Lectures 24 & 25 - Psychosocial Aspects of Pregnancy & Postpartum Flashcards
Factors affecting the pregnancy experience?
- Age
- Health
- Resources
- Occupation
- Social support availability
- Birth history
- Whether is planned/desired
Common 6 concerns during pregnancy?
- Management/meaning of physical complaints
- Changes in work and other activities
- Change in appearance
- Change in relationships
- Labor/delivery and baby’s health
- Shift in identity begins
Do most women react well to normal pregnancies and have a stable affect?
YUP
3 psychological stages of pregnancy? Describe each.
- Accepting the news: from learning about it to the first ultrasound (8-10 wks), physical symptoms, memory impairments, ambivalence, fear of miscarriage
- First “stirrings” of a separate being: from ultrasound to point of viability (24-28 wks), stage during which the news is shared, time of relative peace and fulfillment, realization that life exists within
- Attachment and learning about the baby to be: point of viability to birth, physical symptoms causing dependability and vulnerability, nesting, fear about birth and baby’s health (especially as baby moves less)
In what pregnancy stage are there marked differing experiences for partners?
2nd stage
In what pregnancy stage is there a lot of fun sex?
2nd stage
During what pregnancy stage do women feel guilt about abandoning their first baby?
2nd stage
What conflict occurs in the 3rd stage of pregnancy?
Approach-avoidance conflict: occurs when there is one goal or event that has both positive and negative effects or characteristics that make the goal appealing and unappealing simultaneously.
Common 8 reactions to bed rest or hospitalization during pregnancy?
- Heightened concern about one’s own health and health of fetus
- Feelings of uncertainty & lack of control
- Feeling like a “prisoner”
- Feelings of “missing out”
- Concern regarding care for other children in family
- Role reversal with partner
- Financial stress related to stopping work
- Separation from usual support of spouse and family (in case of hospitalization)
% of pregnancies that are high risk in the US? What % of perinatal mortality do they account for?
30%
50%
What factors determine if a pregnancy is high risk? Provide examples.
- Maternal: HIV, diabetes
- Obstetrical: pre-eclampsia, single umbilical artery
- Fetal: twins, fetal anomalies
What is a high risk pregnancy a risk factor for?
Depression and anxiety during pregnancy
4 factors affecting adjustments to “high risk” diagnosis?
- Stage identified as “high risk”
- Etiology of the risk
- Nature of the treatment
- Personality structure and coping style of pregnant woman
Healthy way of coping with transition to motherhood?
Recognize gains and necessary losses
10 necessary losses of motherhood?
- Body/physical changes
- Confidence/self-esteem
- Sleep
- Time for self/independence
- Work identity
- Control/predictability
- Spontaneity
- Intimacy and relationship focus
- Romantic vision of being perfect mother
- Special attentioN from pregnancy
Why is it important to explore losses with patients?
- Validates the pain/grief felt
- Reassures that feelings are not unusual
- Minimizes guilt that frequently compound pain
Is postpartum blues a disorder? What is it due to?
NOPE
Estrogen cliff
7 symptoms of postpartum blues?
- Weeping *
- Emotional lability*
- Sad mood
- Irritability
- Lack of affection
- Hostility towards husband
- Feelings of unreality
What % of new mothers experience postpartum blues?
26-85% of new mothers
How long does baby blues last?
2 weeks usually: begins at day 2-4 and peaks at day 4-5
What are PMADs?
Perinatal Mood and Anxiety Disorders
What causes postpartum depression?
Unclear, but perfect storm:
- Unrealistic expectations
- Hormonal changes
- Sleep Deprivation
- Single biggest identity transition for women
- Possible difficulties in pregnancy or birth
- Possible predisposition for depression or anxiety (prior depression is biggest predictor for PPD)
What are 5 typical scenarios for PMADs?
- Evaluation and tx prior to family planning
- Pre-conception counseling
- Inadvertent conception during treatment
- Acute onset or recurrence during pregnancy
- Acute onset during post-partum
Is depression during pregnancy more common than in other times in life?
NOPE (10-15%)
What is the strongest predictor of PPD?
Antenatal depression
Why is diagnosing depression during pregnancy challenging?
