Perinatal Mental Health

NZ Trust – PMHNZ

GP CME Rotorua June 2014

Postnatal Distress (PND)

PND is an umbrella term to describe a number of psychiatric illnesses…

• Antenatal depression and anxiety

• Postnatal depression

• Postnatal anxiety

• Adjustment disorder

• Postnatal psychosis

• Obsessive compulsive disorder (OCD)

• PTSD from birth trauma

• Grief reactions, perinatal loss and fertility difficulties

It is NOT the baby blues.

Statistics

PND can begin antenatally (10%) or postnatally (more than 20%) which includes immediately after the birth and up to a year later.

10% of men experience PND.

PND is a clinical depression that can occur any time immediately after birth

up to a year postpartum.

The risk of it re-occurring with the next baby is 40%, with approximately 24% of all reoccurrences occurring within the first 2 weeks. (Wisner et al 2004)

Postnatal Psychosis

Postnatal psychosis is a severe medical condition that is often misdiagnosed as

postnatal depression. Psychosis occurs in 1 or 2 out of 1,000 postpartum

women and if often associated with bipolar illness. The most common

symptoms are severe agitation, delusional or bizarre thinking, hallucinations,

insomnia, confusion, and a feeling of being out of touch with reality.

Although this is a rare condition, it is always an emergency and requires

immediate medical attention.

Symptoms

She might:

Have difficulty sleeping

Feel exhausted most of the time

Have a decrease in appetite

Worry about little things that never used to

bother her

Wonder if she will ever have time to herself

again

Think her children would be better off without

her

Worry that her husband will get tired of her

feeling this way

Snap at her husband and children over

everything

Think everyone else is a better mum than she is

Cry over the slightest thing

No longer enjoy the things she used to enjoy

Isolate herself from her friends and family

Fear leaving the house or being alone

Have anxiety attacks

Have unexplained anger

Have difficulty concentrating

Think something else is wrong with her or her

marriage

Feel like she will always feel this way and never

get better

Transition to Motherhood

• Women are far more at risk for depression and anxiety during their child bearing years than any other time.

• Myth exists that women enjoy optimal mental health as though encased in an emotional bubble. Reinforces silence.

• PND can strike without warning — in women with no history of depression or women who have had it before. It can happen to women who are highly successful in their careers or women who stay home with their children. It can strike women in stable marriages and conflicted marriages, as well as single women, and adoptive mothers. It can happen to women who love their baby more than anything in the world. It can happen after the first baby, or after the fourth. It can happen to women who swore it would never happen to them.

Strong risk factors:

Depression during pregnancy

Anxiety during pregnancy

Family history of depression

Previous history of depression, including PND

Stressful recent life events

Lack of social support (perceived or real)

Moderate risk factors:

Maternal personality (worrier, perfectionist, anxious, “nervous”)

Low self-esteem

Relationship difficulties

Previous birth trauma

Low or changed socio-economic status

Obstetric and pregnancy complications

Current interpersonal difficulties

Difficult experiences in early life e.g. sexual abuse or parental neglect

Abortion and reproductive losses

Temperament of the newborn.

Having a sick baby (NICU, reflux etc.)

Postnatal Distress

IS:

A medical condition that can begin before the baby is born

A neuropsychiatric illness that affects every cell in a woman’s brain and body

PND is typically an agitated depression, with symptoms of both depression and anxiety.

Postnatal distress is the most common complication following childbirth

PND Is NOT:

A moral failure

An ethical dilemma

A symptom of weakness

Women feel robbed!

Antenatal and postnatal distress “robs a woman of what can be one

of the most spectacular and truly unique experiences of her life”

(Kleiman, 2009)

PND Affects the Family

PND dramatically affects the entire family

PND chews up and spits out relationships

Recovery will be smoother with the help of a supportive partnership

Her partner needs information and support. He or she may be depressed too!

They may sabotage treatment … Or get in the way of it.

We must think about…

The quiet and terrible desperation with which some women lead their

lives as young mothers

Becoming A Mother

“Much of what we do as postpartum specialists rests largely on what it means to be a

mother. If it didn’t, we would be able to apply any theory of depression and treat

postpartum women as we would anyone else with depression, whether there were a

baby in the picture or not”.

Kleiman (2009:297)

New Mums with PND

Generally speaking

• Are not in the mood for therapy

• Do not want to take medication

• Don’t want to go to yet another appointment

• Don’t have time to go to appointments

• She feels that there is no time to take care of herself

She Feels…

• Tired and sleep deprived

• Restless and overwhelmed

• Upset (tearful and crying and angry) more than usual

• Her nerves are shot

• Everything and anyone makes her feel angry, sad, and irritable

• Scared to death

• That something is wrong

She is…

• Hormonally compromised

• Finding it very hard to concentrate

• Trying her best to be her own ideal image of a mother – what she

“should” look, sound, act and feel like

Messages a new mother learns

from society

The message women hear may be subliminal, but clear!

Good mothers are supposed to be nurturing, devoted and self-sacrificing.

They should put their children's needs before theirs at all times.

But also, she must be able to continue to accomplish her own goals and

maintain her own sense of identity.

THE FEAR OF FAILING CAN MAKE HER VERY SICK!

Shame

Shame tells us that our imperfections make us inadequate and our

vulnerabilities are weaknesses.

It sends two primary messages: “Who do you think you are?” and “You’ll

never be good enough.”

Over time, we learn to hide our struggles and protect ourselves from shame,

judgment, criticism, and blame by seeking safety in pretending and perfection.

