Upload
scott-parrish
View
254
Download
5
Embed Size (px)
Citation preview
8C-8C-22
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Case study
You are visiting a mother called Amal is in the You are visiting a mother called Amal is in the fifirst postpartum week; she feels persistently rst postpartum week; she feels persistently guilty and negative towards herself, cries easily guilty and negative towards herself, cries easily and feels tired and agitated. and feels tired and agitated.
1. What might she be suffering from? 1. What might she be suffering from?
2. What other symptoms would you ask her 2. What other symptoms would you ask her about, to about, to
conconfifirm your diagnosis?rm your diagnosis?
2
8C-8C-33
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
The psychological context of pregnancy and The psychological context of pregnancy and the puerperiumthe puerperium
Stress/anxietyStress/anxiety
Pregnancy and the puerperium are normal life Pregnancy and the puerperium are normal life events, yet they are periods in a woman's life when events, yet they are periods in a woman's life when her vulnerability exposes her to a significant her vulnerability exposes her to a significant amount of anxiety and stress. amount of anxiety and stress.
Stress during pregnancy is both essential and Stress during pregnancy is both essential and normal for the psychological adjustment of normal for the psychological adjustment of pregnant women. pregnant women.
Conversely, elevated levels of stress hormones and Conversely, elevated levels of stress hormones and unnecessary anxiety will stretch coping reserves, unnecessary anxiety will stretch coping reserves, and could prove crippling.and could prove crippling.
8C-8C-44
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
The psychological context of pregnancy and The psychological context of pregnancy and the puerperiumthe puerperium
Stress/anxietyStress/anxiety
there are many factors that contribute to there are many factors that contribute to unhappiness in women's lives and affect their unhappiness in women's lives and affect their emotional health and well-being. emotional health and well-being.
Understanding the root cause and expression of Understanding the root cause and expression of mental distress in women is complex as the social mental distress in women is complex as the social circumstances into which women live and circumstances into which women live and children are born play a major role in their health children are born play a major role in their health and well-being.and well-being.
8C-8C-55
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
NeurotransmittersNeurotransmitters
Serotonin : Serotonin : – Inhibits stress responseInhibits stress response– Regulates sleepRegulates sleep– Pain sensitivityPain sensitivity– Sexual functioningSexual functioning– AppetiteAppetite
Diminished serotonin – result of stress?Diminished serotonin – result of stress?
8C-8C-77
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Transition to parenthoodTransition to parenthood
- Postnatally, parents may find coping with Postnatally, parents may find coping with the demands of a new baby, e.g. infant the demands of a new baby, e.g. infant feeding, financial constraints, the whole feeding, financial constraints, the whole process of lifestyle adjustments and role process of lifestyle adjustments and role changes, a real strain.changes, a real strain.
- For new mothers, this will involve diverse For new mothers, this will involve diverse emotional responses ranging from joy and emotional responses ranging from joy and elation to sadness and utter exhaustion. elation to sadness and utter exhaustion.
8C-8C-88
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Who is at risk?Who is at risk?
– Difficult labor or unexpected outcomeDifficult labor or unexpected outcome– Fatigue, pain and discomfortFatigue, pain and discomfort– Disturbed sleepDisturbed sleep– Twins or higher multiplesTwins or higher multiples– Breastfeeding Breastfeeding – C-sectionC-section– Change in libido Change in libido
8C-8C-99
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Role change/role conflictRole change/role conflict
– Having a baby, and particularly the transition Having a baby, and particularly the transition
to parenthood that accompanies the first child, to parenthood that accompanies the first child,
leads to a significant shift in the couple's leads to a significant shift in the couple's
relationship. Social networks are disrupted, relationship. Social networks are disrupted,
especially those of the mother and the quality especially those of the mother and the quality
and quantity of social support such networks and quantity of social support such networks
can and do provide. can and do provide.
8C-8C-1010
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
CommunicationCommunication
– Effective communication during pregnancy and Effective communication during pregnancy and the puerperium is essential. Yet poor the puerperium is essential. Yet poor communication is still the single most common communication is still the single most common factor that is associated with women's factor that is associated with women's dissatisfaction with their care. dissatisfaction with their care.