Symptoms overlap: fatigue, low concentration, changes in sleep and appetite
Is depression underdiagnosed during pregnancy?
YUP (50% of cases go unrecognized)
What is the #1 complication of childbirth?
PMADs
Impact of antenatal depression on mother?
- Non-compliance with prenatal care
- Self-medication with drugs, alcohol, tobacco
- Poor bonding with baby
- Impact on family
- Self harm/suicide
- Post-partum depression
Impact of antenatal depression on fetus?
- Pre-term labor
- Premature birth (<37 wks)
- Low birth weight
- Small for gestational age, small head circumference (stress state)
- Low APGAR scores
- Neonatal complications
- NICU admissions
- Fetal demise
6 principles for treating depression during pregnancy?
- Women with a hx of depression should seek consultation prior to pregnancy (perinatal psychiatrist)
- Mild symptoms = non-pharmacologic interventions
- Non-pharmacologic interventions preferred
- Medication should be considered for the treatment of disabling or serious depression, threatening maternal or fetal well-being
- Protects against post partum depression
- SSRI’s are not associated with morphologic or behavioral teratogenicity – large bodies of peer reviewed data
How to make treatment decisions for pregnant women?
Weigh the severity of active symptoms against risks of pharmacologic interventions
Can any psychiatric disorder present or recur in the postpartum period?
YUP
Most common postpartum psychiatric disorders?
Mood and Anxiety disorders are most common:
- Major Depression
- Bipolar Disorder
- Generalized Anxiety Disorder
- Obsessive Compulsive Disorder
- Panic Disorder
- Post-traumatic Stress Disorder
Prevalence of PPD?
12-14%
When does PPD start?
1-6 mos after delivery (may have initial well-being period or grow out of postpartum baby blues)
PPD DSL criteria?
MDE occurring within 4 weeks post partum, so same symptoms as MDE:
- Depressed Mood
- Anhedonia
- Appetite and/or weight changes
- Sleep Problems
- Psychomotor changes
- Fatigue/low energy
- Excessive guilt/feelings of worthlessness
- Impaired concentration
- Suicidal ideation (higher risk than normal)
7 symptoms of PPD?
- Tearfulness
- Despondency
- Emotional lability
- Excessive guilt
- Excessive worry about baby’s well-being
- Poor concentration & memory
- See self as “bad,” “unloving,” “inadequate” mother
7 risk factors for PPD?
- History of depression or mood disturbance before or during pregnancy
- History of PPD
- Lower family income
- Lower occupational status
- Poor marital relationship
- Low social support
- Coexistence of excessive life stress
What is the difference between suicide in women vs pregnant women?
Normally, men have more success committing suicide than women
This does not hold true for pregnant women
Treatment considerations for PPD?
Treatments address both biologic and psychosocial factors
Pharmacologic treatment:
SSRIs most widely studied (esp. Fluoxetine)
Depending on SSRI, could be problematic for women who are breast feeding, story is still unfolding
Strong evidence of effectiveness for psychosocial interventions
What are some non-pharmacological treatments for PPD?
- Elimination of caffeine, nicotine, & alcohol
- Adequate sleep
- Facilitating communication physician
- Reduction of psychosocial stress
- Relaxation techniques
- Light therapy
- Psychosocial Treatments:
- Support groups
- Couples therapy
- Cognitive-Behavioral Therapy (CBT)
- Interpersonal Therapy (IPT)
Incidence of paternal post natal depression?
1 in 10
14 symptoms of paternal post natal depression?
- Irritability
- Isolating/Withdrawing from relationships
- Working a lot more or less
- Low Energy
- Fatigue
- Low motivation
- Poor concentration
- Changes in weight or appetite
- Impulsivity
- Risk-taking behaviors
- Physical symptoms
- Anger and outbursts
- Violent Behavior
- Suicidal Thoughts
Why do dads get depressed? Which is #1?
- Sleep Deprivation
- Psychological Adjustment to 3. Parenthood
- Personal/Family Hx of Depression
- Hormones: testosterone increases, estrogen increases
- A depressed Partner
- Relationship Stress (#1)
- Feeling Disconnected from 9. Baby or Partner
