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Postnatal Depression : Maternal And Child Health

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Postnatal Depression : Maternal And Child Health Question: Discuss about the Postnatal Depression for Maternal and Child Health.     Answer: Introduction: Postnatal depression is a very serious problem affecting many mothers after childbirth up to one year. It is an important issue as it affects both the mother and child physically, emotionally and psychologically. It is often accompanied by mood swings in new mothers followed by feelings of sadness, hopelessness and helplessness (Evagorou, Arvaniti & Samakouri, 2016). The postnatal period is a very crucial period after childbirth when there is requirement of adequate care for the baby. The mother’s health is of prior importance to the nurses and if the postnatal depression prolongs, it would have adverse effects on the parents and the baby as a whole. It is crucial for the nurses to study postnatal depression in mothers, as it would have adverse effects on mother in terms of developing attachments towards their newborn. (O’Higgins et al., 2013). The disrupted attachment between the mother and the child would lead to the unfavorable cognitive and emotional developments (Soh et al., 2013). Postnatal depression is affecting 10-20% of the Chinese mothers in Hong Kong. In Chinese belief, mental disorders disrupt an individual’s ability of problem solving and are a shame for the family. The study of postnatal depression would help them to evaluate the postnatal interventions in nursing and provide adequate care to the mothers during the critical time. As reported by Kandang Kerbau Hospital Singapore, there are also cases in which the suspected mothers for postnatal depression go undiagnosed and untreated. It is affecting 1 in 12 women so there is an urgency to detect and make strategies to help the postnatal depression in Singaporean mothers to get optimum outcomes for the mother and child. According to a study by Sui et al., 2012, the Chinese women confined their feeling to themselves associated to postnatal depression. The risk factors for postnatal depression are under explored in Chinese women so it is important to identify the risk factors and focus on the postpartum intervention strategies. The study of postnatal depression would help the nurses to recognize the factors contributing to it and implement mitigation strategies for the mother and baby (Redshaw & Henderson, 2013). Aims Of The Study: The paper is aimed at describing the experiences of the postnatal depression in Chinese mothers in Hong Kong. They also investigated the perceiving factors that contributed to the postnatal depression in Hong Kong Chinese women. It also identified the help-seeking behaviors in Hong Kong Chinese women suffering from postnatal depression. Methods: The method in the study by Chan & Levy, 2003 is descriptive. A psychiatric nurse interviewed about thirty-five women who were referred from the Obstetric Unit to the Postnatal Depression Clinic who scored over 10 in the Edinburgh Postnatal Depression Scale during their postnatal checkup. Chen et al., 2013 stated that EPDS is an important scale to screen mothers for postnatal depression. They aged 20 to 40 years and have no sign of acute depression or hospitalized because of depression. It leads to the uniformity of the interview as one researcher conducted it. The interview consisted of open-ended non-directive questions like thought process, feelings about depression and questions to analyze the parameters of depression in the candidates. The duration of the interview lasted from 60 minutes to 90 minutes that was tape recorded and transcribed in English. The analysis of the data was done by phenomenological methodology of Colaizzi. In the method, the investigators collaborated and cross analyzed the data for the consistency and agreement of the validation of the findings and their analysis. The oral descriptions of the subjects were read. After the extraction of the significant statements from the transcripts that pertained to postnatal depression, their formulation of the meanings was done and finally organization of the meanings into themes to obtain results pertaining to postnatal depression. After the final validation, the researcher reverted to the participants with the obtained results.   Findings Of The Study: The findings of the study by Chan & Levy, 2003 included the experiences of postnatal depression, factors perceived as contributing to the depression and help seeking behaviors of Hong Kong Chinese women suffering from postnatal depression. The women experienced ambivalent feelings about their baby, feeling of being trapped in the situation, feelings like uncaring husband, powerful and controlling in-laws that described experiences of postnatal depression. The women felt confused, tired, helpless and hopeless. They also experienced loss of control over their emotions. Some women said that they were feeling incompetent, low self-esteemed as they were not able to perform their tasks competently and some felt guilty that they were not able to take care of the baby. The women also experienced ambivalent feelings about their babies and some considered that the baby was the reason for being distant from their husbands and families. There were perceiving factors that contributed to their depression. The unhappiness experienced by the women contributed to their postnatal depression. The women were unhappy about their relationship with in-laws and their attitude towards them. They felt trapped in the situation and could not escape. They were violent and thought of suicide or homicide towards the person they attributed their depression. Majority of the women did not seek help until they were screened for the possibility of depression. The interview at the postnatal depression clinic was helpful