Perinatal Mental Health Flashcards

1
Q

what can influence a developing fetus?

A

During pregnancy, mental and physical health, behaviour, relationships and environment all influence the internal environment and the developing fetus.

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2
Q

what does the growing up in Scotland study show?

A

This study shows that maternal mental health is closely related with socio-economic disadvantage and lower levels of social and emotional support maternal mental health problems in the first year are birth are often associated with further episodes of poor mental health.

By the age of four, children who have prolonged and repeated exposure to a mother with mental health problems were particularly likely to have poor behavioural, emotional and social outcomes. This may affect their transition to school and their subsequent development and attainment.

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3
Q

what does the circle of security involve?

A
  • Welcome my coming to you
    • Protect me
    • Comfort me
    • Delight in me
    • Organise my feelings
    • Support exploration
    • Watch over me
    • Enjoy with me
      Help me
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4
Q

how do children build different attachment styles?

A

Children build different attachment styles in response to the care they receive. That style of attachment is designed to help baby cope with the relationship system they live in. the nature of this early attachment sets the template for later relationships in that it shapes the child’s expectations of themselves, the world and others, and ca predict a number of physical, social, emotional and cognitive outcomes.

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5
Q

what secure attachment?

A

Sophie has an image of her parents as a secure base and available for comfort. Sophies self-image is that she is worthy of her parents attention and love.

Sophie can gain some comfort from this when separate, having confidence that her parents will return, her reactions to separations do no show panic; she has some capacity to contain them in the knowledge of her parent’s availability.

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6
Q

what is insecure avoidant attachment?

A

Liam has a rather troubled attachment to his parent. Liam is often not upset at separation and tends not to get close to his parents even when they are reunited after a separation.

Often he turns away from, rather than towards to parent. Liam seems to expect the parent’s response to be inappropriate and the relationship to be difficult, he seems to lack a solid sense of himself as worthy of affection.

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7
Q

what is insecure ambivalent attachment?

A

Emily is likely to show distress at separation which suggests that the parent’s presence is important to her but seems to lack a firm belief that her parents will return, or that the parent will be able to comfort her effectively on return and therefore fails to use her parents as a source of comfort at reunion.

Emily is not easily able to comfort herself and doesn’t seem to feel herself worthy of her parents affection. Emily also rejects stranger’s attempts to console her and her expectation seems to be a pessimistic one that cannot be eased by another.

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8
Q

what is insecure disorganised attachment?

A

Jason seems unable to ‘know what to do’, there seems to be a lack of clear expectations of what others can do or consistent strategies for handling stress.

Jason may seem to be somewhat hesitant about contact, not quite sure whether it is something to be pursed or not and there is little obvious goal seeking in the behaviour. Jason may turn to himself for comfort and may seem ‘dazed’ or confused or show repetitive stereotyped movements.

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9
Q

what are the four attachment styles?

A
  • secure attachment
  • insecure avoidant attachment
  • insecure ambivalent attachment
  • insecure disorganised attachment
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10
Q

what influences a parental role?

A

These early experience along with factors such as parental mental wellbeing, family circumstance and the support network around families can influence these core elements of how the parent approaches their parental role;

parental reflection function
mind-mindedness
parental sensitivity

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11
Q

what is parental reflective function?

A

refers to a parent’s capacity to recognise their own mental state and be able to communicate to their baby an understanding that they might have a different mental state - to ‘mentalise’. This is linked to how responsive a parent can be to their child needs..

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12
Q

what is mind-mindedness?

A

is a parent’s capacity to interpret what their infant is thinking and feeling. Research has linked this capacity with secure attachment as well as other positive developmental outcomes.

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13
Q

what is parental sensitivity?

A

relates to the parental capacity to see their child as a separate person, be able to accurately ‘read’ their child’s behavioural cues and respond appropriately. High parental sensitivity is also closely linked with the development of secure attachment.

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14
Q

what are the basic build blocks?

