Postpartum Depression

World Maternal Mental Health Day

June 2020
Outline

Current Data Characteristics

01 Maternal mental health
04 Clinical signs

Psychological adaptation Prognosis

02 Emotional changes in postpartum
05 Will it be better?

Brief overview of PPD What to do?

03 Definition, etiology
06 Prevention or to help self strategy

2
WHAT DATA SUGGESTS
..about maternal mental health
Global and Indonesia Mental Health Data
•  According to WHO there are 800.000 people who died of suicide, 1 person every 40
seconds

•  Data from Riskesdas 2018 shows there are one family member that suffer from psychosis/
schizophrenia in 7 per 1000 families

•  There are 19 million people over 15 years old who suffer from emotional mental disorder

•  There are 12 million people over 15 years old who suffer from depression

•  Suicide rate in Indonesia is approximately 1,6%-1,8% per 100.000 person

Data in Indonesia tend to be under reported because mental health is still a taboo topic. In
the US, where mental health is discussed freely, the data can give us a better perspective

4
Mental health data in the US

• In 2017 there are 46.6 light background million people

over 18 years old who suffer from mental health disorder
• Prevalens of mental health disorder is higher in female
22,3% than in male 15,1%
• Age group who suffer mental health disorder the most are
18-25 years old 25,8%, followed by 26-49 years old 22,2%
and then over 50 years old 13,8%

5
PSYCHOLOGICAL ADAPTATION
Emotional changes in postpartum
Psychological adaptation (Rubin, 1963)

1.  Taking in
2.  Taking hold
3.  Letting go

7
Baby blues vs postpartum depression

• Baby blues is a diagnosis of sudden mild mood changes

followed by anxiety, fatigue, and feeling of sadness in 2
weeks after postpartum
• Baby blues is generally not serious, and happened because
sudden changes in life and having to take care a baby
• If this disorder continue after 2 weeks after postpartum,
the diagnosis becomes postpartum depression

8
Postpartum Depression (PURI, B et al., 2012)
•  Mental health disorder that mimics major
depression that happens 1-3 weeks after post
•  One in five women will suffer
partum and could last 3 months after post postpartum depression
partum

•  Major depression disorder has 3 prominent •  But only 1% of women who

characteristics : could afford professional help
•  Anergia (without energy) : looks tired, because of many reasons like
fatigue, and without energy cultural and social aspects
•  Anhedonia : no longer enjoys activity that
previously enjoyable

•  Depressed afect : looks depressed, sad, and

unhappy
9
 Postpartum Depression

Hormonal History of
mental disorder

Physical Traumatic
support birth

Culture Financial

10
ETIOLOGY
 Things to do?
How to prevent or to help self
Celebrating self postnatally (Hill, 2019)

• Tell or write the birth story

• Bonding with baby vs self care
• Post-baby body is normal
• Nurturing food
• Honour the feelings

12
Things to do if postpartum depression is
suspected (Journal of Midwifery & Women's Health,
2019, Mayo Clinic, 2019)
•  Seek professional help. Seek professional help by visiting psychiatrist or using telemedicine facility

•  Maintain healthy lifestyle. Drink enough water, eats balanced foot, exercise, and sleep. Do hobbys in
free time. Try different things to help you sleep, such as a warm bath before bedtime, massage,
relaxation techniques, or meditation.

•  If you are breastfeeding, you may need help with night feeding in order to get some uninterrupted
sleep.

•  Set realistic goals and expectations. As a mother, you can’t do everything by yourself. Set realistic
expecatations, delegate tasks, ask for help, make sure partner and close families are involved in
taking care of the baby

•  Avoid isolation. Talk to the husband or close families. Help them understand about your condition,
ask for their help, and make them involved

13
CITY

Moms lift each other up to beat post-

partum depression
News Desk
The Jakarta Post
Jakarta

Jakarta / Tue, January 22, 2019 / 01:52 pm

A new study found that parents to newborns are getting only four
hours and forty-four minutes of sleep on an average night.
(Shutterstock/Valeriya Anufriyeva)

PEER SUPPORT
Ni Nyoman Meysavitri, 39, could not hold back her
tears as she read through the messages she received

Helps a lot
Prognosis
Prognosis in Postpartum Depression
(PURI, B et al., 2012 )

•  Most of the symptoms will disappear after 3-6 without therapy

•  1/3 of the patients would still have symptoms 6 month after
postpartum
•  10% of the patients would still have symptoms 1 year after
postpartum
•  Postpartum depression could be damaging to the child’s mental
health if substitute mother/parents is absent

