Perinatal health and Wellbeing- Lecture 6 Flashcards

Question

Perinatal Psychopathologies PND in Fathers Predictors Paulson & Basemore (2010)

Answer 1

Meta analysis- having a depressed partner increases the risk

Answer 2

Fathers’ support: >found to shield the infants of chronically depressed mothers from negative outcomes (Field, 1998) >Reduces mother's parenting stress (Jackson, 1999) >minimises negative maternal child-rearing attitudes (Brunelli et al, 1995).

Answer 3

Important to remember that some increased anxiety is adaptive in the perinatal period-- Where is the line? >Many studies assume any anxiety present is "pathological" (Matthey, 2016) >Measurement problematic: general measures include somatic items naturally occuring in postpartum>> should not be used in pregnancy as =likely to be normal & lead to misdiagnosis >Anxiety or stress? important to distinguish as excessive stress not mental illness but excessive anxiety may be

Answer 4

Defining what was traumatic event in DSM- blurred lines >had to be out of usual range of human experience (but birth is inside this) REVISED- 1994... -Added personal appraisal of the event- 'life threatening'

Answer 5

- Stillbirth - Assisted or emergency births - Perceived threat - Care and support during birth * *but subjective experience more important than objective**- what is not traumatic to one may be to another

Answer 6

>Re-experiencing symptoms, such as upsetting thoughts, images and nightmares about event (Hard not to relive when caring for product of them) >Avoidance and numbing, trying to avoid thoughts or reminders of the event >Hyperarousal symptoms such as sleep disturbances, being overly vigilant, and irritable (Confounded by the normal by-products of the postpartum – adaptive anxiety, blues, lack of sleep etc.)

Answer 7

Extreme fear of pregnancy >>as a result of PTSD ----but can also heal the woman (go either way)

Answer 8

>Severe mental illness with dramatic onset shortly after birth (Brockington, 2006) >Significant danger to self and child >1/1000 mothers >childbirth= trigger of mood episodes w/ psychotic features >Pre-existing bipolar increases risk=570/1000 REQUIRES HOSPITALISATION- many mothers and babies separated= lacking specialist units

Answer 9

Health in pregnancy should not just focus on negatives, should be balance>> positive psychological aspects This can help inform interventions aimed at promoting wellbeing, rather than reducing risk of mental health

Answer 10

Just as a positive affect is not the opposite of a negative affect, wellbeing is not the absence of mental illness. >>Can be achieved by individual with a diagnosis

Answer 11

Role satisfaction Role competence Social support Good health

Answer 12

Foetal programming- foetus involved in dynamic communication with the mother Maternal stress affects the foetal hypothalamic pituitary adrenal axis (central stress response) increasing cortisol released in baby.

