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Lifespan and Development > Perinatal health and Wellbeing- Lecture 6 > Flashcards

Perinatal health and Wellbeing- Lecture 6 Flashcards

1
Q

Importance of Perinatal health and wellbeing

A

> 353000 babies born every day around world
Every pregnancy brings unique set of biopsychosocial changes in person
1 in 5 women will experience clinically significant mental illness during or after pregnancy

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2
Q

Hormonal changes:

Human chorionic gonadotropin

A

Egg meets sperm, hCH amps up Est. and prog.

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3
Q

Hormonal changes:

Estrogen

A

Uterus growing, regulating other key hormones, triggers dev. of baby’s organs

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4
Q

Hormonal changes:

Progesterone

A

Encourages breast tissue growth, later helps soften ligaments and cartilage to prepare for birth

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5
Q

Hormonal changes:

Relaxin

A

Relaxing muscles, bones, ligaments and joints in preparation for birth

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6
Q

Hormonal changes:

oxytocin

A

Stimulating labour

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7
Q

Hormonal changes:

Prolactin

A

Causes breasts to increase in size and produce milk

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8
Q

Early pregnancy: 1st trimester (1-12 weeks)

Key bio changes

A 
>Nausea and vomiting- 70-85% (ACOG, 2004): direct effect of hCG
>Fatigue- 96.6%:
(Zib, Lim & Walters, 1999)
  Contributing factors:
  -increased oxygen 
   consumption
  -metabolic changes
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9
Q 
2nd Trimester (12-27 weeks)
& 3rd trimester (28-birth)
Key bio changes
A

> Symptoms most affecting QoL are increased urination, fatigue and heartburn (75-88%)- Nazik and Eryilmaz (2013)
Worsening of sleep quality during pregnancy (63%)
Due to:
-Fetal movement
-Impaired movement

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10
Q

Postpartum

Key bio changes

A

-Healthy recovery usually takes 6 weeks approx- huge drop in pregnancy hormones
-Poor sleep quality- newborn wakes every 2-3 hrs
Woodland et al. (2013) most common complaints 3 months after birth= fatigue, back pain, breast probs & urinary incontinence,

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11
Q

Key social Transitions
The Woman
Emmanuel & St. John (2010)

A

Becoming a mother encompasses several psychosocial challenges:
-Known > unknown reality
-New maternal identity- w/ assoc. feelings & behaviours
-Renegotiating prior social roles- e.g. family, work, partner
-Balancing multiple demands
-Experiencing losses
Normal adaptation to these» personal growth

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12
Q

Key Social Transitions:

Relationship and sexual functioning

A

> Common belief that parenthood is central in fulfilling romantic relationship (Hanson, 2012)

> Sexual and relationship satisfaction and functioning declines from preg. to 1st b-day (Mitnick, 2009)

> Increased marital conflict compared to during pregnancy (Hanington et al. 2012)

> Twenge (2003)- meta analysis: parents vs non-parents
-P’s = lower relationship satisfaction and quality

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13
Q

Key Social Transitions:
Relationship and sexual functioning
Key predictors…
Twenge (2003)

A

> pre-pregnancy quality and duration
planned pregnancy
parents relationship status
mental health status

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14
Q

Key psychological changes

-Adaptive Anxiety

A

Anxiety = adaptive in pregnancy and postpartum
>health
>wellbeing
>survival of mother and infant postpartum
tightly linked to period of childbearing

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15
Q

(Fallon et al. 2016)

A

Adaptive anxiety is tightly linked to the specific period of childbearing one is at
Anxiety is adaptive at:
>Pregnancy- to avoid miscarriage, birth complications, health of infant
>Postpartum- for attachment, infant safety, routine care of infant, breastfeeding and coping

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16
Q

Key psychological changes:

Stress response and coping

A

> Stress decreases as pregnancy progresses (Entringer et al 2010)
Cope with stress better during pregnancy
-avoidant coping
strategies used less
- -> avoidant strategies assoc. w reduced preparation for parenting, bonding problems

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17
Q

Key psychological changes:

Why do we stress less and cope better during pregnancy

A

Exposure to high stress= potential to adversely impact fetal development etc. (Van den Bergh, 2005)
**Innate protective mechanisms to preserve fetus at critical periods in development? **

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18
Q

Key psychological changes:

Postpartum blues

A

Mood changes common in postpartum- 50% of women

3-5 days PP peak in blues
»thought to be due to drop in hormones
Initial studies study variants of depression:
- found increased tearfulness and lower mood

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19
Q

Postpartum blues:

Issues with literature

A

All negative findings in earlier studies
Findings due to focusing on negatives
Newer studies look at both + & - :
>Found that the predominant mood experienced is happiness (e.g. Edborgh, 2008)
>Found BOTH neg and pos moods elevated (Wilkinson, 1999)

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20
Q

Psychopathology during pregnancy and the postpartum

Aetiology

A

> Biological- History of MH problems, genetics, substance use, MASSIVE DROP IN HORMONES (ESTROGEN AND PROGESTERONE)
Social- Intimate relationships, supports, people at work
Psychological- Personality, attachment style, cognitive style, coping techniques
Interpersonal- role transitions, grief and loss, interpersonal disputes, birth of baby, breastfeeding difficulties

