Nursing Case Study Analysis: Dorothy's Postpartum Depression (NURS 1)

This case study analyzes the postpartum depression experienced by Dorothy, a new mother facing various challenges. The essay delves into the bio-psychosocial factors contributing to her condition, including hormonal changes, psychological stressors, and social issues like lack of support, economic instability, and a strained relationship with her husband. The analysis also explores the nursing management and interventions required to address Dorothy's symptoms, emphasizing the importance of early recognition, assessment, and support. Ethical implications related to screening and treatment are discussed, highlighting the complexities of addressing mental health concerns in new mothers. The study underscores the need for comprehensive care, considering both the mother's well-being and the safety of the baby, to ensure a positive outcome for both. The case highlights the impact of postpartum depression on the mother and the importance of timely intervention by healthcare professionals.

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Mental Health - Nursing
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BIO-PSYCHOSOCIAL ANALYSIS OF CASE STUDY – 1
INTRODUCTION
Postpartum depression or PPD is classified as one of the major episodes of depression, which
starts tentatively a few weeks after delivery. Although childbirth is one of the significant and
joyful events in the life of a woman, almost 15-85% suffer from PPD due to various biological,
psychological and social factors (Sylven, 2012). While there are several causes for the
development of postpartum depression, some factors, such as those seen in the case of Dorothy,
seems to enhance the effect. Her economic conditions, estrangement from her immediate family
and friends as well as the strained relationship with her husband, all seem to contribute to her
postpartum depression.
Since postpartum depression is not uncommon among the mothers (and not just the first timers),
several theories have been put forth to assess the impacts of various factors that might be
responsible. Whatever the reasons for the condition early recognition by the physicians or nurses
can ensure quicker treatment to reduce the distress of the patients like Dorothy (Abdollahi, Lye
& Zarghami, 2016).
This essay is an analysis of the bio-psychosocial causes of the condition experienced in Dorothy,
where she is not able to respond to her child, and is all the more depressed with her
circumstances. Also, since nursing care or medical intervention is sought, this essay will also
look into possible ways one can help Dorothy to overcome her depression under clinical
conditions.
ANALYSIS: DISCUSSION OF BIOPSYCHOSOCIAL FACTORS

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There are innumerable factors that can contribute to after-childbirth distress, and they can be
categorized as biological, psychological and social conditions. One or all of them, in
combination, can result in postpartum depression in new mothers. Let us look at these factors
separately.
Biological Factors of Postpartum Depression
It is not only Dorothy here, who might not feel elated to hold her baby or nourish her. There are
many who might not feel the ability to care for the young one, or share their enthusiasm so
openly, due to a simple reason that they have undergone a physically and emotionally exhausting
labour, as here in Dorothy (Caplan, 2013).
Researchers attribute this to the hormonal changes related to pregnancy and childbirth. There is
an enormous change that takes place in the endocrine system, which involves both the hormones
and neurotransmitters (Skalkidou, Hellgren & Masco, n.d.). These changes are in lieu of the
pregnancy and preparation for childbirth and nursing. It is also believed that the steroidal release
(and enhanced release when compared to normal levels at other times) can cause negative
reactions to set in.
Although, our body systems also learn to cope with the sudden rise and then the fall of secretion
of essential hormones, that is why, innumerable new mothers also enjoy their motherhood from
day one. There are, however, cases where this balancing phenomenon might not be corrected
automatically, and combined with other psychological and social factors, enhance the effects of
depression. Others believe that the hypothalamic-pituitary-adrenal system or the HPA may
perform differently in women who are more susceptible to depression, as is the case with
Dorothy (Abdollahi et al., 2016). Hence, to sum up the biological factors, it can be concluded

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that certain internal reaction to the extreme hormonal changes happening in the body of a
pregnant woman can lead to depression.
Psychosocial Factors of Postpartum Depression
Psychosocial factors that usually are seen as significant factors for postpartum depression include
the mother's age, unwanted or unplanned pregnancy, high expectations as a mother, family
history of depression, bipolar disorders in the patient and so on.
The social causes, such as lower income, no proper relationship between the husband and wife,
estrangement in the family, no proper support, abusive husband, alcohol or drug abuse, are some
of the contributing factors to depression after childbirth.
Unfortunately, here, in case of Dorothy, there are several of the above mentioned social and
psychological factors as well as family history of depression that is contributing to her anxiety
and distress.
Dorothy, does not have the support of her family, and her economic status does not seem to be
very good. Also, with a husband, who is both alcoholic and abusive, and an unplanned (surprise)
pregnancy, as well as an authoritative mother-in-law, she does not feel herself worthy of caring
for the baby. With a family history of depression, it is not surprising that Dorothy feels the signs
of distress very strongly, to the extent that she has visions of damaging her daughter.
Anxiety, meeting up to the standards of the society as a new mother, and also dealing up with
sleeplessness, and no proper nutrition, all toll on the mother's health, and in turn, increase the
depression, as in the case of Dorothy. Without proper medical intervention, she might not be able
to overcome this, to look after Amy.

