Optimizing Postpartum Care: Examining the Effects of Postpartum Care on Postpartum Depression and Anxiety

Abstract

Postpartum is a vulnerable period that calls for careful monitoring, support, and anticipatory guidance. More than half of pregnancy-related deaths occur postpartum, with substantial morbidity occurring in the early postpartum period. Depression during or immediately after pregnancy is a common medical complication affecting one in seven women in the United States. There is a large body of research that supports earlier and more frequent postpartum care for all women. Healthcare governing bodies, including the American College of Nurse Midwives (ACNM) and the American College of Obstetricians and Gynecologists (ACOG) currently have guidelines in place for more frequent postpartum visits. There is a gap between research evidence and current practice related to postpartum visits; therefore, the project was translating evidence into practice. The project design was comparative, pre-and post- (retrospective and prospective). The project’s primary aim was to compare postpartum depression rates in women who received postpartum care with a six-week postpartum visit only (the pre-group) with women who received optimized postpartum care with the addition of a one-week visit in the office and a three-week virtual or in office visit if needed (the post-group). Mothers in the pre-practice change groups had one six-week postpartum visit. Mothers in the post-practice change group were scheduled for a one-week appointment in the office after delivery and a six-week comprehensive postpartum visit. Mothers with an Edinburgh Postnatal Depression Scale (EPDS) score of eight or greater, a history of a postnatal mood disorder, or a history of a mood or psychiatric disorder all returned for an additional three-week postpartum visit. The project included 297 women, 185 in the pre-practice change group and 112 in the post-practice change group. The results revealed a decrease in the mean EPDS score at six weeks postpartum in the post-practice change group (M = 6.2), compared to the mean EPDS score in the pre-group (M = 7.8). Early postpartum visits had a statistically significant impact overall on postpartum depression symptoms (p = 0.28). The addition of early postpartum visits positively influenced the presence and severity of postpartum depression symptoms, and therefore could decrease maternal and infant morbidity and mortality.