Definition of shame

It is best defined as the intensely painful feeling or experience of believing

we are flawed and therefore unworthy of acceptance and belonging.

(B Brown: 2004)

Shame: A Web

Women often experience shame as a web of layered conflicting and

competing social-community expectations:

Who we should be

What we should be

How we should be

Once in the web, women feel flooded with feelings of fear, blame

and disconnection.

Perfectionism

Perfectionism is a self destructive and addictive belief system that

fuels this primary thought: If I look perfect, live perfectly, and do everything

perfectly, I can avoid or minimize the painful feelings of shame, judgment

and blame.

(From B Brown blog)

Resistances to Therapeutic Treatment

• PND is a weakness

• Feelings of shame

• Treatment costs too much money

• Having PND means I'm crazy

• It means I'm not a good mother

• It means I'm not perfect and in control

• I don’t have time to be unwell

It is so hard to differentiate the symptoms of the illness from how she feels as a

mother.

What every new mother with PND does

want, despite the resistances is…

SYMPTOM RELIEF!

She wants:

• To sleep

• To think clearly

• To feel less anxious

• To stop crying all day

• To feel like herself

• To enjoy and love her baby

Karen Kleiman

“Postpartum depression can create a conglomeration of

conflicting emotions; it can cause a woman to

challenge everything she has ever thought about

herself and about her own childhood experience, as

well as her identification with her own mother. It robs

her peace of mind and it makes her feel as if she’s lost

touch with her very core…

IT FRACTURES HER SOUL”

Several barriers for healthcare providers

in identifying PND:

Failing to assess for PND

Minimizing symptoms of PND, which can leave Mums feeling

Embarrassed/Ashamed

Disappointed

Frustrated

Alone

Limited training in detecting and managing PND

Not knowing how to effectively help, so reluctant to raise issues

Not being culturally sensitive

Language barriers

Widespread Implications

Studies suggest that chronic effects are three-fold:

Long term effects on women’s mental health, including stigma and

further risk of depression

The mother infant relationship and it’s influence on child

development

The marital relationship – consider how many women on the DPB

might have had PND?

Long term consequences for the child

Consequences include:

Ongoing cognitive and social difficulties

Difficulties in infant attachment and development

Parental attachment to the baby is compromised

Parental attachment to other children is compromised

Emotional neglect

Child abuse only in the most severe cases

As an adult the baby may have:

Difficulties parenting their own children

Attachment issues in relationships

Educational and social difficulties

Early detection is vital!

PND robs woman of a unique experience of mothering

Can we all be doing more? YES!

Sick mothers deserve empathy, psycho-education, and access to timely and effective treatment.

Depression hurts both mothers and their children and their partners. Once depression is detected treatment will help and can prevent the long term inter-generational consequences identified.

Untreated Depression

We all must become aware that the long term risks of untreated depression

in women potentially pose difficulties to their child’s social, intellectual, and

cognitive development, as well as to the quality of attachment and the later

relationship between mother and child.

Early treatment helps!

When antenatal and postnatal depression can be identified early and treated,

women have the opportunity to be supported in their journey through

motherhood.

Support groups

Psychological treatment: Psychotherapy or Counselling

Medication via GP or MMH

Reaching Out

Regardless of who we are, how we were raised, or what we believe,

all of us fight hidden, silent battles against not being good enough,

not having enough, and not belonging enough.

When we find the courage to share our experiences and the

compassion to hear others tell their stories, we force shame

out of hiding and end the silence.”

(B Brown, 2007: 127)

PMHNZ Trust

National Perspective

New National Group – Formed Feb 2011

Hub/umbrella organisation to signpost and support

those working in, and those connected with perinatal

mental health

National Board - members from around NZ

PMHNZ Trust

Mission

To improve outcomes for families and

whanau affected by mental illness

related to pregnancy, childbirth

and early parenthood

PMHNZ Trust

The PMHNZ Trust Networks and supports:

professionals, agencies, researchers, educators, support

groups, community supporters, government agencies &

policy makers, and employers

AND Mums & Dads and whanau

PMHNZ Trust

Aims & Objectives

National NZ Voice for Perinatal Distress - PND

Improving Awareness of Perinatal Distress (PND)

Encouraging De-stigmatisation of PND

Helping to Navigate PND services

Promoting NZ Research

Providing Evidence Based study days

Disseminating Information

National and Regional Networking

Actively working to improve service provision

PMHNZ Trust

Achievements

Run several seminar/training days around NZ

2014 Seminar Series – 6 regions all different

2013 3 day National PMHNZ Conference Auckland with International speakers

Established Annual Perinatal Mental Health Awareness Week in November

3 years - Buggy Walks & Picnics around NZ

Regular Newsletter

Website www.pmhnz.org.nz

Developing national team of advisors, speakers and trainers

Developing National Database of Perinatal Distress services and personnel

Established Wellington Perinatal Mental Health Network and developing other regions

Treatment Support Recovery

You are welcome to call or email me anytime …

Susan Goldstiver

The Postnatal Distress Centre

09 8464978

021 333021

susan@postnataldistress.co.nz

www.postnataldistress.co.nz

Perinatal Mental Health Trust

- PMHNZ

Contacts :

Rosie Smith

Chairperson

pmhnztrust@gmail.com

www.pmhnz.org.nz

PO Box 57223 Mana

Porirua 5247

027 242 2499

Treena Cooper

Administrator

pmhnzoffice@gmail.com

www.pmhnz.org.nz

PO Box 58122, Whitby,

Porirua 5245, NZ

Ph: (+64) 021 02482123

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Perinatal Mental Health

Trust