The postpartum period is a time of great physiological and psychological transition for many women, especially women giving birth to preterm infants. These women may be at greater risk for "postpartum blues," a phenomenon that occurs between Days 3-14 in 40-60% of postpartum women. Although postpartum blues are transitory, 20% of women experiencing them may develop postpartum depression. Cortisol, a physiologic index of stress, may also index postpartum blues (Ehlert, 1990). Kangaroo care (KC), wherein mothers hold their newborns skin-to-skin, is a nursing intervention that facilitates maternal relaxation, decreases stress, and alleviates feelings of depression (Affonso et al., 1989, 1993).
Objectives: The objectives of this study were to 1)determine the effect of KC on cortisol and depression and 2) describe the relationship between depression and cortisol in postpartum women.
Design: Women were randomily assigned to the KC group or the control group immediately after delivery. At 6 hours postbirth and twice daily on Days 1-5, saliva was collected on filter paper to measure cortisol, and a visual analogue scale was used to measure depression.
Sample: 72 postpartum women who gave birth to 32-36 week infants in a tertiary level midwestern hospital.
Intervention and Outcome Variable: The intervention variable was kangaroo care or skin-to-skin contact between a mother and her newborn infant. Outcome variables were feelings of depression and salivary cortisol.
Findings: Comparative and descriptive statistics showed 1) a significant difference for morning salivary cortisol between KC and Control groups (p=0.028) on Day 5 2) a significant difference for afternoon depression scores between KC and Control groups (p=0.038) on Day 3 and 3) no correlation between depression and cortisol during Days 1-5.
Conclusions: Feelings of depression peak on Day 3 for the control group. This is consistent with the onset of postpartum blues in the general population. The KC group does not exhibit this peak indicating KC may help prevent the onset of depression. Also, there is an increase in cortisol on Day 5 for the KC group. This could be an indicator that KC facilitates reactivation of the hypothalamic-pituitary-adrenal axis during the postpartum period. Finally, there does not appear to be a relationship between maternal feelings of depression and salivary cortisol in these postpartum women.
Implications: Kangaroo care may be one simple nursing intervention used to decrease feelings of depression for postpartum women. In additional, these results contribute to the ongoing exploration of the physiological mechanisms underlying postpartum depression.
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