งdiscussion
The clinical implication of these findings for nursing requires that we alter our practice to more adequately meet the needs of women during pregnancy and in the postnatal period. It is important that we acknowledge stressors that women have identified as contributing to the development of thier PPMD. This should direct our practice by giving us important opportunities to ask women without judgment about the emotional impact of thier pregnancy, previous mental health issues, birth experiences, and breastfeeding issues. This may provide helpful the insight into the mental well-being of a women and allow for open and safe discussions in various clinical contexts. The continuing stigma and shame associated with having a psychiatric illness serves as a significant barrier for women to seek out help from lay and professional others when experiencing a PPMD(Pinto-Foltz& Logsdon,2008). In this study, the mothers spoke often of the stigma around mental illness that forced them to hide and mask thier symtoms and negative feelings around mothering ultimately diminishing thier quality of life. At the same time, in delaying thier treatment to avoid judgment from others, thy identified that thier interactions with thier children were often markedly compromised. Maternal mood disorders greatly diminish the quality of the interaction between the dyad ultimately resulting in emotional, social, and cognitive delays for thier children (Luoma et al,2001). The outcomes for children are particularly compromised and correlated with the chronicity of thier mother's illness indicating that delayed treatment has significant long-term implications for the dyad and family unit as a whole (Hay et al.2001). These findings highlight the urgency in detecting and treating mental illness within this population while also giving strong evidence that women want to be asked open and direct questions around their mental health.
The finding that maternity care should be delivered within the context of the mother-child dyad as the unit of care is an important one. Our current system often places primary focus on the health and well-ness of infants to the exclusion of their mothers. Women need their physical health monitored appropriately but also need emotionally supportive care that values and honors the needs of both women and their babies. This philosophy of care highlights the necessity for a holistic approach with the dyad together as a focus throughout this life event.
Women very clearly identified that they wanted universal screening for mood disorders to be implemented as part of the standard of practice for maternity care. Screening for mood disorders is a simple and economical process that is well within the scope of our nursing practice allowing us to not only take ownership for its implementation but also to be leaders in advocating for this best practice standard to be availiable to all women. The design and derivery of mass screening programs for perinatal mood disorders will require the concerted effort of maternal-child nurses, pubic and community health nurses, and other nurses who work directly with this population.