A
  • Healthy food
    • Safe environment
    • Sleep
      Medical needs met
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15
Q

what happens if sensitive and responsive care is absent?

A

If sensitive and responsive care is absent, the infant does not have the opportunity to learn that they can depend on their caregiver for meeting their emotional and physical needs.
This impacts on their sense of self, their interactions with other and their attachment to their caregiver.

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16
Q

what happens if consoling when they cry is absent?

A

If consoling when they cry is absent, it may have an impact on the infant’s development of secure attachment relationships and the development of their emotion regulation skills and capacity.

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17
Q

why is being able to read baby’s cue and communication important?

A

Being able to read the baby’s cues and communications allows you to respond appropriately to their needs. One way to understand a baby’s communication is through recognising key behaviour states. This helps you decide when the baby is ready for sleep, feeding or interaction so you can provide most sensitively to their needs.

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18
Q

Brazelton (Brazelton et al., 1990) identified six states of alertness in newborns, which are?

A
  • deep sleep
  • active (light) sleep
  • drowsy state
  • awake, alert state
  • alert, but fussy state
  • crying
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19
Q

what is deep sleep?

A

lies quietly without moving with eyes firmly closed, their breathing is deep and regular with no motor activity. The baby may have brief startles but will not be rouse. In this state, growth hormones are active.

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20
Q

what is active (light) sleep?

A

moves while sleeping and startles at noises. The baby’s eyes are firmly closed but there may be slow rotating movements of the eyes as the state is REM (rapid eye movement) sleep. There will be bodily twitches and irregular or shallow breathing may be apparent. Facial movements include frown, grimaces, smiles, twitches, mouth movements and sucking. It is thought that brain growth and differentiation may occur during active sleep.

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21
Q

what is drowsy state?

A

eyes may open and close but looked glazed in appearance. The baby may doze where their arms and legs may move smoothly. Their breathing is regular but faster and shallower than in sleep. Babies in this state may be stimulated to a more alert and responsive state.

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22
Q

what is awake, alert state?

A

the baby’s body and face are relatively quiet and inactive with bright shining eyes. Sights and sounds may produce predict responses which can be very rewarding for parents. This is the state in which the baby is most amenable to play.

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23
Q

what is alert but fussy state?

A

this is a transitional state to crying. They are available to external stimuli and may be soothed or brought to an alert state by attractive stimuli. If this is too much, they make break down to fussiness where their movements are jerky, disorganised and these movements may produce startles in themselves.

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24
Q

what is crying?

A

cries, perhaps screams which can set off an automatic response of concern, responsibility and guilt in parents. This is the most effective mode for attracting a care giver. There are different types of cries such as hunger, pain, boredom, discomfort and tiredness.

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25
Q

how do you observe parent infant interaction?

A
  • Sensitivity to cues from baby
    • Emotions between parent and baby
    • How the interaction were paced
      Responsiveness to these cues
26
Q

how do you promote the parent and infant relationship?

A
  • Strengthen the parent infant interaction
    • Helping to support the couple’s relationship
    • Support family life
    • Help to build and bolster social support
    • Understanding baby’s development
    • Support parent in making healthy choices in looking after their own emotional wellbeing.

Even before baby is born, parent and baby are forming a relationship. When you work mothers-to-be its important to give them the opportunity to talk about their feelings towards their unborn baby, their hopes, fears and expectations of birth and motherhood, and how they think they are going to be as a mum.

27
Q

what is the containment role?

A

One of the roles that you can have in supporting infants in the perinatal period is to help their parents with their containment role.

Infants can feel overwhelmed by their feelings and need a responsive adult to recognise this and help them regulate their emotions, for example, to feel that their distress is contained and manageable.

To be able to do this for their child, the parent also needs to be able to process their anxieties and distress which in turn allows them the emotional space to receive and manage their child’s distress.

28
Q

what percentage of fathers will experience depression pre and postnatally?

A

8-10

Fathers who may be more at risk are those who have a history of depression, unemployment, or social deprivation or those where the pregnancy was unplanned or where there are difficulties in the relationship.

