Postpartum depression (PPD) occurs during pregnancy and the first 12 months following delivery.  It affects at least 1 in 10 new mothers (20-22%). Prior to our PPD program, women received written materials and education about signs and symptoms of PPD. None of these patients received follow-up from our organization after discharge.  The immediate, long-term, and sometimes tragic effects of PPD on families made an evidence-based initiative to provide seamless care and follow-up for these families a priority.

Proposed change:

A comprehensive program of PPD risk assessment, education, screening, time-sequenced follow-up and referral  during pregnancy, postpartum  and after discharge for all mothers delivering at our hospital.

Implementation, outcomes and evaluation:

An interdisciplinary team reviewed the literature and identified opportunities to develop PPD services. Feedback from our clients identified needs and supported screening all mothers for PPD.   We chose the Edinburgh Postnatal Depression Scale (EPDS) for screening.

 Our program included education for nurses, physicians, office staff about PPD, EPDS, and follow-up.  Patient education materials and discharge instructions were revised.  All mothers were screened  before discharge,  with repeat screens two weeks later during RN  follow-up calls.  We established direct links with our organization’s behavioral health for antepartum/postpartum assessments and interventions and obtained grant funding for services. Outpatient emergent and follow-up behavioral health care was priority. Results of initial/follow-up screenings  were shared with physicians.  

In the first year of the program, all mothers were screened for postpartum depression risk while in the hospital and received either a follow-up phone call by a registered nurse after discharge or a visit by a clinical nurse specialist. This has resulted in early identification of risk and access to behavioral health services that may prevent/reduce symptoms of PPD.

This program has strengthened the relationships among maternal and child health departments, behavioral services, and private physician offices  and improved  the early identification/referral of at risk women. Physician practices not having done formal screenings at postpartum follow-up visits are now using the EPDS.  Weekly antepartum support groups are led by a therapist, who also provides individual counseling through grant funding. 

Implications for nursing practice:

Comprehensive maternity care must include PPD screening, assessment and referral.  Seamless care for antepartum, postpartum and sequential follow-up  has positively impacted on families through education, early identification, and referrals for treatment/support.  The development of interdisciplinary collaboration is essential and strengthens the care offered to families. Our program provides a seamless model that hospitals may replicate

Keywords: postpartum depression, EPDS