Postpartum Depression: A Case Study

Evaluation:

The main positive was that the student recognised Rebecca’s low mood. She asked about the reasonings behind the low mood and the severity of the low mood at each appointment she attended. The student offered additional appointments to Rebecca, discussed support groups within the local area and recommended that she saw the GP if symptoms worsened or she was finding it difficult to cope.

Another positive was that the student provided continuity of care by providing care at home for Rebecca, alongside her mentor, on days 5, 10 and 14 postpartum. This is important because continuity of care helps to monitor changes in mood between appointments and usually leads to better management of the scenario (The King’s Fund, 2010).

McCoy (2014) proposes that postnatal depression may have several different causes. It is not clear why Rebecca developed low mood postnatally for the first time with her third child. Rebecca reported that she was finding it difficult to sleep and multiple studies have shown that sleep disturbance may be a cause rather than effect of postpartum depression (Ross, Murray and Steiner, 2005) (Pearlstein et al, 2009). However, research also suggests that the cause may be physiological, with the rapid decrease in oestrogen and progesterone levels following the delivery of the placenta, thought to have psychological effects which may result in postnatal depression (Albrecht and Pepe, 1990). Two trials were reviewed where postnatal women were given synthetic progesterin administered within 48 hours of delivery, transdermal oestrogen therapy or a placebo (Ross, Herxheimer and Dennis, 2008). Synthetic progesterin was associated with a significantly higher risk of developing postnatal depression, while oestrogen therapy was associated with a greater improvement in depression scores than the placebo (Ross, Herxheimer and Dennis, 2008). Consequently further research into oestrogen therapy should be conducted. One benefit of both of these trials is that they were both randomised and double blinded. The randomisation process should result in both groups being comparable in everything other than the treatment received, therefore eliminating selection bias (Kahan, Rehal and Cro, 2015). The double blinding helps to prevent performance and selection bias (Day and Altman, 2000). Nevertheless, within the oestrogen trial although the