Being provided with adequate information will serve to:
diminish women's anxiety levels and allay emotional distress
facilitate choice
enable women to maintain control over decision-making.
8C-8C-1111
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
The ideology of The ideology of motherhoodmotherhood
Motherhood, it is thought, ensures that a woman Motherhood, it is thought, ensures that a woman has fulfilled her biological destiny, confirms a has fulfilled her biological destiny, confirms a woman's femininity and raises her status in woman's femininity and raises her status in society, but without financial gain.society, but without financial gain.
Instead of feeling elated by motherhood some Instead of feeling elated by motherhood some women experience displeasure, feelings of women experience displeasure, feelings of unhappiness and feel dismayed or even unhappiness and feel dismayed or even disappointed in their role as new mothers.disappointed in their role as new mothers.
The ideology of motherhood is therefore an assumption and a paradox with inherent dichotomies as the woman strives to be ‘super mum, super wife, super everything’
8C-8C-1212
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Facts about MotherhoodFacts about Motherhood
I will fall in love with my baby immediately.I will fall in love with my baby immediately.
Being a mother will complete me.Being a mother will complete me.
Having a child will strengthen our relationship.Having a child will strengthen our relationship.
Having a child will keep him around.Having a child will keep him around.
Mothering is natural.Mothering is natural.
Breastfeeding is natural, and it will be easy.Breastfeeding is natural, and it will be easy.
8C-8C-1313
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Social supportSocial support
During periods of stress, supportive and holistic care from midwives will not only assist in promoting emotional well-being of women, but will also help to ameliorate threatened psychological morbidity in the postnatal period.
Women who are socially isolated or who have poor socioeconomic circumstances are particularly vulnerable to mental health problems and need additional help and support.
8C-8C-1414
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
DefinitionDefinition
Psychiatric disorders are relatively common after Psychiatric disorders are relatively common after childbirth and may include:childbirth and may include:
postpartum ‘blues’, postpartum depression (PPD), postpartum ‘blues’, postpartum depression (PPD), and postpartum psychosis.and postpartum psychosis.
8C-8C-1515
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Spectrum of disordersSpectrum of disorders
Depression/AnxietyDepression/Anxiety Obsessive/Compulsive DisorderObsessive/Compulsive Disorder Panic AttacksPanic Attacks Post-traumatic StressPost-traumatic Stress BipolarBipolar Postpartum PsychosisPostpartum Psychosis
8C-8C-1616
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Postnatal BluesPostnatal Blues
Occurs in about 80% of mothersOccurs in about 80% of mothers Onset 1st week, lasts up to 3 weeksOnset 1st week, lasts up to 3 weeks Mood instability, weepiness, sadness, Mood instability, weepiness, sadness,
anxiety, lack of concentrationanxiety, lack of concentration Treatment supportiveTreatment supportive Not considered part of the spectrum of Not considered part of the spectrum of
perinatal mood disordersperinatal mood disorders
8C-8C-1717
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Depression and/or AnxietyDepression and/or Anxiety
Incidence: 15-20% of new mothersIncidence: 15-20% of new mothersSymptoms:Symptoms: Excessive worry or anxietyExcessive worry or anxiety Irritability, short temperIrritability, short temper Feeling overwhelmed by responsibilities, Feeling overwhelmed by responsibilities,
difficulty making decisionsdifficulty making decisions Sad mood, feelings of guilt, fear, phobiasSad mood, feelings of guilt, fear, phobias HopelessnessHopelessness Sleep disturbances (insomnia or Sleep disturbances (insomnia or
hypersomnolence), fatiguehypersomnolence), fatigue
8C-8C-1818
Eff
ecti
ve P
erin
atal
Car
e (E
PC
) Somatic symptoms without apparent Somatic symptoms without apparent causecause
