Postpartum Depression and the Role of Midwives in Its Early Detection

Transition to being a parent is a stress-producing process that involves adapting both parents and their families even in the most favorable circumstances. Information on the level of psychological adaptation of women and family before and during pregnancy is very important as anxiety and the effects of accumulated life stress can directly affect individual and family well-being in the postnatal period. Especially for women or families facing multiple stresses and limited resources, ensuring security, understanding, compassion and direction may have a significant positive effect during this phase. A sample of 91 women immediately after birth at the Obstetrics-Gynecology Clinic (KOGJ) at the University Clinical Center of Kosovo (UCCK) completed two self-administered questionnaires. Initially, literature on postpartum depression was investigated. Two instruments for this paper have been selected from the range of instruments available for postnatal depression research literature: Patient health questionnaire (PHQ-9) and Postpartum Depression Screening Scale (PDSS). The introduction and analysis of data is done with the Statistical Package of Social Sciences (SPSS), Version 21 (Statistical Package for the Social Sciences—SPSS). Failure or frustration and sleep problems are the highest mean postnatal depression indicators 1.8. Then there is fatigue or lack of energy, increased appetite or anorexia and suicidal thoughts and self-esteem with a mean attendance of 1.7 in the post-depression indicator group. Depression or loss of hope and dissatisfaction or interest in activities are in the group of indicators with an average of 1.6. Movement or speech problems and concentration problems are the least affected indicators in the post-depression indicator group, with only 1.5. Our statistics show a relatively high level of postpartum depression, which includes women of all categories without taking into account the economic situation, the level of education or the number of births, the results derived How to cite this paper: Tahiri, S., Sopjani, I., Ejupi, V., Beqiri, L. and Berisha, A. (2020) Postpartum Depression and the Role of Midwives in Its Early Detection. Open Journal of Nursing, 10, 745-757. https://doi.org/10.4236/ojn.2020.108053 Received: February 4, 2020 Accepted: August 17, 2020 Published: August 20, 2020 Copyright © 2020 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access


Postpartum Mood Disorders
Today, in the reality of a shorter rest after childbirth, the new mother has to pass quickly from concern for herself to concern for her new-born [1]. It is important that the physical and psychological needs of the mother must be met so that she is able to focus on the care of her new-born. The new mother can experience various emotions, such as: crying, happiness, irritation, anxiety, confusion, and fear [2]. There are physical symptoms as well, such as fatigue and headaches. If the mood does not stabilize within 21 days or if severe symptoms occur, the patient should be referred to a mental health professional. Pregnancy affects the entire family; therefore, assessment and intervention should be considered from a perspective that includes the family.

Postpartum Depression
It is a clinical term referring to a depressive episode associated with childbirth [3]. Postpartum depression is a mood disorder 20 that may begin in the first 24 hours after birth or a few months after delivery, but usually occurs two to six weeks after birth [4]. Postpartum depression is worse than "Baby Blues" and may occur at any time in the first year after birth, which occurs in 10% to 20% of mothers [5]. Initially, it can be fast or gradual with two main signs, constant sadness and lack of motherly joy. Behavioral symptoms include a state of despair

Postpartum Psychosis
The most serious condition, postpartum psychosis occurs 1 -2 cases per 1000 women postpartum 16. The start may change from 2 to 3 days 16 to 3 months 17 after childbirth. Symptoms include severe insomnia, indifference to food, extreme anxiety and agitation 16

Postpartum Depression Risk Factors
Risk factors for postpartum depression include stress, low socioeconomic status, low social support, a history of depression, and complications during birth, such as premature birth or as a result of mother-to-child partition. Before the symptoms are identifiable by healthcare professionals, the first signs of postpartum depression may be present in mothers earlier in the postpartum period. Medical check-up is used for early detection of postpartum depression, and is not considered a diagnosis. A positive result during medical examination does not always mean that it shows the current state. The value of the nurse's intuition that "something is wrong" can be taken as a starting point to assess the mother's condition regarding postpartum depression.

