The Unborn Baby

Question 1

What is the perinatal period?

Answer 1

Defined as the period immediately before and after starting at the 20-28th week of gestation and lasting 1-4 weeks after birth so definition is variable

Question 2

What mental health problems are common in women in the perinatal period?

Answer 2

Antenatal and postnatal depression
PTSD
Postpartum psychosis

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 associated with postnatal depression?

Answer 4

Antenatal anxiety and depression SO GAD-2 should be used to assess a pregnant women’s health and wellbeing at all contacts

Question 5

What is foetal programming?

Answer 5

Adverse influences during foetal life can alter the structure/function of distinct cells thereby programming the individual for an increased risk of developing disease in adult life

Question 6

What are the potential underlying mechanisms of foetal programming?

Answer 6

1. Decreased blood flow to foetus
2. Overexposure to glucocorticoids as a result of maternal cortisol crossing the placenta
3. Impact of stress on transplacental transfer e.g. placenta filter

Question 7

How can maternal antenatal stress affect the baby?

Answer 7

The placenta normally filters what passes from the mother through to the foetus but the emotional state of the mother can change this filtering capacity so if the mother is stressed, more cortisol may pass through

Question 8

How can the foetal stress thermostat be affected?

Answer 8

High levels of cortisol can be toxic for the foetal brain and can adversely affect a number of areas of both the foetal and child brain inc. the HPA axis which is responsible for setting the stress thermostat resulting in these children experiencing higher levels of stress throughout childhood into adulthood

Question 9

What the obstetric consequences of antenatal anxiety?

Answer 9

Low birth-weight/small for gestational age
Pre-term labour
Intra-uterine growth restriction
Pre-eclampsia

Question 10

How can intra-uterine growth restriction and pre-eclampsia occur?

Answer 10

Impaired blood flow or raised resistance (blood flow) index to foetus through the maternal uterine arteries is associated with these conditions

Question 11

What are the commons neurodevelopmental outcomes in children aged 3-16 years as a result of antenatal stress?

Answer 11

Child emotional problems esp. anxiety and depression
ADHD symptoms
Conduct disorder

Question 12

What is psychic re-organisation?

Answer 12

In pregnancy, many women will reflect on old psychological conflicts such as their relationship with their own mother and begin to consciously or unconsciously think about and evaluate the way they were parented which may re-awaken negative feelings or emotions

Question 13

What are maternal representations )MR) of the developing baby?

Answer 13

Mental images or thoughts about what her unborn baby is, or will be, like, occurring due the 2nd and 3rd trimester

Question 14

What is maternal representations (MR) associated with?

Answer 14

A child’s attachment security after birth where a mother with BALANCED representations are more likely to have infants securely attached at 12 months whereas mothers with DISENGAGED/DISTORTED representations are more likely to have infants insecurely attached or disorganised

Question 15

What is the Working Model of the Child?

Answer 15

A interview technique used to assess mother’s maternal representations of their developing baby including the categories:

• Balanced
• Disengaged
• Distorted
• Disrupted

Question 16

What can affect maternal representations (MR)?

Answer 16

Biological changes

Psychological and social factors inc. environment and relationships they are in where for example women experiencing domestic violence had more -ve MRs and babies are more likely to be insecurely attached

Question 17

Why is a mother’s relationship with the unborn baby important?

Answer 17

It predicts the quality of the parent-infant interaction in the post-natal period which is an important indicator of infant attachment security at 1 year

Question 18

What is the ‘Ghosts in the Nursery’?

Answer 18

Ghosts from the parent’s childhood invade the nursery via parent-infant relationship by unconsciously influencing the way parents think about and behave towards their baby where the parents may re-enact with their baby ‘scenes from their own unremembered, but still painfully influential early experiences of helplessness and fear’ - these can make appearances during pregnancy as a result of mother’s psychic reorganisation or her developing MRs

Question 19

What are unresolved parents?

Answer 19

Parents who carry with them issues from their childhood that have not been addressed

Question 20

What are the key characteristics of an unresolved parent?

Answer 20

1. Less able to parent their baby because the infants distress triggers their own stress and painful memories of vulnerability and dependence, because they are unable to respond to the infant in terms of his/her current functioning
2. Often unable to understand distress of infant and make inaccurate assumptions about the reason for such behaviours e.g. a mother might suggest her baby is crying to annoy her or described baby in highly critical inappropriate terms i.e. she is evil

Question 21

What is the outcome of an unresolved parent?

Answer 21

Parenting styles can become:

1. Very withdrawn
2. Intrusive

Question 22

How can parents move from being unresolved to resolved?

Answer 22

They need the opportunity to address their childhood issues, and help to learn how to understand the mental state of oneself and others

Question 23

What is reflective functioning?

Answer 23

The capacity of the parents to experience the baby as an ‘intentional’ being rather than simply viewing them in terms of physical characteristics or behaviour

Question 24

How can reflective functioning in the parent positively help the baby?

Answer 24

The baby will develop an understanding of mental states in other people, to regulate their own internal experiences and are more likely to be securely attached at 12 months

Question 25

What is reflective functioning highly indicative of?

Answer 25

Positive maternal parenting behaviours such as flexibility and responsiveness so the baby can use the mother as a secure base

Question 26

What is low reflective functioning of the parents associated with?

Answer 26

Emotionally unresponsive maternal behaviours such as:

• Withdrawal
• Hostility
• Intrusiveness

Question 27

How can you measure a womens reflecting functioning in pregnancy?

Answer 27

Look at the mothers MR of unborn baby utilising the Working Model of the Child Interview