However, during pregnancy and childbirth, there will be strong psychological and physical stress reactions. At the same time, if pregnant women are accompanied by negative emotions such as depression for a long time during pregnancy, it is easy to cause endocrine and nervous system disorders, which will have a serious impact on pregnancy outcome and postpartum mood.
Under the guidance of the service concept of medical humanistic care, the medical social work project of the Sixth People's Hospital of Nanhai District, Foshan City, Guangdong Province, joined hands with obstetrical medical staff to build a multidisciplinary team of pregnant women, carry out prenatal depression screening of pregnant women, and explore the causes of depression of pregnant women and the intervention service path, in order to relieve the psychological stress of pregnant women, help them cope with the risks during pregnancy, reduce the experience of bad diseases, and relieve their depression during pregnancy. It is of great significance to maintain the physical and mental health of pregnant women and newborn babies, the harmony and stability of families, and it is also the embodiment of hospital social responsibility and medical humanistic care.
In the whole service process, social workers play the roles of peers, educators, supporters, therapists and resource connectors. Through evaluation, screening and service contact, they can find the key service cases of depression, and cooperate with medical departments, partners and their families, pregnant women, psychological counselors and parenting education experts to carry out a series of supportive services. Through evaluation and screening, changing bad cognition, empowering and establishing supportive resources, prenatal and postnatal depression can be prevented.
Service path step 1: looking for "people"
Take four methods and ten methods to find pregnant women with depression.
Firstly, an evaluation and screening mechanism was established, and the depression self-identity scale and social work service propaganda were nailed to the cover of the prenatal examination. During the prenatal examination, files were filed for the first time and pregnancy services were involved. Each pregnant woman was evaluated and screened with the scale, and pregnant women with high scores or abnormal emotional state were recommended or referred.
Secondly, based on the pregnant women's school and novice parents' training camp, we designed board games and special services such as "mood space", "yoga meditation and relaxation" and "childbirth dance" for pregnant women, observed, interviewed and found pregnant women's emotions and current difficulties, and provided timely service suggestions. At the same time, through these services, pregnant women can relax, improve their pleasure and coping ability, and open large-scale and external entertainment activities irregularly to enhance their pregnancy pleasure.
Thirdly, with the help of pregnant women's school platform, social workers design and teach courses such as pregnant women's cognition and skills improvement, family relationship management, etc., to establish professional identity and promote pregnant women and their families to take the initiative to ask for help.
Finally, departments such as obstetrics, maternal and child health care, psychiatry, and community social workers should work together so that pregnant women with emotional or practical difficulties can be found and referred to medical social workers.
The second step of service path: fine classification and service-oriented.
Through the above services, we can find our key service groups, make corresponding evaluations according to their needs and characteristics, and choose service priorities:
The first is to change bad cognition. Assist the case owner to express distorted cognition, then change his negative automatic thinking, establish correct cognition, and help the case owner to practice constantly, so that he can know and refute when distorted cognition appears, and prevent the influence of distorted cognition on emotions.
The second is to improve coping skills. The case mainly includes correct cognition and corresponding action guidance, including relaxation training, music and painting therapy, childbirth dance and so on. And when the depression comes, it will be relieved or transferred in time. At the same time, the case owner will be mobilized to establish a benign and interactive social relationship, express his thoughts and emotions, go out to the sun regularly, do what he can, do voluntary service, and increase his sense of self-worth.
The third is to establish supporting resources and improve their resource utilization rate. Support resources are mainly divided into four categories:
(1) Instrumental support, mainly social workers to guide pregnant women to learn to get help from their families or caregivers, especially to ensure food and sleep, and not to be overworked;
(2) Emotional support, linking multiple groups to give pregnant women care, understanding and support, and alleviating their depression, helplessness, loss and loneliness;
(3) Therapeutic support, including medication or drug therapy by medical staff to relieve discomfort caused by physical factors, and professional skills guidance such as family therapy, music and painting therapy and relaxation training provided by psychological counselors and social workers;
(4) Full and accurate support, through courses, online and offline consultation and information transmission and exchange, can reduce the confusion and fear of pregnant women due to lack of knowledge and skills. Among them, social workers are compiling the Lucky Pregnancy Handbook, which includes technical guidance for pregnant women to cope with depression, access to medical service information, non-medical service information, case sharing of follow-up services for depression cases, surrounding community resources and rescue resources.
The third step of service approach: continuous evaluation and timely referral.
In the follow-up service, social workers constantly evaluate the mental and emotional status of the case owner, such as whether the case owner has self-mutilation thoughts or behaviors, the degree of self-isolation, family care and support, etc. When necessary, they will be referred to psychiatric department or higher-level hospital and community social workers for follow-up services. Medical social workers will also pay irregular visits and care for the rehabilitation of the case owners.
Guangzhou Peking University Boya Social Work Resource Center has been stationed in Nanhai Sixth People's Hospital for five years, providing medical social work services. So far, the project has covered multi-dimensional services such as obstetric services, gynecological services, volunteer management, and adjustment of doctor-patient relationship.
Among them, the obstetrical pregnant women's depression prevention and treatment service system has its own characteristics, and the effectiveness of the service has been scientifically tested. Two papers have been published in the medical special issue of China Journal of Social Work.
Service-related departments recognize social work services and actively participate in and jointly promote humanistic care services. At the present stage, Nanhai Sixth Hospital has established the linkage service of "medical staff-social workers-pregnant women", which is dedicated to building a social support system for pregnant women, assisting pregnant women to cope with physical, psychological and social discomfort during pregnancy, and building a social worker service path for the prevention and treatment of depression in pregnant women.
Transferred from: social worker (ID: shegongke)
Contributed by: Boya Social Work Resource Center of Guangzhou Peking University
Author: Ou Miaoxian