Week 9 Journal
M.L. is a 35-year-old women coming in for her postpartum visit, four weeks out from a vaginal delivery. The patient looked as if she had been upset and crying prior to visit. When asked if she was okay the patient began to cry. I gave the patient a tissue and allowed her time to calm down enough to talk. The patient stated she is “so tired” due to lack of sleep, is feeling overwhelmed, states she cries often throughout the day over “small things like a cup left on the counter.” The patient is finding it hard to get out of bed and some days does not want to get out of bed. The patient continued stating she never thought she would have baby this late in life and starting over at her age has been very difficult. The patient reports she feels she has been overly argumentative with her spouse and two older children causing tension within her home. M.L. denies any suicidal or homicidal ideations. I discussed postpartum depression (PPD) with the patient and informed her what she is feeling fits the diagnosis. I further explained that after pregnancy there is a drastic drop in estrogen and progesterone that can contribute to PPD. Sleep deprivation and feeling overwhelmed increases anxiety and can make minor issues seem like major issues. The patient agreed with the diagnosis of PPD. PPD can affect 10 to 15 percent of women after birth and can occur up to 12 months after delivery (Tharpe, Farley, & Jordan, 2013).
Treatment of Postpartum Depression
Medications postpartum are also important to assess for safety. It is important for the provider to know if the patient is breastfeeding or bottle-feeding due to medications being excreted through breast milk to the baby. In this case the mother was breastfeeding. Antidepressants are used to treat postpartum depression and are excreted in breast milk, although the levels have been found to be very low. The mother has to decide of the benefits of the mediation outweigh the risk of the baby being exposure to the medication. In this case the patient agreed to take the medication. I suggested the patient be started on Zoloft 25 mg 1 tab by mouth daily – my preceptor prefers to start at the lowest dose and titrate up as needed (I only mention that because throughout my clinical experience I noticed postpartum women with PPD seemed to do better once increased to Zoloft at 50 mg daily but I understand the need to start low). I also offered to refer the patient to a counselor – she refused at this time but stated she would keep it in consideration. I informed the patient antidepressants take time to build up in the body and it can take 3 to 4 weeks before she began to feel better. I also discussed birth control options with the patient and she opted for the Mirena IUD. IUD to be ordered and patient informed she would be notified once the IUD was received from her insurance company to schedule an appointment.
The patient seemed was much calmer at the end of the visit. I offered as much support and encouragement as possible during the visit. I made sure I was sitting during this visit and that I was actively listening to the patient and validating her feelings. Creating a non-judgmental environment helps develop trust that women seek when discussing their private issues or feelings (Tharpe, Farley, & Jordan, 2013). The patient was scheduled to come back in two weeks to complete the 6 weeks of postpartum care but patient was informed she would be followed until she felt the Zoloft dose was at a therapeutic level.
Tharpe, N. L., Farley, C. L., & Jordan, R. G. (Eds.). (2013). Care of the infant and mother after birth. Clinical practice guidelines for midwifery & women’s health (4th ed., pp. 219-261). Burlington, MA: Jones & Bartlett Learning.