Postpartum Mental Health Flashcards
When does the taking in phase occur? how long does it last?
immediately after birth, lasting 24-48 hours
how do moms feel in the taking in phase? (3)
- overwhelmed
- focused on herself
- wants to talk about birth & it replays in her mind to process it
Should the nurse teach moms in the taking in phase?
no, they are not yet receptive to learning
if there needs to be teaching, keep it short, realistic & supportive
What does the mom need during the taking in phase?
support from others
What is the nurses role during the taking in phase? (3)
- assisting with newborn care
- assisting with self-care for the mom
- keep any teaching short, realistic & supportive
what is key during the taking in phase?
patience, esp if it is her first baby
when does the taking hold phase occur?
usually around day 2 after birth, may take longer
How is the mom acting during the taking hold phase? (3)
- Begins adjusting to motherhood and accepting the new reality
- Starts focusing on baby and self-care.
- Mom is full of questions like “is this normal?” and will need guidance
Should the nurse teach moms during the taking hold phase?
yes, this is the most ideal time for teaching & is where most teaching will take place
when does the letting go phase occur?
usually after the first month, often by 6 week checkup
how is mom acting/feeling during letting go phase? (3)
- fully assumes motherhood role
- gains confidence in her identity as a mother
- begins to feel more at ease with the role
what is the nurses role during the letting go phase?
Continue to provide support but more in the background, as mom becomes more independent in her new role.
What is a normal & common part of postpartum adaptation affecting approx 80% of women?
baby blues
where does baby blues occur?
may occur at home or in hospital
list the sx of baby blues (6)
- mood swings
- weepiness
- frustration
- irritability
- disappointment
- sense of being let down by motherhood
what often triggers baby blues?
hormonal shifts, particularly the rapid drop in estrogen and progesterone after delivery
when/how does baby blues usually resolve?
Usually resolves in 10-14 days without treatment
what is the nurses role during baby blues?
Important to reassure mothers that baby blues are normal and part of the transition. This helps prevent feelings of inadequacy or guilt.
what is the prevalence of postpartum depression?
Affects 10-20% of women after giving birth
1 in 5 new mothers
what does PPD interfere with?
bonding between mother and baby
how does PPD affect infant development?
There is reduced mother-baby interaction (fewer smiles, cooing, and baby talk) → Less stimulation = developmental delays.
list the risk factors for PPD (6)
- hx of mood disorder
- stressful life events
- unplanned pregnancy
- lack of social support
- complications during pregnancy & delivery
- body image issues
mood disorders during pregnancy = ?
higher likelihood of PPD
List the sx of PPD (6)
- persistent sadness or lack of joy
- disturbances in eating or sleeping
- may have significant anxiety component
- feelings of worthlessness, inadequacy as a mother
- thoughts of hurting self
- may also have OCD componenent
List the tx options for PPD (8)
- cognitive behavior therapy
- support groups
- Zoloft (Sertraline) SSRI
- Prozac (Fluoxetine) SSRI
- Brexanolone (Zulresso)
- Electroconvulsive Therapy (ECT)
- exercise
- sunlight exposure or light therapy
what SSRI is preferred for PPD and why?
Zoloft (Sertraline) → Preferred due to shorter half-life.
Prozac (Fluoxetine) → Longer half-life, sometimes used.
can women taking SSRIs breastfeed?
yes most are safe for breastfeeding; psychiatrists should not discourage breastfeeding if SSRIs are needed
What is the IV infusion for severe postpartum depression? what does it do and why is it used?
Brexanolone (Zulresso)
it addresses hormonal causes
it is expensive but it is promising tx
what is the first line tx for PPD?
SSRIs
what tx for PPD is reserved for severe, treatment-resistant cases?
Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT) works faster than _______. within how long does it work?
SSRIs
1-2 weeks
what is the downside to beginning tx for PPD?
Highest risk for suicide is when treatment begins:
- Energy returns before mood improves.
- More ability to act on suicidal thoughts.
Like all patients with depression:
- Low energy = desire without energy
- Increased energy = ability to carry out plan
differentiate between baby blues and PPD
Baby Blues Sx → temporary and mild
PPD Sx → persist and affect daily life.
what is a rare but severe postpartum mental health disorder? what is the incidence?
postpartum psychosis
1-2 women in 1000 births
although postpartum psychosis is rare, who has a higher risk?
Women with a history of bipolar disorder have 100 times the incidence!
in postpartum psychosis, there is a high risk for what?
suicide & infanticide
in postpartum psychosis, auditory hallucinations often involve what?
harming the baby
what are the signs and sx of postpartum psychosis? (4)
- Delusions/hallucinations
- Depersonalization
- Bizarre and disorganized behavior
- Neglect of self/infant
what is a common delusion/hallucination of postpartum psychosis?
Belief that baby is possessed, evil, or an alien.
women with postpartum psychosis are usually _______ to tx
responsive
when a woman is experiencing postpartum psychosis, what is most important?
safety of the woman and infant
when a woman with postpartum psychosis is treated inpatient, should the infant be there as well?
no, hospitalization is separated from infant
how is a woman with postpartum psychosis stabilized?
on anti-psychotics
anti-psychotic agents may be incompatible with what?
breastfeeding