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21
Q

Perinatal Psychopathologies

Focus on Perinatal Depression (PND)

A

Largest mental health focus on PND
Problematic:
-Lack of info for non PND women w/ symptoms
-Comorbidity goes undetected (blanketed by PND)
-Over diagnosis of PND even when not present
-Mothers who are not diagnosed as depressed may have other conditions that go undetected

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22
Q

Perinatal Psychopathologies

PND

A
  • Can occur at any time from pregnancy> 1st year postpartum
  • Prevalence rates- 9-16%
  • Higher in deprived areas
  • Often comorbid with anxiety
  • Linked to Paradox of loss theory (Nicholson, 2001)
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23
Q

Perinatal Psychopathologies

PND in Fathers

A

-Prevalent in some fathers
»suggests social, psychological and interpersonal factors are independently important in onset
-paternal depression rates twice that of average men (Paulson et al. 2006)

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24
Q

Perinatal Psychopathologies
PND in Fathers
Predictors
(Dudley et al. 2001)

A

> Infant related problems (feeding/sleeping)
Prior experience of fatherhood
Relationship quality

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25
Q

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

A

Meta analysis- having a depressed partner increases the risk

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26
Q

Perinatal Psychopathologies
PND
Paternal protection

A

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).

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27
Q

Perinatal Psychopathologies

Issues with Perinatal Anxiety literature…

A

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

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28
Q

Perinatal Psychopathologies

PTSD after childbirth

A

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’

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29
Q

Perinatal Psychopathologies

Birth factors predicting PTSD

A
  • 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
30
Q

Perinatal Psychopathologies

Particularly problematic PTSD to treat…

A

> 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.)

31
Q

Tocophobia- Definition

A

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

32
Q

Perinatal Psychopathologies

Postpartum Psychosis

A

> 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

33
Q

Perinatal wellbeing

A

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

34
Q

Cacioppo and Berntson (1999)

A

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

35
Q

Factors promoting wellbeing i perinatal period

A

Role satisfaction
Role competence
Social support
Good health

36
Q

Perinatal Psychopathologies

-The effects on the infant in pregnancy

A

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.

37
Q

Infant birth outcomes related to Perinatal Psychopathologies

A 
>Lower birth weight
>Prematurity
>Challenge temperament
>More sleep problems
>Lower cognitive performance
>Emotional problems
38
Q

Pros of using Childbearing specific measures

A

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

39
Q

Perinatal Psychopathologies -Effect on the infant post-partum

A

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

40
Q

Mind- mindedness importance

A

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

41
Q

Meins (2001)

A

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

42
Q

High risk pregnancies

Rates

A

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

43
Q

Risk factors of having a high risk pregnancy

A

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

44
Q

Parental responses and coping with high risk prenancy

A

> 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

45
Q

Stark & Brinkley (2007)

A

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

46
Q

White et al. (2008)

A

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

47
Q

High risk infants

Life in SCBU/NICU

A

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

48
Q

What Premature babies are at risk of…

A

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

49
Q

Parents of NICU infants

Emotional reactions

A

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

50
Q

High risk infants

-Using skin to skin contact in NICU

A

“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

51
Q

Skin to Skin contact effects

A

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
52
Q

Perinatal Loss

A

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

53
Q

Perinatal loss

A

Affects many areas of psychological functioning as it:

-occurs in already emotionally vulnerable individual

54
Q

Hughes et al. (2002)

A

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
55
Q

Perinatal Loss and The Reproductive story

Jaffe et al, 2011

A

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
56
Q

Perinatal loss and Grief

When does attachment begin?

A

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
57
Q

Assignment of Personhood

Dombeck et al. (2001)

A

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

58
Q

Special populations
Teenage pregnancy
biopsychosocial outcomes

A

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?

59
Q

Special populations
Teenage pregnancy
Pregnancy outcomes

A

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)

60
Q

Special populations
Teenage pregnancy
Postpartum outcomes

A

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

61
Q

Positive outcomes

Clemens (2003)

A

25 qualitative studies on teenage mothers- 5 themes some positive:
1. Reality of motherhood brings hardship

  1. Straddling the two worlds (motherhood+adolescence)
  2. Motherhood as positively transforming
  3. Baby as a stabilising influence
  4. Positive influence of social support in reshaping future
62
Q

Teenage pregnancy-
What about the ‘planned’ pregnancies
Coleman and Cater (2007)

A

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

63
Q

Special populations
Cultural context
In pregnancy

A

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)

64
Q

Special populations
Cultural context
During childbirth

A

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

65
Q

Special populations
Cultural context
Postpartum

A

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

66
Q

Special populations
Cultural context
Medicalised pregnancies in West

A

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

67
Q

Special populations
Cultural context
Normalisation of pregnancies in East

A

> 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

68
Q

Special populations

Infertile individuals

A

Fertility declines as women age

Advancing maternal age increases pregnancy risks e.g. diabetes or hypertension.

69
Q

Special populations
Infertile individuals
Fertility awareness

A

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)

70
Q

Special populations
Infertile individuals
Psychological consequences of infertility

A

> 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

71
Q

Special populations
Infertile individuals
Psychological-infertile cycle
(Van Balen, 2002)

A

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

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