29
Q

what are the factors that can have an impact on father’s mental health?

A
  • Before the baby is born - difficulty bonding baby in utero and having fears associated with partner’s labour and birth process.
    After birth - the difficulties often focus on practical aspects of trying to balance work and time with baby. There can be a perceived deterioration in the relationship with their partner, including reduced satisfaction with their sexual relationship.
30
Q

what information can you use to understand baby’s development?

A
  • Ready steady baby
    • Tiny happy people
    • BLISS resources
      Solihull approach resource
31
Q

The perinatal period is a time when it may be easier for parents to think about what changes?

A

The perinatal period is a time when it may be easier for parents to think about changes like giving up smoking, improved diet and exercise or addressing drug and alcohol consumption.

32
Q

when should a child protection risk assessment be carried out?

A

It is important to note that not all partners and families will be support to women in the perineal period and it is important to identify where the partner violence and/or the maltreatment of siblings is a contributing factor to the woman’s mental state and a risk to the mother and/or baby.

Risk and risk factor are discussed in the module on risk and outline the circumstances should give particular cause of concern

33
Q

how does child protection associate with maternal mental health?

A

A common feature of maternal mental illness is thinking that you are not competent mother, or you are a danger to your infant, along with this there will be a fear that your children will be taken away. Referral on child protection grounds should not be routine when mother develop a mental illness but should take place as a result of an individualised risk assessment. When a referral on child protection grounds is necessary, because the infant has or is likely to suffer from harm, then extra vigilance and care are require. Referral to social services may otherwise result in avoidance of care and necessary treatment and may increase the risk of deterioration in the mother’s mental health and suicide.

34
Q

what does the maternity neonatal psychological inventions service (MNPI) involve?

A
  • Multi-professional service based in AMH.
    • Three Psychologists and PMH Midwife
    • Provide psychological interventions where indicated
    • Related to the Maternity Journey
    • Previous Birth Trauma, Pregnancy Loss
    • Neonatal Unit
    • Whole family approach: Service for dads too
    • Looking to provide service for staff
    • Refer via Badgernet
      For Dads specific referral form on intranet
35
Q

what is the role of the PMH midwife?

A

leader
advocate
quality improvement

36
Q

what is the leadership role of the PMH midwife?

A
  • Assessment and Care Planning
  • Deliver Psychological
    Interventions
37
Q

what is the advocate role of the PMH midwife?

A
  • Link
  • Develop local care pathways
    Localised woman centred care
38
Q

what is the quality improvement role of the PMH midwife?

A
  • Education
  • Reduce stigma
    Strategic local and national
39
Q

what is the perinatal period?

A

Preconception -> Antenatal -> Intrapartum -> Postpartum (1 yr)

Burden of perinatal mental illness

Up to 20% of women develop a mental health problem during pregnancy or within a year of birth.

40
Q

what is the pyramid of perinatal need?

A
  • 4% highest risk: complex needs
    • 8%: mental health intervention
    • 8% psychosocial support
    • 80% maternal mental wellbeing awareness and information
41
Q

what falls under mild - standard care, perinatal mental health?

A
  • Depression
  • Anxiety
    Baby blues
42
Q

what falls under moderate - enhanced care, perinatal mental health?

A
  • Depression
  • Anxiety
  • Tokophobia
  • PTSD
  • OCD
  • Sub misuse
    Personality disorder
43
Q

what falls under severe and enduring (SMI) - Specialist care, perinatal mental health?

A
  • Bipolar affective disorder
  • Schizophrenia
  • Schizoaffective disorder
  • Severe depression +/- psychotic symptoms
    Postpartum psychosis
44
Q

what is the onset, duration, symptoms and treatment of baby blues?

A

onset - 2-5 days

duration - A few days

symptoms - Mood liability (lows and highs)

treatment - Self-limiting

45
Q

what percentage of births does baby blues effect?

A

50%

46
Q

what is the onset, duration, symptoms and treatment of perinatal depression?

