Mental Health in Prenatal Care
This presentation describes the integration of mental health services in a faculty based practice. The practice was designed to reduce the effects of health disparities in Sandoval County, New Mexico by utilizing family nurse practitioners and nurse midwives. This county experiences a maldistribution of mental health care providers to meet the needs of rural residents who experience a disproportionate number of mental health care issues. Prenatal care was supported by nurse midwives using a group care format that included community health workers. The mental health nurse practitioner utilized therapeutic counseling and medications as needed to support women and their families during antepartum and postpartum period. The underlying goal was to stabilize the mental health of the mother and support her relationships with her infant and other family members.
Background
Depression is now acknowledged as one of the most common complications of pregnancy with far reaching complications for women, family, infant and child health and well-being. National data indicate prevalence scores of 7.4 percent, 12.8 percent and 12.0 percent during the first, second, and third trimesters, respectively. The New Mexico Commission on the status of women estimate the prevalence of antenatal depression as 20 percent. Scores from the Edinburgh Depression Scale indicated a 30 percent prevalence rate of depression in those who sought out WIC services in Sandoval County.
Brief Description
The Edinburgh Depression Scale was administered to women who participated in prenatal groups at initial appointment, thirty six weeks and six weeks post-partum. Topics on maternal and child health for supportive care of family such as interpersonal violence stress management and self-care were highlighted during prenatal groups.
Outcomes Achieved
Forty six of fifty seven new obstetric patients received prenatal services from nurse midwife with approximately 30 percent being referred to mental health clinician based on scores from Edinburgh Depression Scale of greater than nine. Of the 17 women completing the depression scale during the third trimester, 14 scored low risk and three scored high risk. Of the ten women rescreened in post-partum period, seven scored low risk and three scored high risk. Our data suggests a trend that contrasts with national norms. National data demonstrated an increase in depression as pregnancy progresses. However our data indicate a decrease in depression from first trimester through postpartum period.
Conclusions
Data from this project suggest that participation in prenatal groups contributed to pregnant women feeling less depressed. In those women referred to mental health nurse practitioner, lower scores on Edinburgh during third trimester and postpartum period propose treatment may have also been a contributing factor to less depression. Data collected from this project will be used to demonstrate need for the development of mental health services in a rural community health center.