Purpose for the Program
Postpartum depression occurs during pregnancy and the first 12 months following birth. It affects at least 1 in 10 new mothers (20%-22%). Prior to our postpartum depression program, women received written materials and education about signs and symptoms of postpartum depression. None of these patients received follow-up from our organization after discharge. The immediate, long-term, and sometimes tragic effects of postpartum depression on families made an evidence-based initiative to provide seamless care and follow-up for these families a priority.
A comprehensive program of postpartum depression risk assessment; education; screening; time-sequenced follow-up; and referral during pregnancy, postpartum, and after discharge for all mothers giving birth at our hospital.
Implementation, Outcomes, and Evaluation
An interdisciplinary team reviewed the literature and identified opportunities to develop postpartum depression services. Feedback from our clients identified needs and supported screening all mothers for postpartum depression. We chose the Edinburgh Postnatal Depression Scale for screening. Our program included education about postpartum depression, Edinburgh Postnatal Depression Scale, and patient follow-up for nurses, physicians, and office staff. Patient education materials and discharge instructions were revised. All mothers were screened before discharge, with repeat screenings by a registered nurse 2 weeks later during follow-up calls. We established direct links with our organization's behavioral health department for antepartum/postpartum assessments and interventions and obtained grant funding for services. Outpatient emergent and follow-up behavioral health care was a priority. The results of the initial/follow-up screenings were shared with the physicians.
In the first year of the program, all mothers were screened for risk of postpartum depression while in the hospital and received either a follow-up phone call by a registered nurse after discharge or a visit by a clinical nurse specialist. This has resulted in early identification of risk and access to behavioral health services that may prevent/reduce symptoms of postpartum depression.
This program has strengthened the relationships among maternal and child health departments, behavioral services, and private physician offices and improved the early identification/referral of women at risk. Physician practices that previously had not done formal screenings at postpartum follow-up visits are now using the Edinburgh Postnatal Depression Scale. Weekly antepartum support groups are led by a therapist, who also provides individual counseling through grant funding.
Implications for Nursing Practice
Comprehensive maternity care must include postpartum depression screening, assessment, and referral. Seamless care during the antepartum and postpartum periods, and sequential follow-up has had a positive impact on families through education, early identification, and referrals for treatment/support. The development of interdisciplinary collaboration is essential and strengthens the care offered to families. Our program provides a seamless model that hospitals may replicate.