A

onset - Antenatal or postnatal (common by 6-8 weeks PN)

duration - From weeks - years

symptoms - Typical symptoms of depression

treatment - Psychotherapy,
Antidepressants

47
Q

what percentage does perinatal depression affect?

A

10-15%

48
Q

what is the onset, duration, symptoms and treatment of puerperal psychosis?

A

onset - Usually first 2 weeks
Peak first 3 months [postnatal

duration - Weeks - months

symptoms - Severe affective, psychosis, rapidly changing, mixed presentation

treatment - Medication in patient treatment

49
Q

what is the likelihood of puerperal psychosis?

A

2 per 500 deliveries

50
Q

what are the adverse outcomes of perinatal mental health?

A
  • Suicide
    • Non accidental injury
    • Physical complications
      Obstetric complications
51
Q

how does untreatment mental illness affects the baby?

A
  • Foetal & neonatal deaths
    • Neurological malformations
    • Obstetric complications
    • Attachment & bonding problems
    • Emotional & behavioural problems
    • Developmental /cognitive delay
      More accidents, neglect, abuse & death
52
Q

who does maternal mental illness impact?

A
  • Mother
    • Infant/ unborn child
    • Dependents
      Partner
53
Q

what is the management pathway for standard care?

A
  • Watchful waiting
  • Screen by GP/Midwife/Health Visitor
  • GP review if on antidepressant therapy
  • Mental health midwife
    Other support
54
Q

what is the management pathway for moderate care?

A
  • Counselling/CBT
  • GP review - may need medication
  • May need psychiatric review if not responding/complex needs
  • Perinatal CPN +/- psychiatrist
    Have plan to monitor MH
55
Q

what is the management pathway for severe and enduring (SMI) care?

A
  • Requires psychiatric assessment + monitoring
  • Is she open to mental health services?
  • If not, refer
  • If current relapse, suicidal ideation, will need urgent review
  • Psychiatry input + CPN
    Close monitoring
56
Q

what are the standards of care, NICE guidelines in relation to perinatal mental health?

A
  • History of mental illness should be documented in communication with maternity
    • All women with history of SMI/current illness should be referred to secondary MH care team
    • Should have access to specialist perinatal MH Service
    • Should be able to access psychological intervention in timely manner (within 4 weeks)
    • Should have mental healthcare plan documented in notes, copy to all relevant professionals
    • Inpatient admission should be to mother & baby unit (not general adult ward
57
Q

what are the general principles of perinatal mental health care?

A
  • Acknowledge the woman’s role in caring for her baby and support her to do this in a non-judgmental and compassionate way
    Involve the woman and, if she agrees, her partner, family or carer, in all decisions about her care and the care of her baby.
58
Q

what is the overview of standard care perinatal mental health pathway?

A
  • Sharing of information between GP and maternity services
    • Screening at booking and subsequent contacts (Personal and Family History, Whooley Q, GAD-2y)
    • Postnatal screening: community MW/ HV
    • Primary Care management
    • Review of mental state, discussion of relapse
    • Management by GP
    • Prescribing advice as needed from MH services
      Engagement with community supports, e.g. parenting support
59
Q

what is the overview of enhanced care perinatal mental health pathway?

A
  • Review of MSE, discussion of relapse indicators
    • Review of MH/ screening at all contacts
    • Input from GP+/- mental health services
    • Perinatal MHT +/- CMHT
    • Multi-agency liaison as needed
    • Engagement with additional supports
      Pre-birth mental healthcare planning meeting as needed – child and family SW involvement
60
Q

what is the overview of specialist care perinatal mental health pathway?

A
  • All women should be referred for review by mental health services as early as possible – pre-conceptual
    • Should have discussion of risk of relapse
    • Regular monitoring and active engagement
    • Admission to specialist Mother & Baby unit, prophylactically or in case of relapse
    • Pre-discharge planning meeting prior to discharge home
    • Multi-agency working, liaison with maternity team Mental Health Services