Answer 13

``` >Lower birth weight >Prematurity >Challenge temperament >More sleep problems >Lower cognitive performance >Emotional problems ```

Answer 14

Studies using childbearing specific measures have more predictive power >stress as related to childbearing rather than general stress

Answer 15

Maternal mind-mindedness Poor mental health after birth> makes responding to child in a sensitive and emotionally responsive fashion more difficult Evidence: mothers with mental health conditions > more inaccurate reflections of infants thoughts and feelings

Answer 16

Thought to be a vital cognitive component of relationship between mental health and maternal responsiveness Measured during free-play in attuned or non attuned comments

Answer 17

Mind mindedness is the "parental tendency to think and comment appropriately on their infants internal states"

Answer 18

15% of pregnancies affected by e.g. - Gestational diabetes, pre-eclampsia, and preterm labour (Davis and Miles, 2016) >Preterm labour most common- 1 in 10 (WHO, 2018|) -Premature rupture of membranes

Answer 19

Biological: Multiple pregnancies, preeclampsia, , diabetes, bleeding, growth restriction, infection, genetics Sociodemographic: age, poverty, marital status, ethnic background (African American women = 2X rate of prematurity Lifestyle: smoking, alcohol use, substance use, stress

Answer 20

>Ride range of emotional reactions- shock, uncertainty, sadness, excitement and happiness (Price et al., 2007) >Depression and anxiety much higher - but levels of cortisol remained the same>> Suggests it is 'perceived stress' of high risk that contributes to the onset of symptoms

Answer 21

Mental illness due to H.R. pregnancies results in lower use of health promoting behaviours, such as: >Diet >Exercise >Attendance at prenatal appointments

Answer 22

Mental illness due to H.R. pregnancies results in lower quality of maternal-fetal attachment **particularly in hospitalised women**

Answer 23

Hamilton et al. (2010) Smaller and younger infants have highest rate of problems >>stay in NICU/SCBU -hospital stays range from days>years

Answer 24

higher mortality, morbidity, and adverse outcomes across the life span

Answer 25

Pelcovitz (1996): "horrifying life event" that doesn't compare to anything else like "coping with life threatening illness in one's child" Franck et al. (2005: -Grief over loss of parental role *similar to that of losing a newborn*

Answer 26

"Kangaroo care" Initially in low -income countries as NICU under resourced >Found infants had better health outcomes and less mortality >>Transferred to high-income countries as means of promoting healthy attachment

Answer 27

Improves: >parenting competence, knowledge, responsiveness, infant sleep, want to breastfeed Decreases: >Depression, Infant crying, Pain responses, Length of stay - Effects continue after discharge - Critical in improving maternal and infant health by humanising the NICU experience

Answer 28

Miscarriage: loss upto 20 weeks Stillbirth: loss 20> weeks Neonatal: death in newborn period (28 days)

Answer 29

Affects many areas of psychological functioning as it: | -occurs in already emotionally vulnerable individual

Answer 30

Depression, anxiety, and post-traumatic-stress disorder (PTSD) increased depending on whether the mother: - Had no contact with stillborn - Saw the stillborn - Held the stillborn

Answer 31

One aspect of identifying as adult is development of parental identity - thoughts abouts parenthood and logistics start from young age implicitly - perinatal loss interrupts this and changes concept of parental identity

Answer 32

Previously>>Perinatal loss = non event with no serious consequences as thought attachment begins after birth BUT- widespread argument that attachment starts in pregnancy ,so... - Loss results in painful, lasting, often complicated grief - But still minimised particularly in early miscarriage

Answer 33

Grief reactions based on how much parents regard foetus as a person -Measured by asking women: What they felt they lost (pregnancy, baby, a baby named…, a child who would….) -High scores (more person assignment) significantly predicted intensity of grief response

Answer 34

Pregnancy and parenting prior to 20> worse biopsychosocial outcomes (Logsdon et al., 2016): -competing bio demands of maturing and carrying baby -social tension between adolescence and pregnancy/parenting -more common in low SES groups and depressed individuals >>> could being in these groups cause worse outcomes?

Answer 35

Poorer outcomes in pregnancy: >Less prenatal care, low birthweight infants, preterm birth, c-section birth >Ongoing maternal growth is a risk factor for low birthweight (Wallace et al. 1997)

Answer 36

Poorer outcomes after birth: >Mother: Less likely to perform well in school, negative impact on relationships, reduced parenting skills >Infant: Poor educational attainment, increased risk of mental health problems, increased risk for child abuse

Answer 37

25 qualitative studies on teenage mothers- 5 themes some positive: 1. Reality of motherhood brings hardship 2. Straddling the two worlds (motherhood+adolescence) 3. Motherhood as positively transforming 4. Baby as a stabilising influence 5. Positive influence of social support in reshaping future

Answer 38

Teenage pregnancy is always viewed as negative- an accident Found themes: -changing direction from volatile background -gaining new identity, role -positive and generic preference for parenthood

Answer 39

Experience of pregnancy and childbirth can be strongly rooted in culture (Kitzinger, 2001) Unintentional pregnancies > with poorer mental health outcomes in non-Western cultures E.g. Shameful for women to become pregnant before marriage in Japan (Hertog & Iwasawa)

Answer 40

During childbirth: >In some Asian cultures fathers are not involved in the birth process at all, in others the father speaks for the mother during birth >Chinese and Japanese women report that minimal noise and verbal expression of pain is accepted during childbirth – it is shameful to scream and uses up needed energy

Answer 41

In non-Western cultures the postpartum period is believed to last 40 days New mothers rest and recuperate (confinement) while family take care of the rest >THEORY OF HOT AND COLD -rebalancing the environment - mother requires hot things and avoids cold things + exercise In western cultures: >Nutritious diet and exercise are promoted

Answer 42

Biomedical model of pregnancy dominated western culture >high use of hospitals and doctors >regular appointments despite no problems >>>can become a cycle of birthing negativity

Answer 43

>Pregnancy is viewed as a normal experience which does not require intervention unless there is a problem >The elder of the family provide information and guidance during this time >Stigma around mental health conditions more generally >Less likely to seek help, particularly for adjustment issues >>>lessens likelihood of creating a vicious cycle of fear

Answer 44

Fertility declines as women age | Advancing maternal age increases pregnancy risks e.g. diabetes or hypertension.

Answer 45

Studies suggest women are not aware of the risks of aging on fertility and pregnancy. Particularly relevant > career-focused women or in higher education as these groups are more likely to put off childbearing (Lampig et al. 2006)

Answer 46

>Unable to achieve a desired life-course change (Matthews & Martin Matthews, 1986) - -Sense of isolation and alienation for the “fertile world” - -Loss of control and identity Treatment is stressful, invasive and prone to failure

Answer 47

Psychological distress and infertility are linked : >Not being able to conceive causes stress >Stress reduces the chances of pregnancy