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ANALYSIS-DISCUSSION OF NURSING MANAGEMENT OR INTERVENTION
Postpartum depression not only affects the mother, but also the whole family. Hence, as a nurse
attending to the mother and the child, it is essential to recognize the symptoms of the distress to
treat it effectively. The experts believe that a timely intervention, from the attending nurse or
physician, can help in reducing the depression and its signs.
In case of Dorothy, the vital signs of depression are clear- she feels worthless to care for the
baby, has loss of control, feeling disconnected with the baby (Drake, 2017). In her case, a
nursing intervention is very much essential to ensure the safety of the baby as well as to reduce
the anxiety and distress Dorothy is feeling.
Nursing Assessment and Diagnosis
So, how can a nurse intervene, or assess the situation? The assessment of a patient can be done
even before the child birth. The general psychological condition of a mother before the
childbirth, maybe in the later months of pregnancy will give a fair idea. Similarly, noting down
the mental health history of the patient, her family members and the socioeconomic conditions in
which she lives, can give a general idea about the mother-to be (Belleza, 2016).
Although the assessments before childbirth may be rendered a safe option, the diagnosis (or
general assessment after dealing with the new mother) can be done to ensure any signs of
depression is found before it progresses to a greater extent.
Some of the symptoms experienced by Dorothy, are examples of how a postpartum depression
can be. Although the percentage of postpartum depression is less, any previous history or

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hormonal response, or lack of social support (as is the case with Dorothy) can be noted down by
the nurse as a warning sign.
Nursing Intervention
When a nurse recognizes the symptoms of postpartum depression, it is essential to relate the
problem to the client, if possible, and the family members about the problem and possible
outcomes. Involving the other health care providers as well as the attending physician can also
aid the cause.
First and foremost, it is required to understand the problem or the exact factors that are
contributing to the depression. For this, the nurse should be able to evaluate the patients'
capabilities of understanding her problem, and patiently explain the treatments that can help her
further. Allowing the patient to speak up and vent out the negative feelings can help in the
healing process and also in understanding the specific problems the new mother is facing.
(Abastar, 2015)
Once the nurse has recognized some signs (or causes if possible), it is time to encourage the
patients to seek help, and also to reassure them of all assistance if they require it. Sleep is also
one of the major triggers for depression. Helping the patients to get enough sleep, and eating
nutritious meals can bring their focus back to the responsibilities in hand.
Depression can lead a mother, like Dorothy to seek solace in their own company, and thus,
aggravate the situation. It is, therefore, essential for a nurse to urge them to make contact with
the social circle, and thus, to share their feelings and anxiety with their near and dear ones.

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In case of Dorothy, with an unsupportive mother-in- law and husband, it is essential for her to
stay in a medical care, and establish contact with her parents, sisters and friends to bring her
focus back to the baby.
The nurse, with the help of the assistants and physician, can plan her day for Dorothy, and
encourage her to help take care of Amy in her own way, away from her mother-in-law and
husband. Also, ensuring that she takes all her medications properly can further aid in overcoming
her depression.
ANALYSIS: DISCUSSION OF ETHICAL IMPLICATIONS
It is not easy to identify postpartum depression without a screening process, or a simple
assessment by questioning the mother about her new responsibilities. Although it is advisable for
the doctors and the nurses to assess the situation after birth, in say, 3 weeks to ascertain the
setting of depression or any signs, it becomes increasingly difficult for them if the patient is not
cooperative. Some experts also claim ethical implications for such screening processes.
Some of the experts also feel that the patients might not be comfortable about disclosing
information about a violent partner, problems in their married life, and so on (Palmer, Yelland &
Taft, 2011). Since it is impossible to intervene or help until one knows the causes or factors
influencing the depression, the ethical constraints might put a damper to the efforts.
Also, there are many, who question the integrity and scientific idea behind the screening process
that determines if a person (a mother-to-be) is depressed or not. There are no specific symptoms
that one can pinpoint at, while testing mental disorder. It is difficult to ascertain if a person is
suffering from post-natal depression, just because she is not in tune with her baby's requirements.
So, how is one to determine, and what are the factors that can be assessed to make it certain?

