Unborn Baby

Question 1

What does perinatal period mean? What’re the dates?

Answer 1

The period immediately before and after birth

20th-28th week of gestation and ends 1-4 weeks after birth

Question 2

How prevalent are mental health problems int he perinatal period? What types of mental health does it include?

Answer 2

20% of women

Antenatal and postnatal depression
PTSD
Postpartum psychosis

Question 3

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

Answer 3

Suicide

Question 4

What questionnaire is used to assess a pregnant woman’s mental health? What 2 questions does it ask?

Answer 4

GAD-2

Over the last 2 weeks how often have you felt:
Nervous, anxious or on edge
Unable to stop or control worrying

Question 5

Outline foetal programming

Answer 5

Adverse influences during foetal life can alter structure/function of distinct cells = programme individual for increased risk of disease development in adult life

Decreased blood flow to foetus?
Overexposure to glucocorticoids from maternal cortisol crossing the placenta?
Impact of stress on transplacental transfer

Question 6

How can the role of the placenta influence the foetus? (Eg in maternal antenatal stress)

Answer 6

Placenta filters what passes from the mother through to the foetus
Emotional state of mother can change filtering capacity
If mother is stressed, more cortisol can pass through

Question 7

What’s responsible for setting the foetal stress thermostat?

Answer 7

HPA axis
High levels of Cortisol (toxic to developing brain)
Children likely to experience higher levels of stress throughout childhood

Question 8

What are obstetric consequences of antenatal anxiety?

Answer 8

Low birth weight - small for gestational age
Preterm labour
Intra-uterine growth restriction and pre-eclampsia (due to impaired blood flow/raised resistance to the foetus through uterine arteries)

Question 9

What are children aged 3-16 at a greater risk of, if exposed to prenatal stress?

Answer 9

Anxiety 
Depression
Symptoms of attention deficit
Hyperactivity disorder
Conduct disorder

Question 10

What’s psychic re-organisation in pregnancy?

Answer 10

When old-psychological conflicts may be revived

Many women reflect on their relationship with parents during pregnancy which may re-awaken negative feelings

Question 11

What are maternal representations of the developing baby? Which trimesters does it occur in?

Answer 11

Mental images or thoughts about what the unborn baby is/will be like

Second and third trimester

Question 12

What’s a consequence of distorted/imbalanced maternal representations of the developing baby?

Answer 12

Insecure or disorganised attachment

(Mothers with balanced representations are more likely to have infants who are securely attached at 12 months0

Question 13

How can maternal representations of the developing child be assessed?

Answer 13

Through interview technique - the Working Model of the Child Interview

Balanced
Disengaged
Distorted
Disrupted

Question 14

What’s ‘Ghosts in the nursery’?

Answer 14

Ghosts (previous experiences) from the parent’s childhood invade the parent-infant relationship (nursery) unconsciously influencing the way parents think about and behave towards their baby

Parents may re-enact scenes from their own unremembered but painfully influential early experiences of fear

Question 15

What are unresolved parents? How can this affect the child?

Answer 15

Parents who carry issues from their childhood that haven’t been addressed

Parents may be less able to parent baby because infants distress triggers their own stress and painful memories = unable to respond to infant

Question 16

How can parents move from unresolved to resolved?

Answer 16

They need the opportunity to address issues from their childhood eg counselling/CBT

Question 17

What is reflective Functioning? What’s it’s purpose?

Answer 17

Capacity of parents to experience the baby as an intentional being
Rather than viewing them in terms of physical characteristics/behaviour

Helps baby to develop understanding of mental states in other people and regulate own experiences

Question 18

Women who are high in reflective functioning in pregnancy are likely to have an infant with what type of attachment?

Answer 18

Securely attached at 12 month

Question 19

What’s the importance of reflective functioning?

Answer 19

Strongly associated with positive maternal parenting behaviours
Associated with baby’s use of mother as a secure base

Question 20

What’s low reflective functioning associated with?

Answer 20

Emotionally unresponsive maternal behaviours: withdrawal, hostility and intrusiveness

Question 21

What are maternal representations and when do they occur?

Answer 21

Refer to mental images/thoughts about what the unborn baby will be like (mothers with balanced representations are likely to have a securely attached infant at 1 y/o)

Occur from the second trimester (week 12)

Question 22

What does ghosts in the nursery refer to and when do the ‘ghosts’ appear?

Answer 22

How a parents behaviours is influenced unconsciously by their own painful experiences, unremembered, unresolved childhood experiences

Occur in the antenatal period

Question 23

Why do ghosts in the nursery develop?

Answer 23

In the antenatal period

As a result of either: maternal psychic reorganisation or developing representations of the unborn baby