Community Resources For Postpartum Depression

Hospital Births: Length Of Hospital Stay

In 1993, the average length of stay after a vaginal birth was 3.2 days, decreasing to 2.0 days by 2012.Footnote 5 During the same period, the length of hospital stay following Caesarean birth decreased from 5.0 days to 3.4 days. The safety of a shortened hospital stay has been debated with regards to the needs of the mother and particularly the newborn. What research says about shorter hospital stays can differ from various organizations guidelines for both mother and baby.Footnote 48Footnote 49

Each family needs to discuss with their HCP the risks and benefits of a stay that is shorter than the institutional standard. Base this discussion on the babys and the mothers needs and not on routine policies. From the perspective of family-centred care, leaving the hospital as early as possible has a number of potential benefits: the opportunity for the entire family to get to know the baby together, resulting in greater attachment more involvement for the partner and less sibling rivalry better rest and sleep for the mother in her own environment, without constant interruptions from hospital staff reduced exposure of mother and baby to hospital-acquired infections and greater confidence on the mothers part in her ability to care for her baby.Footnote 49

Refer to the following CPS guidelines related to infant discharge:

Key Features Of An Effective Postpartum Depression Screening Protocol

Research nurses telephoned all mothers who signed a permission form and who did not return an opt-out card. The 10-item Edinburgh Postnatal Depression Screening Scale and the Mothers Information Tool to elicit demographic information and responses to a series of open-ended questions were administered on the telephone. If the nurse failed to contact a woman within one week, the EPDS and MIT-brief were sent by mail. Data from this study support the recommendations of Gaynes and colleagues and others that the EPDS merits continued use as a standard postpartum depression screening measure as it continues to demonstrate strong reliability and validity. For phone or mail-in screens, if a woman’s EPDS score was > 10, she was informed about the research study and invited to have a diagnostic interview with possible enrollment in the clinical trial. As the authors of the EPDS recommend the lower score of 9/10 to reduce failed detection to less than 10%, EPDS > 10 was selected as the cutoff score. Cox and colleagues also suggest that mental health referral is indicated whenever a woman scores 13 or higher.

Postpartum Depression Resources For Mothers

1 in 7 pregnant and new mothers may experience depression or anxiety. New mothers may experience little sleep and new and increasing responsibilities that may cause stress and anxiety, all of which can lead to depression.

If you are experiencing any signs or symptoms, seek help by contacting your healthcare provider.

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Integrated Care Of The Mother And Baby

The mother and newborn should be considered a unit during the immediate postpartum period . It is important to avoid disrupting this close relationship during these crucial few hours and to encourage skin-to-skin contact between the baby and the mother . The International MotherBaby Childbirth Organization refers to this as motherbaby care to emphasize the importance of recognizing that mothers and babies are a unit.

The parentbaby bondthe first step in the babys subsequent attachmentsis formative to a childs sense of security and has long-lasting effects.Footnote 19 Having early physical contact with the baby can affirm parents sense of accomplishment and promote their self-confidence as parents. Keeping babies and parents together is of the highest priority. Institutional policies should only disrupt this contact in the event of a necessary, evidence-based medical reason.

HCPs can demonstrate respect for the family by interfering as little as possible during interactions between the mother and baby. Observations, assessments, and interventions can be completed with minimal intrusion, while skin-to-skin contact is maintained. Anything that is not essential to the immediate well-being of the baby or mother can wait for 2 hours or after the first breastfeeding. Even medically necessary procedures can be done while the baby remains in skin-to-skin contact as long as it is medically safe to do so.Footnote 23Footnote 24

Intimate Partner Violence And Child Abuse

HCPs are ideally positioned to recognize signs of family violence, including intimate partner violence, as well as child exposure to intimate partner violence and other types of child maltreatment. These forms of violence can negatively impact the health of mother and child, and the effects can persist over time. It is important that providers be equipped to recognize and respond safely to situations involving family violence, and to ensure that their interactions or interventions do not revictimize the mother or child.

