Effects of Postpartum Depression on Maternal Identity MORGAN BRIGGS
Overview of Postpartum Depression Definition: major depressive disorder that occurs
within 12 months after childbirth Characteristics: (Beck, 2006)
5 of these: Insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, change in appetite, feelings of worthlessness or guilt, decreased concentration, suicidality 1 of these: Depressed mood, loss of interest or pleasure
Prevalence: 10-15% (Howell, Mora, & Leventhal, 2006) Significance: serious impact on health of mothers &
their babies
Metaparadigm Concept of Person Characteristics of Persons: (Doornbos, Groenhout,& Hotz, 2005) Embodiment Independent Dependent and interdependent Image-bearers of God Co-authors: characters in a narrative Part of a community
How PPD Affects a Mother’s Identity as Person Independence (Doornbos, Groenhout,&
Hotz, 2005)
Subjective: “I”- separate from environment Sense of agency: able to interact with environment
Effects of PPD Decreased functionality (Beck, 2006) Lacks energy to interact with infant- leads to compromised
parenting (Howell et al., 2006) Increased risk of mortality (Mallikarjun & Oyebode, 2005)
How did PPD affect your sense of independence? “I couldn’t balance the checkbook, clean the house, or even
Interviews: Sense of Agency
finish a load of laundry.” “I was not interested in seeing friends or leaving the house.” “I didn’t want to get out of bed.” “I wanted to run away from myself.” “I felt very restless. I couldn’t fall asleep during the day or at night, but I often laid down without wanting to get up.” “I was irritable and anxious. I cried easily and felt overwhelmed.” “I started having panic attacks when my husband left for work each day… I had panic attacks at the grocery store too, since I was afraid I wouldn’t know how to respond to my baby’s cries in public.” “I felt like I was in a straight black hole, like an upsidedown funnel that got wider and wider as I neared the bottom.” “I felt trapped and tied down, like there was no way out.”
How PPD Affects a Mother’s Identity as Person Dependence/interdependence
(Doornbos, Groenhout,& Hotz, 2005)
Need help of other people and social institutions Fragility, vulnerability, openness To suffering, to others’ expectations, to responsibility Setting aside one’s own needs to help or care for others
Effects of PPD Vulnerable to suffering and others’ expectations Unable to be open with others Unable to set aside own needs to care for her infant Dependent infant: (Howell et al., 2006, Mazzeo et al., 2006) insecure infant attachment cognitive/behavioral/social/emotional/physical problems increased risk of mortality
Interviews: Dependence & Interdependence
How did PPD affect your sense of identity as a wife and mother? How did it affect your relationship with others? “I argued continually with my husband.” “I was constantly criticizing my husband and blowing
up; I just couldn’t think clearly.” “I didn’t want to raise a baby… I didn’t hear or just couldn’t respond to my baby’s cries.” “I didn’t interact with my kids much. I get overstimulated with big groups of people, and this was happening a lot at home.” “I wanted to harm myself and my baby.” “The depression stalled a lot of my relationships.” “When I told my mom, she was very embarrassed. She didn’t tell anyone. She saw it as a failure.” “My dad was not empathetic. He said, ‘You should just get over this.” “I desperately wanted to flee my baby, my marriage, and, most importantly, God.”
How PPD Affects a Mother’s Identity as Person Image-bearer of God (Doornbos, Groenhout,&
Hotz, 2005)
God’s stewards, representatives, co-workers, co-authors
Effects of PPD mother’s suffering reflects Christ’s suffering on the cross Unable to experience wholeness and enjoyment in relationship to
others and to God
How did PPD affect your sense of identity as a Christian? Interviews: Image-bearer of God
“When I prayed, it felt like God was standing
with his back to me with his arms folded.” “I felt like God was cruel to create us—why would he do this to me?” “I was angry at God, a feeling I hadn’t experienced before.” “God felt distant and uncaring.” “I felt completely worthless and very inadequate.” “I doubted God’s goodness.” “I found myself reading the Bible less, praying less, and going to church less.” “People would tell me to pray and ask God for help. Believe me, I prayed, and prayed and prayed. It seemed as though I just couldn’t pray my way out of this.”
How PPD Affects a Mother’s Identity as Person Co-author: character in a narrative
(Doornbos, Groenhout,& Hotz,
2005) Passively: specific historical, social, and cultural context Actively: accepting or rejecting the conditions of that context
Maternal risk factors for PPD:
(see references)
Passive factors (background/circumstances) Active factors (choices) Younger age
Poor body perception or
Minority Personal or family history of mental
illness Difficult labor Infant with difficult temperament Environmental stressors Fatigue (to some degree) Personality (to some degree)
history of eating disorder No social support system Smoking Lack of exercise Lack of optimism/ hope Fatigue (to some degree) Personality (to some degree)
Case Study:
Interviews: Historical, social, and environmental context
Moved to a new state one month before the baby was born. Had no social support system in place yet. Husband started new job and had to travel to Austria for 3 weeks after the baby was born. Very fatigued. Lots of unpacked boxes. Personal and family history of depression. Introverted. Low self-confidence. First child. Indecisive about how to care for her baby. Confused by the conflicting advice of friends. Infant with fussy temperament. Expected being a mother to be more like it was in the movies. Thought she would just lay the baby in his crib and he would go to sleep.
How PPD Affects a Mother’s Identity as Person Part of a Community (Doornbos, Groenhout,&
Hotz, 2005)
Members of community must share benefits, resources, and
burdens Ethical call to justice
Connection to PPD Unequal distribution of resources: finances, jobs, child care Lack of resources increases stress and fatigue, which can lead to
PPD (Grote & Bledsoe, 2007) When the community shares the burden, the results are immensely positive
Resources that Aided Recovery: Interviews: Part of a Community
HUSBAND Friends Mother-in-law, family MOPS, support groups People at church Babysitter Psychiatrist Midwife Counselor Hospitalization ECT treatments, medication, exercise Faith in God
Metaparadigm Concept of Nursing Promoting/protecting health (Doornbos, Groenhout,& Hotz, 2005) Lessening pain Restoring physical, emotional, social, and spiritual functioning Promoting wholeness and flourishing Therapeutic relationship Treating others with dignity Being present/active listening to build trust Exemplifying core virtues
Role of Nurses in Caring for Women with PPD Promoting/protecting health (see references) Promoting wholeness (primary health protection) Educating moms-to-be about PPD Encouraging low-intensity exercise and feelings of optimism Referring women to social worker/community services for financial or
employment needs Teaching mothers and mothers-to-be how to cope with fatigue Encouraging mothers and mothers-to-be to utilize social support network Restoring functioning (secondary/tertiary health protection) Early screening for PPD Treatment with psychotherapy, counseling, cognitive-behavior therapy, and antidepressants as needed
Role of Nurses in Caring for Women with PPD Therapeutic Relationship Active listener, be present and walk with mothers with PPD in their
suffering and their experiences of chaos/confusion/sadness/anger
Barriers to a Therapeutic Relationship (Sword et al., 2008) Discounting/ normalizing symptoms Offering unacceptable interventions Disconnected care pathways
Facilitators to a Therapeutic Relationship (Sword et al., 2008; Coast, 2008) Established and supportive relationship equality, honor, respect, input in decision-making Legitimization of PPD and validation of feelings Caring attitude: follow-up Timeliness of appointments
Questions?
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