Purpose for the program: When one considers that every year in the United States approximately 6 million pregnancies occur and up to 20% of women develop postpartum depression, the far reaching implications of this devastating illness are significant. Despite the many negative consequences associated with postpartum depression, the results from multiple studies that have addressed the screening practices of nurse practitioners, obstetricians, and family physicians suggest postpartum depression screening is not routine practice.  The program’s purpose was to increase postpartum depression awareness and identification.

Proposed change:   In a metropolitan area prior to starting the program only one obstetrician in a private practice and two primary care facilities offered postpartum depression screening.  The change involved implementing routine postpartum depression screening at the four to six week postpartum visit in out-patient obstetrical practices.  The screening instrument used was the Edinburgh Postnatal Depression Scale (EPDS), a 10-item self-report scale.  Training the out-patient obstetrical practices’ registered nurses and office staff was also completed.  The educational training focus was comprehensive and emphasized the nurse’s role in patient education, screening, and EPDS scoring.  Participating obstetricians agreed to initiate routine postpartum depression screening for three months logging only the patients’ EPDS score. The goal was that by agreeing to screen for three months, routine screening would be so woven into the fabric of postpartum care that the obstetrical providers would formally adopt this screening strategy.

Implementation, outcomes and evaluation:  Twenty-two obstetricians or 82% implemented routine postpartum depression screening using the EPDS for 3 months.  The percentage of women screened in each practice ranged from 39% to 100%.  Five of the nine obstetrical practices screened 100% of their postpartum patients.  The other four fell below the targeted 90%.  Over a seven month period, a total of 415 women were screened. Of the 415 women screened, 38 or 9.2% had EPDS scores greater than 13 suggesting postpartum depression.  The highest documented EPDS score was 26 and lowest was 0.  Twenty-one of the 22 obstetricians returned an evaluation letter and 71.4% indicated they planned to continue using the EPDS as part of their routine postpartum care

Implications for nursing practice:   Nurse leaders caring for mothers and newborns should passionately advocate for care that is evidence-based and patient-centered.  This project can serve as a model in which nurses’ can facilitate replication regionally, state-wide, and nationally.

Keywords: Postpartum, depression, Edinburgh Postnatal Depression Scale