Introduction
Postpartum depression is a condition found in women after child birth. The reproductive system of a woman is dominated by two main hormones namely progesterone and estrogen. During pregnancy, these hormones increase to extremely high levels, but they stabilize almost immediately after child birth (Williams, 2005). The sudden fluctuation of hormone levels may have detrimental effects on the woman who may end up having depression. This is a common occurrence among new mothers, and it goes off within a very short time after birth. But there are women who suffer from a greater and more severe form of depression called postpartum depression, which may evolve into a severe mental condition known as postpartum psychosis (Williams, 2005). This form of depression is severe in terms of the symptoms and effects it may have on both the mother and her new born baby. Postpartum depression is mostly prevalent in women, but there are cases of affected men have been reported (Devito, 2005).
The major symptoms of this condition have been found to include sleeplessness, irritability, feeling of worthlessness, suicidal thoughts among others. A mother with this condition may have low or no responsiveness to her new born. Responsiveness is the measure of how the mother can adjust her own behavioral patterns to suit those of her baby (Williams, 2005). Some of the major causes of this condition mainly include poverty, anxiety during pregnancy and rejection or low support of the expectant mother because of factors like unwanted pregnancy (Devito, 2005). This condition is taken with a lot of seriousness because the bonding and relation between a mother and her baby is of utmost importance. It begins moments after birth and evolves over the first years of the baby’s life (Devito, 2005).
There are many individuals and organizations that have conducted research concerning prenatal and postnatal health, and more specifically on postpartum depression and related conditions. The purpose of this paper is to critique the research report entitled: Promoting Responsiveness between mothers with depressive symptoms and their infants retrieved from the fourth quarter of the Journal of Nursing Scholarship, 2001. It is authored by June Andrews Horowitz, Margaret Bell, JoAnn Trybulski, Barbara Hazard Munro, et al.
The main purpose of the above mentioned study was to determine how useful a training and promotion of responsiveness between mothers suffering from this condition and their infants. Those undertaking the study hypothesized that a sample of mothers suffering from postpartum depression upon who care and treatment is given will show more responsiveness to their babies than those who did not experience treatment and care.
The research, which was conducted by June et al, was conducted using one hundred and sixteen new mothers from the Northeastern United States who willingly volunteered. These women, whose ages ranged from seventeen to thirty years, were about ten percent of the total estimate of the women suffering from postpartum depression in Boston and the surrounding areas. The total research period was divided into two phases: phase one entailed the signing up of the volunteers and screening for postpartum depression symptoms, while phase two was the medically quantifiable trial. The group of women was divided into two groups namely the treatment group and the control group.
The sample size was reasonably good, but the sample distribution was found wanting. This is because the one hundred and sixteen women used in this study were picked from the same state. Another reason why the sample distribution was found wanting is because of these women, about 70% were white, only 7% were black and the rest were a mixture of mothers of different races. This limited the research, because the data sampling was skewed towards one racial origin and one geographical zone. However, the age distribution of the sample was good and unbiased, because it covered teenage mothers all the way to pre menopausal mothers.
The ethics in this study were commendable because the research team did not commence this study without seeking a written approval from the university’s committee of human subject and also from some renowned clinical institutions. The scales and instruments used in this study included the Demographic Information Sheet, the Edinburgh Postnatal Depression Scale (EPDS), the Beck’s Depression Inventory-II (BDI-II) and the Dyadic Mutuality Code (DMC). All of these instruments worked in different ways and were used in different parts of the two phases. This also is commendable, because the use of many tools to obtain the required data in this study ensured that there was minimal room for errors and distortion of results.
The Demographic Information Sheet was helpful in helping to extract basic information about the history of the mother’s general and maternal health, age of the mother and the baby, ethnicity, her status in regard to marriage, finances and academics. The Edinburgh Postnatal Depression Scale (EPDS) is an instrument that is usually used to spot any present symptoms of postpartum depression on a scale. It consists of ten items that describe any symptoms related to postpartum depression, each having a range of four choices that are arranged in order of severity and length of time the symptom prevails. This tool exhibits great sensitivity and accuracy, because it has a wide scale (0-30) and it is able to detect and show the variation of the depression in relation to time (Williams, 2005). Almost all mothers found it simple to use this scale, and this shows that this scale was effective.
The Beck’s Depression Inventory-II (BDI-II) is also used to give any present symptoms of postpartum depression and to quantify the intensity of the same. The advantage that the BDI-II has over the EPDS is that instead of ten, it has twenty three items, making it to have better accuracy than the EPDS (Williams, 2005). To allow for greater accuracy and precision, the BDI-II was used about three times on each mother. This instrument was effective, because it gave a wide range of choices for the mother to choose from. It therefore had the ability to capture the diversity in which this condition manifests in different people.
The Dyadic Mutuality Code (DMC) was used to rank the responsiveness of the depressed mother to her baby. This was done by making an observation of how the mother directly relates to her baby, by asking her to position her baby in a position where the two could see each other’s faces. The mother was then asked to have five minutes of playing with the infant without the help of any assisting device for instance music or a toy. This was recorded by video, after which the responsiveness was ranked. The Dyadic Mutuality Code test, though useful, may have been subject to bias and prejudice, because the mother was aware that she is being recorded as she plays with the baby. This would have caused tension and therefore interfere with the natural way in which the mother related with the infant during playtime.
After establishing the presence and the intensity of symptoms of postpartum depression, the procedure for training the mothers commenced. The mothers were first taught how to study and familiarize with the baby’s behavior and to adjust their own to suit those of the infant. The mothers were then showed how to place the baby in an accurate face to face position and how to make use of various expressions and patterns in combination with her voice and physical contact. This was followed by correcting of any low responsiveness noted and by honoring and rewarding any improvement. This method is good, but it may have had some failure. The desire anyone would have for a reward would have been the reason why a mother would perform well. On the other hand, the presence of the research nurses would also have been a cause of anxiety on the infant and the mother, causing underperformance.
The results obtained showed that in the initial stages of the research, there was no major difference between women of the two separate groups: the treatment and the control group. The gap between the two widened with time, and positive results were obtained with the treatment group. This showed that mothers suffering from postpartum depression that were given care and treatment exhibited more responsiveness to their babies than those who did not experience treatment and care. It was therefore concluded that it was necessary for the presence of intervention programs to help mothers who were at a risk together with their babies.
Whilst this study by Judy et al has its numerous strengths, the methods used in sampling and collection of data need to be modified. There is need to expand the sampling from one geographical zone or racial group to a wider zone, so as to increase precision and minimize errors. More research needs to be conducted especially on means by which PPDS can be prevented, and the means by which the consequences of the same on babies can be undone. These studies should also not only be restricted to mothers and their babies but should also include the fathers and siblings if any.
References
Devito, J. T. (2005). Focus on depression research. Los Angeles: Nova Publishers.
Williams, R. A., Kawczak, B. & Ketefian, S. (2005). Depression research in nursing: global perspectives. New York: Springer Publishing Company.
