Reflective Sample Assignment: Perinatal Mental Health and Postpartum Depression

REFLECTION

Perinatal Mental Health [PMH] Nurses are accountable for performing core role in supporting pregnant women who are suffering from mental health issues (Sezgin et al, 2023). Midwives educate about resilience capabilities and enhances the potential to cope up with stress in females. The present essay will be a reflective piece that examines a case of woman suffering from depression during first year of the postnatal period. The aim of the essay is to implement informed judgement while using evidence for supporting woman and her maternal mental health. Furthermore, literature and evidences that adheres with evidence-based outcomes would be underpinned. In order to write reflection, scholar use Gibb’s reflective cycle and accordingly, in-depth analysis would be undertaken via considering the stages; description, feelings, evaluation, analysis, conclusion and action plan. The essay will be evaluation of own experience and thereby, scholar will refer as midwife throughout the reflection.

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The Perinatal mental disorders prove to be one of the commonest morbidities of pregnancy, this develops significant impact on maternal mortality, infant and child outcomes (Zivin et al, 2024). From the existing literature certain insights were recognised which states that if mental health complexities left untreated then, it develops drastic influence on mother and child (Zivin et al, 2024). Therefore, specialist PMH services should be provided to pregnant women. During own clinical placement privilege for providing care to a birthing person was received and consequently, active role in understanding the situation of patient was undertaken along with facing varied challenges. In accordance with the Nursing and Midwifery Council [NMC] code of conduct, confidentiality will be maintained and patient will be referred as Jane, a 25-years-old woman was experiencing severe depression as a result of perinatal period. The exhibited persistent feelings of anxiety hopelessness and sadness developed drastic influence on Jane and her family members. Despite having supportive family and friends Jane reported that she feels overwhelmed and further patient was not able to connect with his new born.

Perinatal mental illness considered as a significant complication in pregnancy and postpartum phase that is encountered by obstetrician–gynaecologist. It refers to the psychiatric disorders which are prevalent during pregnancy and continues to 1 year after delivery (The Nursing and Midwifery Council, 2023). Jane’s mental health complexities issues prior to her pregnancy compounded by the current situation thar made her care huge complex. Throughout the care process, midwife experienced varied emotions towards Jane as she was struggling and her frustration was creating barriers in accessing mental health support. Adane et al, (2021) elucidated that after child birth a dramatic drop within estrogen and progesterone takes place that might contribute in depression. Furthermore, other hormones that are produced through thyroid gland might drops that results in tiredness and emotional fluctuations that lead to depression (Gopalan et al, 2022). However, there are consistent debates regarding postnatal or postpartum depression [PPD] context have been arising. The systematic limitation upholds the notion of identifying whether PPD distinct from major depressive order, arguments have been implemented in this area and differences between both the context considered as topmost notch. Brown et al, (2021) revealed that PPD is considered as a major depressive order as PPD develops huge stress and anxiety in females and it can further develop long-lasting trauma. Hence, Postnatal and postpartum depression can create a long-lasting trauma for an individual if consistent support throughout this phase has not been given.

However, in own experience midwife realised that there is no sense of differentiating these components, Jane’s condition was evident and this changed the perception of midwife, for a birthing person it is so hard to cope up with depression. Collaboration with Multidisciplinary Teams [MDTs] was implemented for assuring consistent support to Jane (Daehn et al, 2022). The team was concerned with psychiatrist, social workers, senior healthcare professionals, mental health nurse and midwives. The approach was associated with conducting regular mental health assessment, undertaking discussion about self-care and providing psychoeducation about postpartum depression. At initial stage Jane was heisting and after consistent support Jane started to involve and she often adopted recommendations related to therapy. Eventually, it led to show the sign of improvement. Person-Centred Care played pivotal role in the care procedure as midwife and team was able to identify the needs and requirement was Jane (Antoniou et al, 2021). The discussion with Jane led to clear significant things, after birthing child Jane feels that she is receiving less love from family members as everyone is looking over child.

