, 28(2), 46-48.

Khazaie, H., Ghadami, M. R., Knight, D. C., Emamian, F., & Tahmasian, M. (2013). Insomnia treatment in the third trimester of pregnancy reduces postpartum depression symptoms: A randomized clinical trial. Psychiatry Research, 210, 901-905.

O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women: Evidence report and systematic review for the US preventive services task force. JAMA, 315(4), 388-406.

O’Hara, M. W., & McCabe, J. E. (2013). Postpartum depression: Current status and future directions. Annual Review of Clinical Psychology, 9, 379-407.

O’Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression – A meta-analysis. International Review of Psychiatry, 8(1), 37-54.

Räisänen, S., Lehto, S. M., Nielsen, H. S., Gissler, M., Kramer, M. R., & Heinonen, S. (2013). Fear of childbirth predicts postpartum depression: A population-based analysis of 511 422 singleton births in Finland. BMJ, 3, e004047.

Tremain, S. (Ed.). (2018). Foucault and the government of disability. Michigan, MI: University of Michigan Press.

Vliegen, N., Casalin, S., & Luyten, P. (2014). The course of postpartum depression: A review of longitudinal studies. Harvard Review of Psychiatry, 22(1), 1-22.

Werner, E., Miller, M., Osborne, L. M., Kuzava, S., & Monk, C. (2015). Preventing postpartum depression: Review and recommendations. Archives of Women’s Mental Health, 18, 41-60.

Yim, I. S., Tanner Stapleton, L. R., Guardino, C. M., Hahn-Holbrook, J., & Dunkel Schetter, C. (2015). Biological and psychological predictors of postpartum depression: Systematic review and call for integration. Annual Review of Clinical Psychology, 11(1), 99-137.

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