Chapter 5 Flashcards
what is the #1 medical complication related to childbearing
Perinatal Mood and Anxiety Disorders (PMADs)
PMADs is ___ and ____
detectable and treatable
why do we care about PMADs?
we have the opportunity to help women with prior undiagnosed mental illness or those at risk for continued mental illness
what societal tragic consequences can PMADs lead to?
- relationship problems/divorce
- disability/unemployment
- child neglect and abuse
- developmental delays/behavior problems
- infanticide/homicide/suicide
when do PMADs occur?
- depression and anxiety disorders can occur any time in pregnancy or in the first year postpartum
PMAD is replacing what narrow definition term?
PPD
what % of mothers experience baby blues?
80% experiencing baby blues lasting for the first two weeks after baby arrives
prevalence of serious depression and/or anxiety in pregnancy or postpartum period
1 in 7 mothers
**spikes to 1 in 5 during months 5-7 postpartum
prevalence of postpartum psychosis
1-2 in 1000 women
prevalence of fathers with depression in the postpartum period
1 in 10 fathers
myths of motherhood
- getting pregnant is easy/hard
- 50% of pregnancies are unplanned
- becoming a mother is easy/natural
- being pregnant is easy or always wonderful
- labor and delivery will always go as planned
- breastfeeding is natural and will be easy
- the baby will sleep all the time
- superwoman/wife/mother is the expectation
- all pregnancies are wanted
pregnancy equivalency myths
- pregnancy = live baby
- pregnancy = love in a relationship
- pregnancy = healthy baby
- pregnancy = fulfillment
PP psychological and physiological changes
- focus on baby/forming attachment
- fatigue/sleep deprivation
- loss of freedom, control and self esteem
- hormonal changes
- birth not going as expected
- learning new roles
- role transitions
- dreams and expectations
feelings of “loss”
- loss of freedom/feeling tied down
- loss of old identity
- loss of control
- loss of a body image
- loss of self esteem
- loss of financial means
- loss of image of career/loss of career potential
types of perinatal mood disorders
- depression
- anxiety or panic disorder
- obsessive compulsive disorder
- psychosis
- bipolar
- post-traumatic stress disorder
** These disorders can affect people at any time in their lives however there is a marked increase in prevalence of these disorders during the pregnancy and postpartum period.
is postpartum blues a mild form of depression?
no
postpartum blues peaks at what time?
peaks 3-5 days after delivery
features of postpartum blues
tearfulness, lability, reactivity
postpartum blues: predominant mood
happiness
is postpartum blues related to stress or psychiatric history?
no
what is believed to be the cause of postpartum blues?
- hormone withdrawal
- maternal bonding hormones
baby blues affects what % of new mothers
80%
symptoms of baby blues
** these symptoms are MILD
- crying
- feeling overwhelmed with motherhood
- being uncertain
cause of baby blues
due to the extreme hormone fluctuation that happens in the days and weeks surrounding birth
how long does baby blues last?
lasts 2 days to 2 weeks
contributing factors to baby blues
- extreme sleep deprivation
- fatigue
perinatal depression symptoms
- OVERWHELMED
- lack of feelings toward the baby
- inability to take care of self or family
- loss of joy, pleasure, interest
- anxiety
- isolation
- “this doesn’t feel like me”
- mood swings
- worthlessness
anxiety symptoms
- Agitated
- Inability to sit still
- Excessive concern about baby’s or her own health
- High Alert
- Appetite changes- usually rapid weight loss
- Sleep Disturbances- inability to fall or stay asleep
- Constant Worry
- Racing thoughts
- Shortness of breath
- Heart palpitations
OCD is characterized by
intrusive, troubling thoughts (obsessions) and repetitive, ritualistic behaviors (compulsions) which are time consuming, cause significant distress and impair functioning
classic OCD symptoms
- cleaning
- checking
- counting
- ordering
- obsession with germs and cleanliness
- checking on baby
- hypervigilance
what are the components of the “OCD cycle”
obsessions, anxiety, compulsions, relief
prevalence of OCD
- general population: 1.08%
- pregnant women: 2.07%
- postpartum women: 2.43%
incidence of OCD (in pregnancy/postpartum)
- in pregnancy: 2.1-13.7%
- in postpartum: 2.3-15.2%
___ and ___ are associated with the onset of OCD
pregnancy and postpartum
**more frequently than other life events
risk factors associated with postpartum OCD
- primiparity
- first 4 weeks of PP period
- higher levels of anxiety
- previous hx of OCD
- avoidant personality disorder
- personal hx of major depression
- existence of OCD related dysfunctional belief
OCD % prevalence: primiparity vs multiparity
primi: 6.57%
multi: 1.8%
what is PTSD?
Anxiety disorder after a terrifying event or ordeal in which grave physical harm occurred or was threatened
**subjective (“it’s in the eye of the beholder”)
symptoms of PTSD
- intrusive re-experiencing of a post traumatic event
- isolation from family and friends
- “emotional numbing”
- hyperarousal/hypervigilance
- avoidance
are postpartum blues and baby blues the same thing or different?
same thing, different names
postpartum PTSD themes
- perception of lack of caring
- poor communication
- feeling of powerlessness
- do the ends justify the means
PTSD theme: perception of lack of caring
- feeling abandoned
- stripped of dignity
- lack of support or reassurance
PTSD theme: poor communication
- moms felt invincible
PTSD theme: feeling of powerlessness
- betrayal of trust
- didn’t feel protected by staff
PTSD theme: do the ends justify the means?
healthy baby justified traumatic delivery?
- healthy mommy, healthy baby
PTSD in NICU parents: risk factors
- neonatal complications
- lower gestational age
- greater length of stay in NICU
- stillbirth
PTSD treatments
- EMD (eye movement)
- CBT (cognitive behavioral therapy)
prominent symptoms of PTSD in NICU parents
- intrusive memories of infant’s hospitalization
- avoidance of childbirth reminders
types of birth trauma
- Emergency c/s
- Postpartum Hemorrhage
- Preterm Birth
- Infant in NICU
- Vacuum or forceps delivery
- Severe Pre-ecclampsia
- 3rd or 4th degree laceration
- Hyperemesis
- Traumatic Vaginal Birth
onset of psychosis
usually within first 3 weeks after delivery
postpartum psychosis symptoms
- Delusions (baby is possessed by the devil)
- Hallucinations (seeing someone else’s face where the baby’s should be)
- Insomnia
- Confusion/disorientation (worse than in normal postpartum psychoses).
- Rapid mood swings (worse than in normal postpartum psychoses).
- Waxing and waning (can appear to see normal in-between psychotic symptoms).
postpartum depression in dads is ____ as common as adult male population in the US
twice
dads with depression symptoms
- initial high after gives way to depression
- irritable
- agression
- hostility
- distancing or “checking out”
- not very likely to show sadness
factors that would exacerbate PMADs
- Complications in pregnancy, birth or breastfeeding
- Age related factors : teenage or perimenopause
- Climate Stressors: Seasonal affective disorders Mania or Depression
- Perfectionism, high expectations (“Superwoman Mentality”)
- Pain (intolerable/untreated)
- Sleep Disturbances
- Abrupt discontinuation of breastfeeding.
- Childcare Stress/Relationship stress
- Losses- miscarriages, neonatal death, stillborn, elective termination
- History of childhood sexual abuse
treatment options for PMADs
- medical evaluation and treatment
- social support and practical help
- new parent classes and groups
- mental health counseling
