Continuity of midwifery care plays an instrumental part in the successful identification and management of postnatal depression, says Professor of Perinatal Mental Health Debra Creedy.

“The midwife plays a central role in detecting depression and supporting women along their journey,” says Professor Creedy.

“Continuity of midwifery care is essential to develop a trusting relationship.”

Continuity of midwifery care occurs when a woman is seen by a known midwife during pregnancy, during birth and up to 6 weeks postpartum.

“This enables a trusting relationship to develop and for a midwife to ensure that the woman stays safe.

“If the depression develops into a severe condition, then the woman may be admitted for care.”

Identifying post-natal depression is a critical part of a midwife’s role, with many maternity services around Australian incorporating routine screening for depression.

The Edinburgh Postnatal Depression Scale (EPDS) is the recommended tool for use both antenatally and postnatally to identify whether a woman is likely to be experiencing depression and/or anxiety in pregnancy or the postnatal period.

“In the public system screening using the EPDS is formalised and documented,” Professor Creedy says.

“I’m aware of some private practice midwives who also routinely screen and document.”

In undergraduate Bachelor of Midwifery programs students are introduced to EPDS and psychosocial risk assessment – this includes identification of risk factors, signs and symptoms, treatment, role of the midwife in screening and providing care.

There are also a number of professional workshops and seminars available to maternity health professionals to further enhance their understanding of pre and postnatal depression, such as those offered at beyondblue and COPE.

When assessing women who are about to, or have just given birth, midwives should be aware of the following signs:

Mood: anger, anxiety, guilt, hopelessness, loss of interest or pleasure in activities, mood swings, or panic attack
Behavioural: crying, irritability, or restlessness
Whole body: fatigue or loss of appetite
Weight: weight gain or weight loss
Cognitive: lack of concentration or unwanted thoughts
Psychological: depression or fear
Also common: insomnia or repeatedly going over thoughts

“Many studies estimate that between eight and 15% of pregnant women in Australia, and seven to 21% of mothers of infants up to four months of age will experience postnatal depression.

“The estimated prevalence of anxiety disorders among childbearing women attending has been proposed to be as high as 20%. In addition, depression and anxiety disorders frequently coexist.”

Professor Creedy says if a midwife suspects postnatal depression, they should first ensure the woman and her baby are not at immediate risk.

“Midwives can provide a clinical pathway, a resource and referral list, and written patient education.”

Due to the frequency of Baby Blues, which many women experience soon after birth, it’s important for midwives to be able to differentiate between this and postnatal depression.

“After a woman gives birth, her hormone levels drop, which impacts on mood. Her newborn is probably waking up at all hours, too, so she isn’t getting enough sleep. That alone can make the woman irritable.

“A woman might simply be worried about caring for her baby, and it makes her feel a kind of stress she hasn’t dealt with before.

“These feelings often begin when her newborn is just 2 or 3 days old, but a woman is likely to feel better by the time her baby is 1 or 2 weeks old.

“If her feelings of sadness last longer than that, or become worse instead of better, a woman may have postpartum depression.

“It’s more severe and lasts longer than the baby blues, and about 10% of women get it. A woman is more likely to have postpartum depression if she has already had bouts of depression or if it runs in her family.”

When It’s the Baby Blues:

• mood swings quickly from happy to sad. One minute, a woman feels proud of the job she’s doing as a new mom, the next, she could be crying because she thinks she is not up to the task.
• doesn’t feel like eating or taking care of herself because she is exhausted.
• feels irritable, overwhelmed, and anxious.

When It’s Postpartum Depression:

• feels hopeless, sad, worthless, or alone all the time, and will cry often.
• doesn’t feel like she is doing a good job as a new mom.
• is not bonding with her baby.
• can’t eat, sleep, or take care of her baby because of her overwhelming despair.
• could have anxiety and panic attacks.

With many women in hospital for just a few days or less, continuity of care post-birth would make the identification and successful treatment, that much easier.