16
THE ROLE OF THE MIDWIFE
In mental health promotion
-Amanda Peet

“I want to be honest about [postpartum

depression] because I think there’s still so much
shame when you have mixed feelings about being
a mum instead of feeling this sort of ‘bliss.’ I think a
lot of people still really struggle with that, but it’s
hard to find other people who are willing to talk
about it.”
18
Salutogenic as a concept (Downe, 2008)

•  A central role of the midwife is to support and facilitate this

transition for mothers.
•  ‘salutogenesis’ encourages a focus on the factors that support
health and well-being rather than those that cause ill health. It
provides midwives with the necessary holistic approach,
knowledge and skills relevant to health promotion roles.
•  Gain an understanding of the woman’s mental health history from
the first antenatal appointment. This should be done in a sensitive
and systematic manner with the aim of establishing rapport.
19
Cont’d

• During labour and birth, the midwife can provide

individualised, sensitive care and maintain this ethos of
care during the postnatal period
• In the postnatal-period it is useful for the midwife to
provide an opportunity for talking each day, to present
realistic portrayals of motherhood and to speak about the
prevalence and symptoms of PPD
• Providing information empowers women and their families
to be aware of their feelings and know what help is
available, by mean referral if necessary
20
 It is only in our darkest hours that
we may discover the true strength
of the BRILLIANT LIGHT within
ourselves that CAN NEVER, EVER, BE
DIMMED
Doe Zantamata

21
References
•  Rafferty L. Well informed midwives can help: perinatal mental health. Pract Midwife. 2013;16(6):35-37

•  Johnson J, Galal S. Mental health--what's that got to do with midwives?. Aust Nurs Midwifery J. 2014;21(8):44-45.

•  KEMENTRIAN KESEHATAN RI. 2019. Kemenkes RI. [online]. [Accessed 12 June 2020]. Available from World Wide Web: <
https://www.kemkes.go.id/article/view/19101600004/pentingnya-peran-keluarga-institusi-dan-masyarakat-kendalikan-gangguan-kesehatan-jiwa.html>

•  MAYO CLINIC. 2019. Mayo Clinic. [online]. [Accessed 12 June 2020]. Available from World Wide Web: <
https://www.mayoclinic.org/diseases-conditions/postpartum-depression/diagnosis-treatment/drc-20376623>

•  NIH. 2019. Mental I. [online]. [Accessed 12 June 2020]. Available from World Wide Web: <https://www.nimh.nih.gov/health/statistics/mental-illness.shtml>

•  PURI, B, P LAKING, and I TREASADEN. 2012. Buku Ajar Psikiatri. Jakarta: EGC.

•  Journal of Midwifery & Women's Health. 2019. Postpartum Depression and Anxiety., 64: 137-138. doi:10.1111/jmwh.12949

•  Hill, M. (n.d.). Give Birth Like a Feminist Your Body Your Baby Your Choices. HarperCollins UK, 2019

•  Den A-W, Xiong R-B, Jiang T-T, Luo Y-P, Chen W-Z. Prevalence and risk factors of postpartum depression in population-based cample of women in Tangxia community, Guangzhou. Asian Pasific Journal of
Tropical Medicine. 2014;7(3):244-9.

•  Kim THM, Connolly JA, Tamim H. The effect of social support around pregnancy on postpartum depression among Canadian teen mothers and adult mothers in the maternity experiences survey. BMC
Pregnancy and Childbirth. 2014;14(162):2-9.

•  Romero AMO, Rodriguez LMd, Cardenas CHRd. Coping and adaptation process during puerperium. Colombia Medica. 2012;43(2):167-74.

•  Ho C-L, Chang L-I, Wan K-S. The relationship between postpartum adaptation and postpartum depression symptoms of first pregnancy mothers in Taiwan. The International Journal of Psychiatry in
Medicine. 2013;45(1).

•  Ozturk M, Surucu SG, Ozel TE, Inci H. Evaluation to adaptation of motherhood in postpartum period. International Journal of Health and Life-Sciences. 2017;3(1):65-76.

•  Tracy, S. K., Thorogood, C., Pincombe, J., & Pairman, S. (2011). Midwifery: Preparation for Practice. Elsevier Health Sciences. Retrieved from https://books.google.co.id/books?id=D6EuzGoLSWYC

•  BUDIMAN, M. Elyas Arif et al. Strategy Intervention to Prevent and Reduce Postpartum Depression: A Systematic Review. Jurnal Ners, [S.l.], v. 14, n. 3, p. 292-297, jan. 2020. ISSN 2502-5791. Available
at: <https://e-journal.unair.ac.id/JNERS/article/view/17149>. Date accessed: 12 june 2020. doi:http://dx.doi.org/10.20473/jn.v14i3.17149

22
THANK YOU!
any questions?

23