According to the Maternity Experiences Survey, about 1 in 10 women who have given birth reported experiencing one or more acts of violence in the past 2 years, most often being pushed, grabbed, or shoved in a way that could have hurt them.Footnote 215 Over half identified their partner, husband, or boyfriend as the perpetrator of this violence. One-third experienced the violence during pregnancy, and 16% reported that the violence increased after the birth of the baby, 52% that it decreased, and 32% that it stayed the same. Of those women who experienced abuse, 61% reported discussing or receiving information about what to do if they experienced abuse.Footnote 215

Provincial/territorial child welfare legislation considers exposing a child to intimate partner violence/family violence a form of maltreatment, and HCPs are required to report it.Footnote 296

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Screening Women At Risk For Postpartum Depression

The evidence-based Agency for Healthcare Research and Quality screening framework begins by identifying a cohort of postpartum women with unknown mood state, proceeds to formal postpartum screening, diagnostic evaluation for those with positive screens, and random group assignment with follow-up evaluation. Applying this framework, research nurses visited women recovering on the postpartum units of two Harvard teaching hospitals from August 2004 through September 2007. Research nurses visited women previously identified by staff who met all eligibility criteria: English-speaking, medically stable and sufficiently recovered from labor and birth, with uncomplicated delivery of full-term, singleton infants cared for in the newborn nursery. Interested mothers were approached by research nurses and asked to complete the Permission to Be Contacted Form for depression screening at 4 weeks postpartum. As postpartum blues resolve by 2 weeks and postpartum depression is defined as beginning by 4 weeks , this was an appropriate time for screening. Materials were also given to mothers take home.

Alaska Postpartum Depression Support

Anchorage Monday Mamas Support group. Postpartum Support Alaska meets at the Maternity Education Center at the Childrens Hospital at Providence. Contact the Family Support Counseling Clinic at 907-212-4940 or , Family Support Services counselor.

Fairbanks Alaska Family Health & Birth Center Support Group. Contact 907-456-3719 to register

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How You Can Help Yourself

• Get as close to eight hours of sleep a day as you can

• Maintain a well-balanced diet

• Try your best to find time to exercise

• Practice relaxation, even if its a few minutes with your feet up or a quick breath of fresh air

• Be gentle with yourself and your feelings

• Find support from family and other loved ones

• Have time for yourself away from the baby

• Educate yourself!

What Is Postpartum Psychosis

Postpartum psychosis is a rare, severe form of depression. Its not the same as PPD. About 1 or 2 in 1,000 women has postpartum psychosis after giving birth. It usually begins in the first 2 weeks after giving birth. Women who have certain mental health conditions are more likely to have postpartum psychosis than other women.

If you have postpartum psychosis, you need treatment to get better. Call your health care provider right away if you have any of these signs or symptoms:

• Seeing or hearing things that arent there
• Feeling very confused
• Feeling hopeless, upset or restless
• Feeling paranoid, like you cant trust other people or you think other people want to harm you
• Having rapid mood swings
• Having trouble sleeping, even when youre really tired
• Thinking about or trying to hurt yourself, your baby or other people

If youre thinking of hurting yourself or your baby, call emergency services right away.

Additional versions of this article are available in: Arabic, Chinese Simplified, Hindi, and UrduTranslated documents are courtesy of the employees of CooperSurgical Inc.

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Virginia Postpartum Depression Support

Postpartum Support Virginia Support Groups for times and locations visit:

Manassas Prince William Medical Center Hylton Birthing Center. Contact Nancy Sonnenberg, 703-369-8649

Portsmouth Military member and dependents. Portsmouth Naval Medical Center Contact Kimberly Barnard-Bracey, 757-953-5861

Prolonged Stay In Hospital/neonatal Intensive Care Unit

A baby remaining in hospital for an extended period can create a great deal of stress for parents and families. The kind of care that the baby receives, and the approach to care, affects not only the babys physical well-being but also parentbaby attachment, feeding, neurodevelopmental outcomes, and the overall health and well-being of the baby, parents, and family. The parents and family may be experiencing extreme emotions such as anxiety or depression, or conflicting feelings such as the joy at the birth of their baby and the fears for the babys well-being and their ability to provide care.