During initial phase, midwife felt huge concern and empathy towards Jane and recognised that her mental health struggle is severe which might drastically impact her well-being and ultimately develops negative influence on child. The discussion with Jane was undertaken and she told midwife that “All of us are concerned about child, what about her”? A sense of fear experienced during this case as it was such a sensitive issue that would hinder the potential of providing support. Following the discussion, midwife expressed the concern towards team leader and obstetric team afterwards, they have reviewed Jane and immediate referral for psychiatric team was implemented. From MDT, psychiatrist and mental health nurse were approached and sessions of counselling was undertaken, Midwife was told to look upon the requirement of Jane along with undertaking communication with family members. From the literature it has been analysed that midwife are accountable for undertaking consistent communication with patient so that sense of belongingness can be developed in them (Fisher et al, 2021). The engagement with Jane led to develop mutual trust between Jane and Midwife and strong sense of responsibility for advocating patient needs was developed. Following the multiple discussions and coordinating with family and MDT led to witness gradual improvement that brough immense sense of satisfaction and relief. On the other hand, midwife experienced huge pressure related to lack of immediate mental health resource and stigma associated with perinatal mental illness.

Moving ahead with the evaluation stage certain insights were identified, one of the positive outcomes was associated with developing effective collaboration with MDT. The coordination led to facilitated comprehensive care which addressed Jane’s mental and maternal well-being. Thus, coordination within MDT is essential as it plays pivotal role in enhancing patient outcomes. On contrary note, challenges developed from systematic delay within mental health referrals and it often developed initial hesitation for jane with regards to perceiving feelings (Ghahremani et al, 2022). Furthermore, it has been identified that there is need to organise consistent education related to maternal mental health and it is important to emphasise on identifying the intervention that assures consistent support. Thus, considering the evaluation part, it can be said that integration of perinatal mental health within routine obstetric care presenting significant opportunity for addressing challenges.

It is important to undertake early identification of mental health issue within identifying existing maternity care protocols (Layton et al, 2025). This can result in improving health outcomes for mothers. From the literature it has been identified that EDPS screening tool proves to be most acceptable tool in terms of versality and sensitivity (Darwin et al, 2021). This has been proven effectual for depression among postpartum women, this tool is mainly utilised for antenatal and postnatal periods. However, contextual issues related to the screening tools was developed as cultural nuance and language can create huge impact on the expression of distressing symptoms. Nevertheless, in the monitoring of experts appropriate screening can be done and support can be ensured to woman suffering from depression in prenatal phase.

From Jane’s case it has been evident that there is need to adopt an integrated approach for maternal mental health. Antoniou et al, (2021) study have shown that prevalence of depressive disorder in prenatal period influences mother and infants in drastic manner. The initial thoughts of midwife were that Jane might experience issues related to mental health as she appeared erratic in her behaviour and the rapid changes in mood was signifying about postpartum psychosis. Antoniou et al, (2021) stated that postpartum psychosis experienced by mother after childbirth and this associates with mood and behaviour changes. The consistent hallucinations and disorganised though process made this condition severe and develops significant impact on mental well-being of mothers. From the perception of healthcare professionals, it was witnessed that Jane is facing depression due to lack of support from family members. Jane has been suffering from emotional traumas due to fluctuation in hormones and lack of support from family members creating stress which is further leading to depression.

However, midwife recognised that, family members are consistently supporting Jane, her husband, mother and father are tackling patient but still she is not able to manage stress. Somehow Jane feels that everyone started valuing infant instead of her, this shows that she is not able to accept the new event in her life. The lack of connectivity with infant clearly signifying about postpartum depression, Jane was not able to develop an attachment with baby as she was concerned about herself. The mother-infant interaction proves to be one of the main aspects of perinatal phase. Daehn et al, (2022) depicted that in case of postpartum depression, Parental Bonding Questionnaire [PBQ] can be used for witnessing the extent of interaction between mother and infant. Using PBQ supports clinicians to assess the severity of relationships disorder and accordingly, further actions could be taken.

