The unborn baby

Question 1

What is the perinatal period?

Answer 1

Period immediately before (approx. 20th-28th week gestation) and after (1-4 weeks after birth)

Question 2

What types of perinatal mental health problems can occur?

Answer 2

Antenatal/ postnatal depression
Postpartum psychosis
PTSD

Question 3

What is the leading cause of death for women during pregnancy and in the first year after giving birth?

Answer 3

Suicide

Question 4

What is a key indicator that a woman may suffer postnatal depression?

Answer 4

Antenatal depression and anxiety

Question 5

What assessment should be used to identify postnatal depression in primary care postnatally?

Answer 5

GAD-2

Question 6

What 2 questions are included in the GAD-2 assessment?

Answer 6

In the last 2 weeks:
Feeling anxious, nervous or on edge
Not being able to stop or control worrying

Question 7

What can a foetus be exposed to in utero that can predispose to increased risk of disease in later life?

Answer 7

Decreased blood flow to foetus
Overexposure to glucocorticoids (result of maternal cortisol crossing placenta so increased stress increases exposure to cortisol)

Question 8

What are the effects of cortisol on the foetal brain?

Answer 8

Toxicity affects areas of foetal and child brain, particularly HPA axis (responsible for setting stress thermostat - affected HPA axis results in increased stress levels throughout childhood and into adulthood)

Question 9

What are the potential obstetric consequences of antenatal anxiety?

Answer 9

Low birth weight/ small size for gestational age
Preterm labour
Impaired blood flow or raised resistance index to the foetus through the maternal uterine arteries associated with intra-uterine growth restriction and pre-eclampsia

Question 10

What neurodevelopmental problems can children be at risk of due to prenatal stress?

Answer 10

Childhood emotional problems (esp. anxiety and depression)
Symptoms of ADHD
Conduct disorder

Question 11

What does psychic reorganisation refer to?

Answer 11

Old psychological conflicts can be revived during periods of reorganisation including during pregnancy - women may reflect on relationships with their own mother and begin to consciously or unconsciously think about and evaluate the way they were parented - may revive negative feelings or emotions

Question 12

What does maternal representation of the developing baby refer to?

Answer 12

Mental images or thoughts about what a mother’s unborn baby is, or will be, like
Usually occurs during 2nd or 3rd trimester
Associated with child’s attachment security after birth

Question 13

What impact can maternal representations have on a child’s future attachment?

Answer 13

Mothers with a more balanced representation are more likely to have a child who is securely attached at 12 months
Mothers who have disengaged or distorted representations are more likely to have a child who is insecurely attached or disorganised

Question 14

What is the Working Model of the Child?

Answer 14

Interview technique used to assess mother’s maternal representations of their developing baby
Categories: balanced, disengaged, distorted or disrupted

Question 15

What can affect maternal representations?

Answer 15

Biological, psychological and social factors including environment and relationships of the mother-to-be

Question 16

How can domestic violence impact maternal representations?

Answer 16

More likely to experience negative representations resulting in an infant who is insecurely attached

Question 17

How can a mother’s relationship with her unborn baby predict future attachment?

Answer 17

Predicts quality of the parent-infant interaction in the postnatal period which is a key indicator of infant attachment security

Question 18

What is “Ghosts in the Nursery”?

Answer 18

The idea that ‘ghosts’ from the parent’s childhood invade the ‘nursery’ (parent-infant relationship) by unconsciously influencing the way parent’s think about and behave towards their baby
Can also appear during antenatal period as a result of mother’s psychic reorganisation or her developing maternal representations

Question 19

What are “unresolved parents”?

Answer 19

Parents who carry issues from their childhood that have not been addressed and therefore may be less able to parent their baby effectively due to infant distress triggering their own stress and painful memories of vulnerability and dependence

Question 20

How might you be able to identify an “unresolved parent”?

Answer 20

May make inaccurate assumptions about the reason’s for infant’s distress (e.g. crying to annoy)
Describing child in highly critical or inappropriate terms
May become withdrawn or intrusive with parenting

Question 21

How can a parent move from being unresolved to a resolved parent?

Answer 21

Require the opportunity to address issues from their own childhood and require help to learn how to understand the mental state of oneself and others

Question 22

What is reflective functioning?

Answer 22

Capacity of parent’s to experience baby as an ‘intentional’ being rather than viewing them in terms of their physical characteristics or behaviours - helps baby to develop understanding of mental states in other people and to regulate their own internal experiences

Question 23

How can reflective functioning impact attachment?

Answer 23

Those with higher reflective functioning during pregnancy are more likely to have an infant who is securely attached at 1 year - strongly associated with positive maternal behaviours and the baby’s use of their mother as a secure base

Question 24

What can be the consequence of low reflective functioning on maternal behaviour?

Answer 24

Can result in unresponsive maternal behaviour (e.g. withdrawal, hostility and intrusiveness)

Question 25

How can reflective functioning be assessed during pregnancy?

Answer 25

Working Model of the Child interview

Question 26

What are the key predictors of attachment in the perinatal period?

Answer 26

Maternal representations of baby
Parent-infant interactions
Reflective functioning
Unresolved vs. resolved parent