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Postpartum depression (PPD) is a debilitating mood disorder that has a major impact on the health of women and their families. Since the early 1990s, the U.S. Congress has acknowledged that PPD is a serious problem, but it has not yet passed a national plan to help at-risk women. (See "Congress mulls PPD legislation.")

Answering a need

Nurses at Spectrum Health's Butterworth Hospital in Grand Rapids, Mich., weren't going to wait for a law to tell them to help the new mothers in their care. They have collaborated to create a universal screening program for postpartum mood disorders (PMD). As a result, more than 8,200 new mothers each year are assessed before they are discharged from the hospital.

The need for the universal screening program became apparent through a support group for postpartum women hosted by the hospital's Healthier Communities Department, says Nancy Roberts, RN, coordinator of the Postpartum Emotional Support Program. Many of the women in the support group, formed in 1993, were suffering from PMD.

"During those years, women came to the group after they had been enduring their illness alone for varying periods of time," Roberts says. "There was a lot of stigma attached to postpartum depression. Comments from celebrities and media coverage of serious crimes that may have been caused by postpartum depression only added to the problem. It was heartbreaking when women expressed the wish that someone had informed them about this problem sooner and that they were not alone in their suffering."

Assessing the risk

Roberts and her colleague, Kathleen Buchanan, RN, Postpartum Emotional Support Program nurse, attended several conferences and began to realize that needless suffering could be avoided if women were assessed for PMD risk factors before they developed a problem or before it became severe.

"One of the first things we had to do was find an acceptable tool to use to assess the mothers," says Buchanan. "There really wasn't a published risk assessment that we felt was short, simple, and comprehensive. Therefore, we worked with a 30-member advisory board to develop our own and wrote a project proposal to introduce the assessment into the hospital setting."

The resulting risk assessment, available in English and Spanish, includes a short demographic section and 11 simple statements designed to reflect different risk factors known to contribute to PMD. The mother completes the assessment on admission to the postpartum unit by checking "yes" or "no" for each statement. The original assessment is placed in the patient's chart for the primary care provider and a copy is retained by the PPD nurse to document a follow-up phone call.

Patients who are identified as either a high risk or an immediate risk are asked to complete the Edinburgh Postnatal Depression Screening Tool and are counseled by nurses according to program-specific protocol. Social Work also is consulted to assess patient needs. The nurses notify the patient's primary care provider with the screening results and help develop a plan of care to meet their needs. All patients who are identified as having a significant risk for developing a PMD are contacted by telephone three to six weeks after discharge.

Finding resources

"Our next project was the financial aspect of the program since it would require extra time for patients who were at risk," says Roberts, who pointed out that writing a grant to cover the initial cost of the screening program was a logical step in the process.

After obtaining the grant, Roberts and Buchanan presented the proposal to Cindy Reistroffer, director of Women's Health at Spectrum Health's Butterworth Hospital, who agreed to adjust the budget and added a 0.9 full-time equivalent position, divided among several part-time nurses to accommodate the new program's seven-day-a-week coverage.

A program worth sharing

Through a grant-funded program, Roberts provides guidance and support, which includes a PPD Program Development toolkit, to 12 other hospitals in Michigan as they implement PPD programs for their new mothers. The Postpartum Emotional Support Program also hosts an annual conference designed to share the most current information on postpartum mood disorders.

Buchanan says the program makes risk assessment for PPD a part of standard nursing practice for every postpartum nurse. It improves the care the nurse gives to new mothers. When a mother is healthy and aware of her risk factors, she is able to care for herself and her family more effectively.

Editor's note: For more information about the Postpartum Emotional Support Program, contact Nancy Roberts, RN, program coordinator, at (616) 391-1771, (616) 391-2561 (voicemail), or nancy.roberts@spectrum-health.org.

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Sharon Strek, MSN/Ed, RNC-OB, is a staff nurse for the Birthplace at Spectrum Health’s Butterworth Hospital. To comment, e-mail editorMW@nursingspectrum.com.

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