In case of Jane, PBQ was used and accordingly, it was identified that Jane has fear of losing loved ones due to child. She has intrusive thoughts that her husband does not give her attention and whole attention would be grabbed by baby. Here, the team realised that Jane is not able to accept the change and there is need to educate her about resilience abilities so she can develop connection with her child (O’Brien et al, 2023). Furthermore, her husband played crucial role as his support was mandatory for tackling Jane and enhancing her emotional intelligence [EI]. While analysing the strategies for effective care delivery, it was identified that enhancing communication channel is pivotal so that mental health training can be organised within maternity services (Lever Taylor et al, 2021). Care quality evaluation depicted that consistent follow-up and maintaining open communication with patient related to mental health supports in fostering trust which is crucial for ensuring consistent support to patient.

The postpartum psychiatric disorders further divided within three categories and those are known as postpartum blues, psychosis and postpartum depression (Lever Taylor et al, 2021). The third category was evident in case of Jane that was consistently impacting her mental health. The postpartum depression has the ability to predisposing chronic and recurrent depression that might impacts mother-infant relationship which later impacts the child growth and development. Tripathy (2020) specified that mothers who faces postpartum depression possess greater risk related to underweight and stunted.

According to Saharoy et al, (2023) Jane experienced postpartum depression after the childbirth. This has been analyzed that postpartum depression has created an environment which is not conducive to the personal development of Jane and the optimal development of the infant. The potential adverse influence of the postpartum depression on the Jane as well as infant reinforces the need for early intervention as well as efficient treatment models. Oxytocin promotes the emotional relationship, trust as well as attachment among the mother and infant. This is vital for developing the healthy and secure attachment-based relations. This relationship is very significant for the infant's emotional as well as psychological development that influences their future well-being. However, Śliwerski et al, (2020) argued that Jane with depression showed less attentiveness as well as receptiveness to her child's necessities. Infants of depressed mothers appear to be more impassively non-compliant as well as less mature expressions of age-appropriate autonomy (Śliwerski et al, 2020). For infant, being exposed to Jane suffering postpartum depression can harm cognitive, emotional as well as social development. Postpartum depression needs instant medical attention as there is a risk of suicide as well as maltreatment to the infant.

Children of depressed parents are at the high risk of psychopathology such as conduct disorders as well as anxiety (Ayano et al, 2021). Child of Jane is more likely to have an emotional as well as behavioral issues like eating and sleeping difficulties as well as delay in language development. However, Beck (2020) said that as a midwife, early diagnosis as well as treatment of PPD can enhance the outcome as well as prevent relapse. By accomplishing insights into to multifaceted concerns of PPD for Jane and her infant, midwives can implement the target interventions as well as support systems to alleviate the negative influence as well as promote the well-being of those affected. By enhancing awareness as well as understanding of PPD rates, a midwife can be equipped to support Jane. This includes fostering the open discussions, offering accurate specific information as well as create a supportive atmosphere where Jane can get the support and care she needs (Eliason et al, 2022).

In the views of Lubotzky-Gete et al, (2021) Jane with PPD has experienced with the inadequacy, guilt as well as self-doubt regarding her parenting abilities. This negative self-perception has undermined her confidence in caregiving abilities and skills. This feeling of inadequacy has created a barrier to engaging in responsive care practices for children. Jane faces challenges in establishing the secure as well as robust emotional bond with her infant. This has manifested as reduced emotional warmth, limited eye contact as well as reduced expression of feelings towards the baby. Nevertheless, as a midwifery understanding the complexities of the maternal and infant attachment is vital in developing the targeted intervention to support Jane as well as promote healthy infant development.

Jane with PPD might also face with the attuning to her baby’s emotional signals. Attunement includes the mother capability to comprehend as well as understand her baby’s response as well as emotional sensitivity. Because of the emotional chaos linked with PPD, Jane finds it difficult to interpret her child's cues as well as respond with the appropriate responsiveness (Handini and Puspitasari, 2021). Nevertheless, Shapiro et al, (2020) mentioned that early intervention as well as detection with targeted therapy for Jane can assist in mitigating the effects as well as promote the cognitive development of the infant. Midwifery by offering education, resources as well as interventions that can support the well-being of Jane and her child.