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Although there are specific signs that the physicians monitor in a new mother, sometimes they do
not appear or the mother can sufficiently hide it and not make it obvious.
Since postpartum depression can not only distress the mother, but also the new born baby, it is
mandatory that the new mothers are sent for screening, to analyse the problem well before it
takes over. However, there are ethical restraints which the experts fear can cause problems.
Here, in this case study, although Dorothy's situation has been assessed correctly, and her history
has been assessed, cooperating further on the treatment, and without the interference of her
Husband or mother-in-law might pose a problem. There might also be ethical and legal
considerations, and these needs to be taken care of, if she is to be treated for her depression. With
the socioeconomic conditions not very strong, keeping Dorothy under supervised medical
interventions might also pose a problem. Similarly, the family might also question the
correctness of the diagnosis that Dorothy has postpartum depression, and may need medical
intervention to treat it.
CONCLUSION
To conclude, the problem that Dorothy faces has affected a few percentages of new mothers, and
can be treated efficiently, if predicted beforehand. There are a myriad of reasons for postpartum
depression in women, and are mostly segregated as biological, psychological and social factors.
While biological factors are not completely researched and are related to the increased secretion
of hormones and their sudden decline after the baby is born, the psychosocial factors vary
widely. In case of Dorothy, however, according to what the case studies predict, the case is more
of psychosocial cause.

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With unsupportive family, and no friends, as well as a pregnancy that might be called as
unplanned and a 35 hour labour, everything falls directly in line for a postpartum depression.
Also, there is a family history of depression, which makes Dorothy a susceptible victim to the
problem. The only positive factor here, in favour of Dorothy is her willingness to take medical
intervention (and although she is doing it so she can be away from her husband and mother-in-
law). The nurses and doctors, with their intervention, can help Dorothy overcome the postpartum
depression. It is, however, up to Dorothy, and the nurses (as well as her family) to overcome the
ethical and legal implications, to come out of the situation successfully.

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REFERENCES
Abdollahi, F., Lye, M., & Zarghami, M. (2016). Perspective of postpartum depression theories:
A narrative literature review. N Am J Med Sci., 8(6), 232-236.
Abastar, D. (2015, September 07). Nursing Care Plan Postpartum Depression. Retrieved from
http://rnspeak.com/nursing-care-plan/nursing-care-plan-postpartum-depression/
A Psychosocial Approach to Postpartum Depression. (n.d.). Retrieved from
http://www.psychiatrictimes.com/articles/psychosocial-approach-postpartum-depression
Belleza, M. (2016, May 23). Postpartum Depression: More Common Than You Think! Retrieved
from https://nurseslabs.com/postpartum-depression/
Caplan, P. J. (2013, March 31). The Debate about causes of postpartum depression. Retrieved
from https://www.psychologytoday.com/blog/science-isnt-golden/201303/the-debate-
about-causes-postpartum-depression
Chaudron, L. H., Szilagyi, P. G., Campbell, A. T., Mounts, K. O., & McInerny, T. K. (2007).
Legal and ethical considerations: risks and benefits of postpartum depression screening at
well-child visits. Pediatrics, 119(1), 123-128.
Drake, E. (2017, June 28). Postpartum depression: Don't let patients suffer in silence. Retrieved
from https://www.americannursetoday.com/postpartum-depression-dont-let-patients-
suffer-in-silence/
Ethical Issues of Depression (n.d.). Retrieved from
http://nathanelypapers.blogspot.in/2012/09/ethical-issues-of-depression-depression.html

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Everything You Need to Know About Postpartum Depression. (2016, December 07). Retrieved
from http://www.healthline.com/health/depression/postpartum-depression
Kleiman, K. (2013, July 23). Screening for postpartum depression is not enough. Retrieved from
https://www.psychologytoday.com/blog/isnt-what-i-expected/201307/screening-
postpartum-depression-is-not-enough-0
Palmer, V. J., Yelland, J. S., & Taft, A. J. (2011). Ethical complexities of screening for
depression and intimate partner violence (IPV) in intervention studies. BMC Public
Health, 11(5), S3.
Phillips, C. (2013, December 09). Nursing Interventions for Postpartum Depression. Retrieved
from https://prezi.com/krd39ce-zoc1/nursing-interventions-for-postpartum-depression/
Postpartum depression: Manage your symptoms, enjoy your baby. (2015, August 11). Retrieved
from http://www.mayoclinic.org/diseases-conditions/postpartum-depression/basics/risk-
factors/con-20029130
Postpartum Disorder (2017, April 19). Retrieved from
https://www.psychologytoday.com/conditions/postpartum-disorder
Skalkidou, A., Hellgren, C., & Masco, E. (n.d.). Biological Aspects of Postpartum Depression.
Retrieved from http://www.medscape.com/viewarticle/775406
Sylven, M.S. (2012). Biological and psychosocial aspects of postpartrum depression. Retrieved
from https://uu.diva-portal.org/smash/get/diva2:509540/FULLTEXT01.pdf