New hospital guidelines to help mothers at risk of postpartum depression
Although 13 percent of new mothers experience postpartum depression (PPD) in the first year after childbirth, few women recognize the symptoms and seldom discuss their feelings with a health care provider.
University of Louisville Hospital (ULH) hopes to change this statistic through a new policy to guide hospital-based perinatal nurses in caring for women with risk of PPD.
M. Cynthia Logsdon, UofL School of Nursing, and associate chief of nursing research, ULH and the James Graham Brown Cancer Center, and her team created evidence-based practice guidelines using research recently published online in The American Journal of Maternal Child Nursing.
“The hospital policies and procedures are designed to provide perinatal nurses the tools they need to prepare new mothers so they are able to self-monitor for symptoms of depression and know what steps to take if they experience symptoms,” Logsdon said.
Most hospitals lack comprehensive perinatal patient PPD assessment, education and referral policies, according to Logsdon. Although such professional organizations as the Registered Nurses’ Association of Ontario previously published a best practices guideline, the recommendations did not focus on the first few days following childbirth or nursing care while the new mother was hospitalized.
“Our recommendations for nursing practice of hospital-based perinatal nurses go beyond previous published guidelines,” Logsdon said.
Logsdon and her team, Diane Eckert, clinical manager, mother-baby unit, ULH; and Roselyn Tomasulo, perinatal educator, collaborated with internationally known researchers in the field to write the article, “Identification of Mothers at Risk for Postpartum Depression by Hospital Based Perinatal Nurses” They consulted a task force of clinical nurses to determine how to improve nursing practice at ULH. Implementation included identifying at-risk patients and referral sources; physician and staff education was another component.
“When many nurses enter the profession, they don’t fully understand their critical role as patient educators,” Tomasulo said. “We are helping our perinatal nurses feel more competent in their roles by offering inter-hospital online education and staff training.”
The process includes assessing new mothers for PPD and suicide risk factors during the obstetric patient admission process. ULH perinatal nurses screen for low-income status, lack of social support and previous history of depression and report at-risk patients to the obstetrical physician. Before hospital discharge, all new mothers fill out a questionnaire that uses the Edinburgh Postnatal Depression Scale (EPDS) to determine their risk for PPD.
The results are factored into the patient’s future care. New mothers go home with a list of community resources and physician referrals, so they have names and numbers at their finger-tips if they need to seek help. ULH also asks them to retake the EPDS questionnaire about a week later after leaving the hospital to see if they’re experiencing PPD symptoms.
“We hope our work will be seen as a model of good policy and can be considered by other hospitals and professional organizations,” Logsdon said.