Social support plays a significant role in changing lifestyle as well as enhancing the psychological health outcomes in Jane. Midwifery education is the key solution in offering the universal as well as quality maternal as well as newborn care to meet the sustainable development goals (Rizzo and Watsford, 2020). The spectrum of postpartum mood disorders includes psychological and emotional challenges which affect mothers after the childbirth. These disorders encompass numerous mental health conditions such as anxious and depression that majorly impair women's well-being. Jane by experiencing midwife continuity of care models can feel more positive experience during postpartum (Zhao et al, 2021). Maternal care in this phase is vital for Jane and her newborn’s emotional, physical as well as psychological health. Maternal care comprises of range of aspects like a supportive environment which promotes breastfeeding as well as handles mental health needs.

Galbally et al, (2020) assessed that the multidisciplinary approach to the maternal health signifies the incorporation of the midwiferies as well as other health care professionals to work collectively to handle the complicated needs of postpartum women. Efficient interpersonal communication is significant in offering respectful, quality care as well as newborn care. On the critical note, working together presents various challenges such as professional boundaries which can limit the health outcomes of the postpartum depressed women (O’Brien et al, 2023). Integration of maternal mental health within the primary care setting is an efficient strategy to enhance the mental health of Jane. For midwifery identifying the challenges linked with the access to maternal mental health is vital in enhancing the mental health of Jane. The Edinburgh

Postnatal Depression Scale (EPDS) is referred as a screening tool used by the midwifery for perinatal depression as well as women’s mental health. Midwives can simplify the development of the reassuring relationships with the competent mutual trust, communication skills as well as partnerships. Workplace culture in maternity units impacts the midlife capability to develop as well as maintain the supportive connections with Jane (Steenland and Wherry, 2023). When women are supported to make the informed decisions reduces the instances of birth trauma as well as enhances the health of the mother as well as her newborn. On the other hand, women that feel unable to make informed decisions regarding their procedures, care options as well as bodies feel abuse and powerlessness. Midwife empathy as well as shared decision making is the major element of women-centred midwifery care. The physical as well as emotional support midwives offer to postpartum depressed mothers can contribute to positive child bearing experience.

By linking literature with the scenario varied insights have been developed and further in practical context challenges were faced by midwives and their colleagues that has consistently cared for Jane. Midwife recognised that she needs more training with regards to supporting woman suffering from postpartum depression. The case of Jane was aligned with lack of self-esteem after childbirth due to which she preferred isolation. Mother faces huge fluctuations after giving birth to baby and therefore, it is important to assure consistent emotional and social support to them. Implementation of consistent communication with Jane supported in understanding her situation and therapist undertook cognitive behavioural therapy [CBT] for reinforcing positive thoughts in Jane so she can enjoy her motherhood with family support.

In the study of Pilav et al, (2022) it was stated that cognitive behavioural therapy is one of the effective treatments for treating postpartum depression and stress. The treatment has been undertaken in short-term sessions that comprised with 12-15 sessions and specific emphasis implemented on recognising feelings, behaviours and thoughts of patient and accordingly, significant actions are taken. However, Herbert et al, (2022) criticised CBT and revealed that, it only addresses current issues and does not focus on the underlying causes of mental health conditions. However, in Jane’s case there was no underlying causes were witnessed, her postpartum depression was result of current event in her life. This significantly shows that, Jane needed consistent social and emotional support for accepting the change and therefore, CBT proves to be most appropriate technique for her. The small sessions were organised and consequently, therapy was provided to Jane. This led to result in reinforcing positive thoughts in her, collaboration with Jane’s husband was implemented and he supported Jane throughout the sessions. Her husbands clarified the doubts of Jane and boosted her self-esteem so she can accept her.

Midwife noticed that after each session Jane started to ask small details about child and she felt strong attachment with infant. The perception of Jane was changed and she felt that her new life has begun with child and husband. The resilience ability in patient was enhanced after each session and this is how her emotional intelligence abilities were enhanced to greater note. It was a quite complex case as the depression was due to lack of self-esteem after giving birth to child. Biological, social and environmental factors led to depression and it is important to take significant action in this area (Wang, et al, 2021). Based on the own experience and analysis there are varied areas has been identified which are essential for enhancing care for woman facing depression after child-birth. With regards to action plan this can be said that there are certain areas which needs to be focused out for taking appropriate actions and those are training and education, enhancing screening protocols, facilitating care navigation, supporting decision-making and advocating systematic changes.

