At the beginning of her career, June Andrews Horowitz, RN, PhD, PMHNCS-BC, FAAN, spotted a serious problem in need of research.
I used to teach Lamaze classes, just when postpartum depression was coming up on the horizon, said Horowitz, a professor at the William F. Connell School of Nursing at Boston College. Nobody really talked about it 30 years ago. I began to realize how many women suffered in silence and didnt get the treatment they needed afterward. That really sparked my interest.
That interest has grown into two major studies of postpartum depression, with the latest published in the May/June 2013 issue of the Journal of Obstetric, Gynecologic & Neonatal Nursing. Horowitz was the lead author of the study, which found nurse-led home visits bring both an increase in quality of mother-infant interaction and decrease in the severity of postpartum depression.
The study screened more than 5,000 new mothers at Brigham and Womens Hospital and Massachusetts General Hospital, both in Boston. Those who had a positive screen were invited to have an advanced practice psychiatric nurse come to their homes for a diagnostic interview. Those found to have postpartum depression and who were willing to continue in the study were invited to have a series of one-hour home visits from nurses at six weeks and three-, six- and nine-month intervals postpartum. Nurses were trained by the researchers to collect data and use the Communicating and Relating Effectively intervention method.
We randomized them into a treatment and control group, Horowitz said. The treatment group got coaching from the nurses around their behavior with the baby, to try to be more tuned in to the babys behaviors and cues. Depression gets in the way of moms really being able to be responsive in a timely kind of way.
If youre depressed, it really takes on two patterns with moms. One is, the mom tends to be kind of muted in her response, Horowitz said. Shes slow, she cant really get her energy up to engaging with the baby in the moment. The other pattern is kind of an anxious, over-intrusive kind of mom who says things like, Baby, baby, baby! Come play with me, come on. Ive had these mothers on film and the babys already looking away like, Mom, PLEASE! Get out of my face. I cant stand it.
The mom whos anxious-depressed needs some help to say slow down, baby needs a chance to catch up, she said. Mom, the baby knows you, hes looking at your eyes, but slow down, do one thing at a time. With the depressed mom who is just sitting there, after a while you get a baby who tunes out because nobody is reinforcing his efforts to engage mommy. So with that mom, the coaching needs to be, Speak up. The baby knows your voice. Look, shes looking at you, you look back, and if you move the rattle like this, the baby will follow. See? The baby can do that. So the coaching needs to be tailored to the mothers particular behavior.
One surprise result, Horowitz said, was the moms seemed to benefit just from the nurse being there, even in the control group that received no coaching.
We dont have to talk about extensive, intrusive, serious long-term intervention, she said. Emotional support and even just being monitored mothers after the group told us that filling out the forms that asked about depression symptoms told them they were validated about what they were feeling. That, in and of itself, told them someone cared and it made a difference. Even the data collection had an unexpected intervention on our part which we didnt even realize.
Ten to 15% of mothers are going to suffer from some postpartum depression, Horowitz said. Its very treatable, and I think what we found from the study is that having a nurse just being supportive, in and of itself, had a good effect on depression.
Nurses can make a difference from the start, she said.
Tuning in and really asking how a mother is doing herself is really important, Horowitz said. Just those couple of minutes to sit down and ask how the mother is coping herself would be important, something that a nurse could do really starting with the birth.
John Grochowski is a copy editor at Nurse.com.