Antenatal Depression Limitations

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DISCUSSION: One limitation of promoting awareness and helping to prevent antenatal depression, whether using Bradshaw’s Taxonomy of Need or Piper’s model, is that they rely on early detection and then early intervention being possible. Often, women showing signs of being most at risk of developing antenatal depression, such as refugees or having complicated social circumstances, will miss bookings and other antenatal appointments. During a time that everyone says should be the happiest moment of her life, women suffering from antenatal depression could be experiencing feelings of hopelessness, guilt, have less concentration and an overwhelming sadness and loneliness (Coverdale, 1996). Often, these feelings stop women coming forwards about depression. …show more content…
For the midwife as a healthcare professional, the main ethical dilemma and limitation is balancing the needs of the woman and her fetus. A positive outcome is dependent on such things as autonomy and preventative ethics. Autonomy enables the woman to be at the heart of the decision making around herself and her fetus. Allowing women suffering from antenatal depression to be autonomous can be done by encouraging screening for depression, counseling about the negative effects of depression on pregnancy, and discussing treatment options (Coverdale et al, 2002). However, it could be argued that her competency to consent is altered due to the nature of depression (Wisner et al, 2000), therefore she cannot be autonomous. Coverdale (1997) argues that paternalistic counseling helps to increase the woman’s values, not those of the healthcare professional’s, in this case the midwife. Preventative ethics is another way to help with the ethics of antenatal depression. Preventative ethics is “anticipating and preventing ethical dilemmas in clinical practice” (Miller, 2009). For example, many pregnancies are unplanned, therefore it makes sense to discuss pregnancy and contraception with all women of childbearing age that have a current, underlying or past mental illness, in order to proactively anticipate potential risks. Both autonomy and …show more content…
The Edinburgh Postnatal Depression Scale (EPDS) (Cox et al, 1987) was developed for women in outpatient, home visit settings. Although originally created for postnatal depression, the EPDS is often used for antenatal depression. Even if women do not turn up to bookings or appointments the midwife can contact them via telephone or letter and include the EPDS as part of the conversation to help judge whether or not there is a higher potential of antenatal depression. The scale can be translated into any language, takes a very short amount of time and can even be used as a reference on improvements or deterioration of her mental health, enabling midwives to see an objective score week after
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