Discomfort around babyDiscomfort around baby Lack of feelings towards babyLack of feelings towards baby Loss of focus and concentrationLoss of focus and concentration Loss of interest and pleasureLoss of interest and pleasure Changes in appetite – significant wt Changes in appetite – significant wt
gain or lossgain or loss
8C-8C-1919
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Obsessive-Compulsive DisorderObsessive-Compulsive Disorder
Incidence: 3-5% of new mothersIncidence: 3-5% of new mothersRisk factors: Personal or family hx OCDRisk factors: Personal or family hx OCDSymptoms:Symptoms:
– Intrusive, repetitive and persistent thoughts Intrusive, repetitive and persistent thoughts or mental picturesor mental pictures
– Thoughts often about harming the babyThoughts often about harming the baby– Tremendous sense of horror and shame Tremendous sense of horror and shame – Behaviors to reduce anxiety and protect babyBehaviors to reduce anxiety and protect baby– Counting, checking, cleaning, other repetitive Counting, checking, cleaning, other repetitive
behaviorsbehaviors
8C-8C-2020
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Panic DisorderPanic Disorder
Incidence: 10% of postpartum womenIncidence: 10% of postpartum womenRisk Factors: Risk Factors: Personal or family hx of anxiety or panic Personal or family hx of anxiety or panic
disorderdisorder Thyroid dysfunctionThyroid dysfunction
Symptoms:Symptoms: Episodes of extreme anxietyEpisodes of extreme anxiety chest painchest pain Sensations of choking, smothering, Sensations of choking, smothering,
dizzinessdizziness
8C-8C-2121
Eff
ecti
ve P
erin
atal
Car
e (E
PC
) Hot or cold flashes, trembling, Hot or cold flashes, trembling, tachycardia, numbness or tinglingtachycardia, numbness or tingling
Restlessness, agitation, irritabilityRestlessness, agitation, irritability During attack, may fear she is going During attack, may fear she is going
crazy, losing her mindcrazy, losing her mind Panic attack may wake her up from Panic attack may wake her up from
sleepsleep Excessive worry or fear (incl. fear of Excessive worry or fear (incl. fear of
another panic attack)another panic attack)
8C-8C-2222
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Posttraumatic Stress DisorderPosttraumatic Stress Disorder
Incidence: up to 6% of postpartum Incidence: up to 6% of postpartum womenwomen
Risk factors: Past traumatic eventsRisk factors: Past traumatic events
Symptoms:Symptoms: Recurrent nightmaresRecurrent nightmares Extreme anxietyExtreme anxiety Reliving past traumatic events (sexual, Reliving past traumatic events (sexual,
physical, emotional, childbirth)physical, emotional, childbirth)
8C-8C-2323
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Bipolar DisorderBipolar Disorder
Incidence: no dataIncidence: no dataRisk factors: personal or family hx of bipolar Risk factors: personal or family hx of bipolar
disorderdisorder
Symptoms:Symptoms: Mania – racing thoughts, high energy and Mania – racing thoughts, high energy and
little sleep, compulsive activitylittle sleep, compulsive activity DepressionDepression Rapid and severe mood swingsRapid and severe mood swings
8C-8C-2424
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Postpartum PsychosisPostpartum Psychosis
Incidence: 0.1-0.2%Incidence: 0.1-0.2% Onset usually 2-3 days postpartumOnset usually 2-3 days postpartum 5% suicide and 4% infanticide rate5% suicide and 4% infanticide rateRisk factors: Risk factors: Personal or family hx psychosis, Personal or family hx psychosis,
bipolar, schizophreniabipolar, schizophrenia Previous hx postpartum psychosis or Previous hx postpartum psychosis or
bipolar episodebipolar episode
8C-8C-2525
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Symptoms:Symptoms:
Visual or auditory Visual or auditory hallucinationshallucinations
Delusional thinkingDelusional thinking Delirium or maniaDelirium or mania Very obviously Very obviously
psychoticpsychotic
8C-8C-2626
Eff
ecti
ve P
erin
atal
Car
e (E
PC
)
Medical ManagementMedical Management
ACOG/APA guidelines (2009)ACOG/APA guidelines (2009)– PsychotherapyPsychotherapy– Pharmacotherapy Pharmacotherapy – Individualized plan of care Individualized plan of care – Consider continuing medications during Consider continuing medications during
pregnancy to avoid risk of relapse (bipolar, pregnancy to avoid risk of relapse (bipolar, psychosis, severe depression)psychosis, severe depression)