Purpose of the Research
Nurses and midwives in contact with birthing women were responsible for early detection of possible symptoms of postpartum depression.
The purpose of the research was: 1) Measurement of postpartum depression with relevant instruments; 2) Detection of the symptoms of postpartum depression; 3) Provide information in the most appropriate form based on the results of the research by making a literature analysis correlated with our findings.

Instruments
Two instruments have been used in this research: Patient health questionnaire Open Journal of Nursing (PHQ-9) and Postpartum Depression Screening Scale (PDSS) scaling.

Patient Health Questionnaire (PHQ-9)
The PHQ-9 instrument is a self-administered questionnaire, consisting of 9 questions that assess the degree of depression in the patient. The PHQ-9 has two components: • Assess the symptoms and their functions to make a preliminary diagnosis for depression; • Based on the results, help to select and monitor the treatment of depression.
The instrument is designed to measure the patient's mood over a period of two weeks. They are required to provide one of the four possible answers: • Never 0 points; • Some days 1 point; • More than half of the day 2 points; • Almost every day 3 points.
Patients are asked whether they have been disturbed by the following actions over the two-week period: • Low satisfaction or diminishing interest in doing things or activities; • Bad feelings, depression or loss of hope; • Sleep problems; • Decrease or increase in appetite; • Low self-esteem, feelings of failure, or disappointment with yourself or your family; • Difficulty concentrating; • Moving or speaking too slowly; • Thoughts that death or self-injury would be a solution.
PHQ-9 has been tested for validity and reliability in a number of languages. It has also been available for use in a variety of afflictions, such as sclerosis, depression in HIV/AIDS patients, and depression in diabetes patients.

Postpartum Depression Screening Scale (PDSS)
The PDSS has been developed to evaluate a woman's emotional state in the postpartum period. It consists of 35 questions grouped into 7 dimensions.

Results of the Questionnaire on Patient Health (PHQ-9)
See Table 2

Results of the Postpartum Depression Screening Scale (PDSS)
Results of the postpartum depression screening scale.

Sleep and Food Disorders
In the category of sleep and food disorder see fully agree that their life after childbirth the child is causing them anxiety and insecurity.
Emotional lability see  In conclusion, the results of the category of mental confusion go in favour of its non-influencing in women's life: 55.4% of women fully agree that they are not confused, 20.2% of women only agree with this finding, 12.3% are neutral in their responses, 6.6% of women agree to have a degree of mental confusion, and 5.5% of them fully agree that they are confused in their lives. paralyzing mood disorder last six months to more than 25% -50% of mothers.