NICU environments that facilitate shared decision-making and partnerships between parents and professionals and enable parents to be their babys primary caregiver, create a more consistent care for the baby. They also protect the baby from trauma associated with the NICU, such as isolation, stress, and lack of support during painful procedures, and provide parents with the opportunity to develop confidence and skill in caring for their babies.Footnote 30Footnote 265Footnote 266

Infrastructure and supportsFootnote 267Footnote 271Footnote 283Footnote 285Footnote 286

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Symphysis Pubic Dysfunction Pelvic Girdle Pain And Diastasis Symphysis Pubis

Symphysis pubic dysfunction has been described as a collection of signs and symptoms of discomfort and pain in the pelvic area, including pelvic pain radiating to the upper thighs and perineum.Footnote 199Footnote 200Footnote 201 While this term has been used to describe pregnancy-associated pain and instability and dysfunction of the symphysis pubis joint or sacroiliac joint , the European Guidelines recommend pelvic girdle pain as the accepted umbrella term.Footnote 201 PGP symptoms occur due to pelvic ligament relaxation and increased joint mobility in pregnancy, and can vary from mild discomfort to severely debilitating pain.Footnote 202

About 20% of pregnant women experience PGP.Footnote 201Footnote 203 Risk factors for developing PGP during pregnancy include a history of previous low back pain and previous trauma to the pelvis.Footnote 201 Prolonged and difficult births, often with larger babies, with the womens legs widely abducted, and possibly assisted by forceps, can also be contributing factors. The reported incidence of clinically persistent PGP from the postpartum stage to 2 years after childbirth ranges from 5% to 8.5%.Footnote 204

Caring For Lgbtq2 Families

Family-centred maternity and newborn care is based on individual needs and a mutually respectful and trusting relationship. While progress has been made in providing equitable health care to the LGBTQ2 communityFootnote *, these families often continue to face barriers in health care.

People in the LGBTQ2 community identify 3 major barriers when dealing with the health care systeminvisibility, lack of information, and negative beliefs. Invisibility refers to the fact that they do not see themselves in the institutions/programsfor example, the posters on the walls, the forms they completeor in conversations with HCPs. The HCPs they encounter often do not understand their experiences as an LGBTQ2 family, their unique and diverse needs, and may have negative beliefs about them.Footnote 11

Sexual minority women have a greater prevalence of depression and depressive symptoms compared with heterosexual women, likely because of the impact of sexual orientation-based discrimination, stigma, lack of social support and exposure to additional stress due to heterosexism from their families and some HCPs.Footnote 12Footnote 13Footnote 14Footnote 15Footnote 16 Invisible sexual minority women are at higher risk for postpartum depression than both visible sexual minority women and heterosexual women.Footnote 14Footnote 17

HCPs can facilitate inclusivity when caring for LGBTQ2 families, including during the postpartum period, by:Footnote 11

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Family Doctor Or Midwife

Connect with your family doctor or midwife to explain how you are feeling. They are available to assess and diagnose your symptoms.They can discuss anti-depressants or other medications that are safe with breastfeeding that may help. They may also refer to additional supports such as reproductive mental health services in your community.

Massachusetts Postpartum Depression Support

Acton Emotional Wellbeing After Baby group at First Connections, 179 Great Road, Suite 104 Contact Heather OBrien http://www.firstconnections.org/

Brookline Support Group $25/session, Contact Rachel Kalvert, LICSW at 617-487-1521

Greenfield Franklin County Postpartum Support Group at the Community Action Family Center, 90 Federal Street Contact Sandy Clark at 413-475-1566,

Plymouth Depression After Delivery at Jordan Hospital, 275 Sandwich St., Meditation Room Contact Gerri Piatelli at 781-837-4242,

Holyoke MotherWoman Postpartum Support at Midwifery Care of Holyoke, 230 Maple Street, 534 2700,

Waltham This Isnt What I Expected PPD Support Group at JF& CS, 1430 Main Street Contact Debbie Whitehill at 781-647-5327 x1925, ,

North Reading Postpartum Adjustment Support Groups at Stork Ready, 325 Mani Street Contact Leslie McKeough at 781-507-2025, lamckeough@gmail.com,

Newton Balance With Baby Postpartum Support Group at The Freedman Center at William James College, One Wells Ave Contact Chardae Golding at 617-332-3666 x 1123, Email: ,

Newton Free Support Groups:

Watertown Strong Roots PPD Support Groups, find information here.

