Question

CASE STUDY (Cheryl Tatano Beck's POSTPARTUM DEPRESSION THEORY)

At the tender age of 11 years, Kim was “sold” by her mother to three adult men for an evening of sex and drugs. Kim related that as her mother went out the door, she advised her to “do what they tell you and I’ ll be back in the morning.” Kim was never okay again. Although she did relatively well during the sporadic times she went to school, her life was a series of drug and sex binges. At 17, Kim was in jail and pregnant. She had been arrested several times and released, but the judge insisted that this time she stay incarcerated until after the baby was born to guarantee the baby would be crack-free at birth. Kim’s prenatal records, however, did not indicate drug or alcohol use, and neither did her jail records. She adamantly insisted that she never used drugs or alcohol once she found out she was pregnant (late in the first trimester). Through a series of misunderstandings, she was released 2 weeks before the baby’ s birth. However, Kim did well, continued to stay drug-free, refused medication during labor, and delivered a beautiful healthy baby—a baby whose blood test results were negative for drugs.

Kim recalls that she began motherhood believing this would be the event that would turn her life around. It did for several weeks, but slowly Kim became involved in her old life. She received money to buy clothes and food for her baby. In spite of that help, however, Kim had no place to live and no money to support herself. She never held a legal job in her life. She qualified for postpartum medical care for 6 weeks, but after that she was on her own. When the baby was 7 months old, Kim called a nurse who had once cared for her during her pregnancy and asked for help to give her daughter up for adoption. She believed she would simply never be able to give her baby the life she knew all babies deserved. Kim was using drugs again, and the baby was being kept by whoever was in the mood to do so. Kim absolutely loved this baby, and the choice for adoption came from this love. Kim chose a local Christian adoption agency. Staff there gave her the opportunity to read the profiles of potential families, see pictures of them, and actually choose the family who would raise her baby. Though she did not know the family’s name or address, the family and the agency committed to regular photographs and updates about her daughter. Without resources or support, and without her baby, Kim returned to the only life she had ever known among the only people she really knew. Eighteen months later, Kim gave birth to another baby. This time, she swore things would be different. When this new baby was also about 7 months old, Kim found herself deeply involved in crack use, with her baby being passed around from relative to relative and from friend to friend. Unfortunately, Kim was present during the commission of a violent crime with a predictably tragic outcome. Although Kim did not actually commit this crime, she was present and was ultimately sent to prison.

Kim once remarked that she loved being pregnant, loved giving birth, and loved the idea of being a mother. She said, “It would be great in the beginning, but after a couple of months I’d start feeling bad. It seems like with both my babies that around 6 or 7 months, I just couldn’ t handle anything.” Although Kim took the baby to a pediatrician for follow-up care, none of those care providers knew her or knew her history—they were primarily concerned with her son’s health. Kim’s affect is usually very upbeat; she smiles easily. It is not likely that anyone ever asked her any important questions about her life or her experience of being a mother. Kim was, for all intents and purposes, “lost to follow-up.” Kim’s story illustrates the kinds of complexities that can make postpartum depression especially challenging for women who live amid drugs and chaos. In the midst of this life, women still want to be good mothers and have the same hopes and same dreams we all have. Drugs, alcohol, crimes, and all the other ways Kim’s life was chaotic were the only avenues by which she received services—after-the-fact services. Interventions by others could have made a difference at many points in Kim’s life. One of these points was during her prenatal period. She clearly evidenced most of the risk factors for postpartum depression, despite her cheerful attitude toward the pregnancy.

ANSWER THE FOLLOWING QUESTIONS: (RELATE TO Cheryl Tatano Beck's POSTPARTUM DEPRESSION THEORY)

1. Identify Kim ’ s experiences suggestive of risk for postpartum depression and justify your answer.

2. If you had been a nurse caring for Kim during her prenatal care and identified her to be at risk for postpartum depression, what kind of care plan would you have developed before or after her baby’s birth?

3. Would you have been willing to intervene on behalf of Kim or her baby, even though their needs occurred within the community and not in the confines of a hospital or office?

Answer 1

#) Kim ’ s experiences suggestive of risk for postpartum depression :-

Going through an extremely stressful event - financial problems,

Dealing with relationship problems with the parents

Lack of support from friends, family, and other members of your community

An unplanned or unwanted pregnancy

#) Nursing Diagnosis that may apply to a woman with a postpartum psychiatric disorder include :-

Ineffective individual coping

Risk for altered Parenting

Risk for violence

- PLANNING/goals for women experiencing postpartum depression may include

The client and family will remain free of injury.

Family members and support persons will provide appropriate care for the newborn.

The client will articulate feelings and concerns.

The client will adhere to the plan of care.

The client will integrate the newborn into the family.

- IMPLEMENTATNION

Alert the mother, spouse, and other family members to the possibility of postpartum blues in the early days after birth and reassure them of the short-term nature of the condition.

Describe symptoms of postpartum depression and encourage the mother to call her healthcare provider if symptoms become severe, if they fail to subside quickly, or if at any time she feels she is able to function.

Encourage the mother to plan how she will manage at home and provide concrete suggestions on how to cope in her adjustment to motherhood.

#) Yes ,I am willing to intervene on behalf of Kim or her baby, even though their needs occurred within the community because they extremely needs a support system to spend a good quality life whether the needs occured within the community or hospital . I will be helping them by providing financial and social support .