In the views of Moyer and Kinser (2021) there is need to implement consistent professional development program which focuses on perinatal mental health and improves awareness regarding mental well-being. Assessing PMH is important for detecting the symptoms of mental complexities such as depression, stress and anxiety (Alshikh Ahmad et al, 2021). In current case, midwife recognised that lack of immediate referral to resource can impact the well-being of patient. Therefore, a coordinated approach is essential that can provide support to staff members and consequently, effectual outcomes could be gained. Thus, by organising training professional development program can be undertaken in PMH and midwives can learn about the ways in which immediate support can be ensured to patient such as Jane. Lack of immediate referral create complexities in tackling patient and therefore, training is essential so that these issues can be resolved. Furthermore, maternity assessment must include standardised mental health screening tools which assures that patient such as Jane’s issues can be identified at early stage and significantly, prompted interventions could be taken.

It is essential to focus on patient navigator role within maternity services and this is specifically for helping patient. It should be aligned with assessing and understanding the requirements of patient (Alshikh Ahmad et al, 2021). For instance- in Jane’s case her requirement was aligned with accessing therapies so positive reinforcement of thoughts can be done and her self-esteem could be enhanced. Hence, it is important to look upon the needs and requirement of patient and for that patient centred care should be approached as it focuses on the unique requirement of service user. There is need to implement established decision framework which lead to empower women while utilising resources and support from professionals (Agrawal et al, 2022). Patient and family education is foremost component in postpartum depression (Deligiannidis et al, 2023). They must be made aware about this phase so that patient can cope up with the situation, this associates with providing information related to medication, therapies and local support groups.

Developing awareness regarding maternal mental health is crucial so that woman like Jane can have the courage to accept themselves after child birth. Midwives plays important role in supporting women who are experiencing postpartum depression (Deligiannidis et al, 2023). They are trained in recognising the postnatal depression and further they use talking therapies for reducing the stress in patient (Bradshaw et al, (2022). Thus, midwives should be trained in this area and responsibilities should be delegate to them so they can effectively undertake communication with patient. The therapist has used CBT in Jane’s case. However, there is need to train midwives as well so they can use talk therapies and accordingly, support can be ensured to patients.

Based on the analysis, this can be said that there are varied insights related to prenatal mental health has been witnessed. While working with MDT there were several challenges witnessed and that was associated with lack of coordination and communication (Carlson et al, 2024). It has been identified that lack of communication can led to develop significant impact on the health of patient and therefore, it is important to adopt effective communication channel so that consistent support could be assured to woman in their prenatal phase.

Studies have shown that the risk factors aligned with Postpartum depression are varied and this might concern with strong to weak association with regards to the development of PPD. In most of the cases, depression occurs due to lack of social and emotional support (Deligiannidis et al, 2023). However, in current case this was not the concern as Jane’s husband and family was supportive. The lack of self-esteem and inability to accept the change created misconception and she thought that her husband and family members priorities child needs instead of her. Further, she started hating herself due to change in body shape and it became hard for Jane to accept her. This was the major complexities associated with current case and midwife consistently communicated with jane.

There is no doubt in stating that CBT sessions changed the perception of Jane and consistent support from husband enabled her to recover from depression. In this manner, consistent support was ensured to Jane. After each CBT session midwife has communicated with Jane which further reduced negative thoughts and self-esteem was enhanced in the patient (Kitt et al, 2021). Thus, there are varied fluctuations experienced by woman after childbirth and it is essential to understand these changes so their mental health can be supported along with ensuring consistent emotional and social support (Deligiannidis et al, 2023). Thus, it can be said that Midwife and the team was able to implement their knowledge and expertise for determining about the mental health issues experienced by Jane. Afterwards, appropriate referral was undertaken and implementation of MDT supported in taking significant actions. Cognitive behavioural therapy’s session enhanced the self-esteem in Jane and she was able to develop connection with her newborn. Patient empowerment has been undertaken by involving Jane in the whole process, her needs were prioritised and accordingly, person centred care was approached that led to support in gaining significant outcomes (Kitt et al, 2021). The knowledge will be used in future while providing care to pregnant women in their prenatal phase and specific focus would be ensured on their mental well-being.

REFERENCES

Books and Journals

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