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Important Postpartum Depression Resources For Canadian Moms

Oh Canada the land of free healthcare!

While healthcare in Canada is free for citizens and I wouldnt want it any other way it can be a challenge for mothers to find and access proper postpartum depression resources.

Obviously, speaking to a doctor would be the first step. But often, our family doctors, obstetricians or gynecologists were not our first choice, but rather, the ones with the shortest waiting list. Its difficult to speak to someone about something as personal as postpartum depression when a strong relationship doesnt exist.

For mothers in Canada, its important to have a list of postpartum depression resources we can access when we dont get the answers we were looking for from our primary healthcare providers. Free healthcare doesnt have to mean that our options are limited.

Here are a few different postpartum depression resources available to Canadians

Could I Have Postpartum Depression

• I feel extremely sad and depressed

• Im having crying spells for no apparent reason

• Im having guilty thoughts or feelings of worthlessness or hopelessness

• Im having thoughts of ending my life or other frightening thoughts

• Im feeling inadequate and Im resenting my baby and other family members

• Ive noticed changes in my sleep or appetite

• I feel restlessness, out of control, or have no energy

• Im having difficulty concentrating

• I find myself withdrawing from family, friends and social situations

Some women may have more physical symptoms such as:

• Feeling weak or feeling flushed

• Gas, constipation or diarrhea

• Headaches or heaviness in the head

It isnt uncommon for women experiencing postpartum depression to have scary thoughts about harming their babies even though its the last thing theyd want to do. While we have all heard stories of women harming their newborns, it happens very rarely. In these cases women who harm their babies usually experience psychosis. Postpartum psychosis affects only one out of 1000 new mothers. Even mothers experiencing postpartum psychosis very rarely harm their children.

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Cardiorespiratory Distress And Cardiac Concerns

Cardiorespiratory distress in the newborn may occur immediately after childbirth or later in the postpartum period. All HCPs caring for newborns must be able to assess respiratory distress, cyanosis, and perfusion. The CPS recommends that all centres in which babies are born have personnel capable of initiating assisted ventilation.Footnote 232 They also recommend following Neonatal Resuscitation Program guidelines for specific resuscitation procedures immediately after the birth and having a written policy regarding the initial care of a baby with respiratory distress outside of each birthing room in each facility.Footnote 232 Regular simulation sessions or other forms of practice scenarios are useful opportunities for continuing education and maintenance of skills.

Heart murmurs are common in the first few days of life and do not normally indicate a significant problem. In the first 24 hours, murmurs are often indicative of flow through the patent ductus arteriosus and disappear following the closure of the ductus. However, any murmur, even within the first 24 hours, must be assessed in the context of the entire physical examination. If a murmur persists or is symptomatic, a more complete evaluation is recommended.Footnote 233Footnote 234

How Can I Help A Loved One

Postpartum depression can be a difficult experience for everyone. Most people expect the arrival of a child to be happy and joyful, and postpartum depression is none of those things. Its important to know that postpartum depression is no ones fault, but you can play a big role in a loved ones recovery.

Here are some tips on supporting a loved one who experiences postpartum depression:

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Results Of The Screening Process

Over 2 ½ years, 5,169 women aged 14â49 were screened by nurses on the telephone, or by self administering and returning mailed questionnaires. Of this group, 674 women had scores on the EPDS > 10. The prevalence rate for the women who self-administered the screening questionnaire was 19% , which was higher than the 11% prevalence rate for the women screened by phone .

A number of women declined the diagnostic interview and subsequent enrollment in the 9-month study for reasons including: lack of interest, no time, moving, or returning to work. Other women responded too late to meet study timelines or were unable to be contacted. One hundred eighty five women with positive EPDS screens received diagnostic interviews. Of this group, 111 were diagnosed with major depression, 24 with minor depression, 8 with depression not otherwise specified and 1 with mixed depression and anxiety. Forty-one mothers were not diagnosed as depressed and dropped from the study.