Discussion
Present is the fear of losing oneself, strong emotional changes, the feeling of guilt that she can not feel so much love for the child, the feeling of guilt and shame that they are not the mothers they should be, feeling that the child would live better without the mother, the desire to escape this world, and the sense of death as the only solution.
The correlation results between the two variables show a p < 0.01 and p < 0.05 significance. Problems with postpartum depression at work, at home and in society are associated with a low level of satisfaction or low interest in doing things or activities (r = 0.398; p < 0.01). Depression or hopeless feeling in the woman who gave birth to her baby comes from a variety of symptoms of depression, and in relation to the baby make her feel she was not the mother she should be (r = 0.517; p < 0.01). The feelings of fatigue or lack of energy lies in a correlation with many emotional burdens that worsen even more mom's health immediately after the baby's birth (r = 0.408; p < 0.01). Failure and frustration come as a result of having the feeling that many other mothers were better mothers than her (r = 0.363; p < 0.05).
The sense of a mix of emotions with respect to an unstable emotional state is caused precisely by the fear that it would never be herself (r = 0.539; p < 0.01).
The presence of anxiety in the life of a woman who has just given birth to her baby is due to the feeling of loneliness she should have because of different experiences not so pleasing to her life (r = 0.427; p < 0.01). Loss of mind due to even simple things causes her to think it would be best if she was dead (r = 0.475; p < 0.01).
The more she feared that she would never be herself, the more she imprints the feeling wanting to leave this world (r = 0.577; p < 0.01).
That she was not the mother that she thought she would be, contribute to make her feel like a failure (r = 0.715; p < 0.01). With the growth of fear that she would never be happier, then the desire to hurt herself increases (r = 0.528; p < 0.01). The feeling of failure as a mother in the face of the newborn baby made her feel guilty that she could not have as much love as the baby needed (r = 0.469; p < 0.01). The manner of the child's birth, especially a Cesarean birth, is followed by increased anxiety caused by even the smallest of things (r = 276; p < 0.01). Open Journal of Nursing Yonkers (2003) states that 80% of women who experience postpartum mood disorder will have another episode later in their lives [7]. More than half of women identified by postpartum mood disorder were not identified with depression by their healthcare provider [8].
Postpartum depression affects the quality of a mother's life in all categories.
The timely identification of postpartum depression is a necessity, as the presence of this phenomenon, results in the mistreatment of the condition. The instruments used in the research give us a clear picture of the degree of depression among our respondents. These figures are alarming and require immediate treatment and interventions. In England, the program used by nurses/midwives to assist postpartum women is divided into two parts.
The first part is screening and the second part is home treatment.
Although in England this is a practice established in nursing processes there is no published report, which has directly examined how well this health practitioner adopts this practice. In Scandinavia, a focus group survey interviewed health workers who conducted these visits and found that using the Edinburgh Postnatal Depression Scale (EPDS) made them feel safer in postpartum depression. Prior to using this instrument, they felt that there was no reliable way to determine the degree of depression of their patients. With involvement in the EPDG daily routine, nurses felt safer and did not need to speculate on the emotional state of the patients [9]. In the context of Australia's national control over screening and implementation of post-ophthalmic depression measuring instruments. 16 It appeared that 83% of 230 nursing respondents believed that EPDS was easy to use, 85% felt it was easy to explain to patients, 75% believed that the instrument was indispensable or very necessary, and 99% reported that they would continue to use it, indicating they had confidence in the instruments.
In the USA, screening for postpartum depression by midwives is supported by the US nursing organization, which has shown efficacy in primary care [10]. The American system does not apply the second part of the English system because they have a different healthcare system from England, where nurses come from a different education and training system [10]. Acceptance of screening for postpartum depression is necessary, but it is not enough. Preparing and implementing screening programs requires the completion of many steps: including staff training, the design of a screening instrument, and the formulation and implementation of protocols for postpartum depression screening [11]. Identifying treatment resources also poses a challenge on its own.

Conclusion
This phenomenon is multi-dimensional and touches on the nucleus of society, the young family. Apart from the direct impact of mother's emotional well-being, postpartum disorders also affect spousal relationships [ [15]. Postpartum depression is a serious public health problem that can lead to ongoing mental health problems for many new mothers [16]. Approximately 15% of 669,000 UK-born mothers have developed postpartum depression, referring to one non-psychotic depressive illness which may last for several weeks, months or even a year after the child's birth [17].
Bringing a home child is a major event for the new mother and for the family,

Recommendations
Timely intervention of medical, nursing, midwife staff is crucial in the clinical course of this phenomenon. Pregnancy affects the whole family and therefore, assessment and intervention should be considered in a perspective with the family at the center.
Transition to being a parent is a stress-producing process that involves adapting both parents and their families even in the most favorable circumstances.
Information on the level of psychological adaptation of women and family be- Mothers' education and counseling by midwives, midwives/midwives should be part of everyday procedures, including education for a healthy life with a focus on: • Food-a diet rich in multivitamins and juices.
• Staying away from alcohol consumption. • Physical exercises.
• Information flayer equipment for the symptoms and importance of handling these at any counseling centers and maternity clinics.
• Creating multidisciplinary support groups not only for the mother but also for the family members who are facing this concern.