As discussed in an earlier post, an estimated 6-10% of incarcerated women are pregnant at any time in the criminal justice system. Therefore, many of these women will give birth while behind bars and must deal with the physiologic and psychological adjustments of the postpartum period in an alien environment with little social support.
Reasons for Concern
Women who give birth behind bars are highly susceptible to postpartum depression. A review of literature on the subject found factors associated with this condition include past histories of anxiety disorders or depression, recent life stresses and poor social support. All these conditions are highly present in the female inmate population. Depression can be exacerbated by separation from the infant soon after birth. Although some progressive settings, such as this New York prison, are allowing babies to stay with mothers, most require that the child be placed with another family member, the foster care system, or given up for adoption.
Keep an Eye on Them
Correctional nurses should assess for postpartum depression in women who have recently delivered. The most common emergence of postpartum depression is in the first 4 weeks after delivery but depression can develop even a year later. Monitor for these indications of developing depression during the postpartum period:
- Sadness and tearfulness
- Exhaustion not relieved by sleep
- Compulsive thoughts
- Sleep difficulties
- Loss of appetite
Use an Objective Screening Tool
The 10-question Edinburgh Postnatal Depression Scale is used in outpatient and home care settings to objectively screen for potential postpartum depression. It could easily be incorporated into a correctional setting with self-administration possible for those patients with good reading skills. Another option is for the nurse to ask the questions.
Treatment for Postpartum Depression
Although treatment options may be limited, postpartum depression must be addressed to avoid poor outcomes such as self-harm. A mental health consult is the first action to take. Management of postpartum depression is similar to any major depression and can include psychological support, cognitive therapy, and antidepressant or antianxiety medication.
How do you manage women after childbirth in your setting? Share your thoughts in the comments section of this post.
To read more about the unique aspects of women’s health care in the correctional setting see Chapter 9 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1402 the price is discounted by $15 off and shipping is free.
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