for many women. Some women reported that they felt helpful after talking to the psychiatrist; they were able to cope with their unhappiness, regained control over their life and felt appreciated while they exchanged a sympathetic behavior with the interviewer. Some women did not accept that they were suffering from depression and needed help. Some of them did not take the prescribed medicines because of their side effects and some did not feel the need to take it. The families also discouraged and stopped them from attending the interview or taking the prescribed medicines. Further Researchers: There are many emerging researches in the postnatal depression and its association with many factors. In a recent study by Pope & Mazmanian, 2016, they showed the relationship between postnatal depression and breastfeeding but however the precise relationship is not clear and provide future research to define the relationship. The diverse studies showed that the postnatal depression resulted in low rates of initiation and cessation of breastfeeding while the women who breast-feed experienced less levels of postnatal depression. A study by Tham et al., 2016 showed that poor sleep is a risk factor for mood disorders and its association with the postnatal depression and anxiety. The participants from Singapore participated in the Edinburgh Postnatal Depression Scale and the results showed that postnatal depression was associated with poor sleep. There is scope of future research regarding the treatment of postnatal depression and the screening of the postnatal depression provides early detection and treatment. There is also scope for research in the diagnostic techniques, encouraging new mothers and their families to focus on parenting skills as it could prevent postnatal depression. New research study would help the psychiatrist and nurses to identify the risk of postnatal depression due to emotional fluctuations. The journal of Behavior Therapy and Experimental Psychiatry 2016 stated that instability in mood related to self-esteem in women might help to predict postnatal depression. The frequent fluctuations during the second and third trimesters are related to postnatal depression. This research was useful in excluding those women who experienced previous depression. Future studies are required in Singapore regarding the postnatal care for the first time mothers in Singapore. The further practices in improving quality of maternal health and provide positive environment for the mothers in Singapore for their well-being (Ong et al., 2014). The phenomenon of ‘phantom crying’ requires further research that is it a characteristic in Chinese culture. Ethical Considerations: As it is a matter of maternal concern, there are ethical principles associated with it. It involves informed consent from mothers involving screening of new mothers and their child for postnatal depression. The respect for autonomy, confidentiality, non-malfeasance, beneficence and ethical concerns of the affected persons and pediatricians in promoting wellbeing of mother and the child are the legal and ethical considerations while screening and treating postnatal depression in mothers (Loudon, Nentin & Silverman, 2016).            Conclusion: It can be concluded from the article that postnatal depression is becoming a concern amongst most new mothers, which are resulting in adverse consequences on the lives of not only the mothers but also their children. Therefore, in order to protect the mothers from postnatal depression, effective interventions should be adopted by the nurses so that they can relieve them from any mental illness.   References Chen, H., Bautista, D., Ch’ng, Y. C., Li, W., Chan, E., & Rush, A. J. (2013). Screening for postnatal depression in Chinese?speaking women using the Hong Kong translated version of the Edinburgh Postnatal Depression Scale. Asia?Pacific Psychiatry, 5(2), E64-E72. Evagorou, O., Arvaniti, A., & Samakouri, M. (2016). Cross-cultural approach of postpartum depression: manifestation, practices applied, risk factors and therapeutic interventions. Psychiatric Quarterly, 87(1), 129-154. Loudon, H., Nentin, F., & Silverman, M. E. (2016). Using clinical decision support as a means of implementing a universal postpartum depression screening program. Archives of women’s mental health, 1-5. O’Higgins, M., Roberts, I. S. J., Glover, V., & Taylor, A. (2013). Mother-child bonding at 1 year; associations with symptoms of postnatal depression and bonding in the first few weeks. Archives of women’s mental health, 16(5), 381-389. Ong, S. F., Chan, W. C. S., Shorey, S., Chong, Y. S., Klainin-Yobas, P., & He, H. G. (2014). Postnatal experiences and support needs of first-time mothers in Singapore: A descriptive qualitative study. Midwifery, 30(6), 772-778. Pope, C. J., & Mazmanian, D. (2016). Breastfeeding and Postpartum Depression: An Overview and Methodological Recommendations for Future Research. Depression research and treatment, 2016. Redshaw, M., & Henderson, J. (2013). From antenatal to postnatal depression: associated factors and mitigating influences. Journal of Women’s Health, 22(6), 518-525. Siu, B. W., Leung, S. S., Ip, P., Hung, S. F., & O’Hara, M. W. (2012). Antenatal risk factors for postnatal depression: a prospective study of Chinese women at maternal and child health centres. BMC psychiatry, 12(1), 1. Soh, S. E., Tint, M. T., Gluckman, P. D., Godfrey, K. M., Rifkin-Graboi, A., Chan, Y. H., … & Saw, S. M. (2013). Cohort profile: Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study. International journal of epidemiology, dyt125.           Tham, E. K., Tan, J., Chong, Y. S., Kwek, K., Saw, S. M., Teoh, O. H., … & Broekman, B. F. (2016). Associations between poor subjective prenatal sleep quality and postnatal depression and anxiety symptoms. Journal of affective disorders, 202, 91-94.

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