Download Telling the Birth Story

Telling the Birth Story
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Susan Dowd Stone, LCSW
The role of a
mother’s support
group in the
identification and
amelioration of high
risk factors in post
partum women
Primary Prevention
“…Prevention is the great challenge of
postnatal illness because this is one of
the few areas of psychiatry in which
primary prevention is feasible…”
Hamilton & Harberger (1992)
Susan Dowd Stone, LCSW
The Obstetric Network
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It is essential to integrate a psychiatric
dimension into this network to break
the vicious circle of mood disorders
that women experience during
pregnancy and motherhood
- Harris, Bryan (2002)
Susan Dowd Stone, LCSW
The efficacy of post partum
support groups
A psychoeducation group for women with low post partum mood
can significantly reduce depressive symptoms
Honey, J.L, Bennett, P, Morgan M. (2002)
A program of supportive group therapy for post partum mothers
can significantly lower or eliminate depressive episodes
Lane, B., Roufeil, M.M., Williams, S., Tweedie, R..(2001)
Post partum mothers attending a group integrating supportive
educational and cognitive behavioral components yielded
significant reductions in symptom frequency and intensity
after 4 – 6 weeks.
Chabrol, H., Teissedre, F., Saint Jean, M., Teisseyre, N., Sistac, C, Michaud, C.,
Roge, B.(2002)
Susan Dowd Stone, LCSW
Undetected depressive illness
despite
antenatal screening attempts
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Premorbid undiagnosed mood disorders
Inaccurate self-report
Fear of involvement of child protection
agencies
Ability to mask symptoms especially if
highly functional
Motherhood myth
Severe life events
Susan Dowd Stone, LCSW
Post Partum Continuum
Post Partum Responses
Healthy Rebound
“Baby Blues”
Post Partum Depression
Post Partum Psychosis
Susan Dowd Stone, LCSW
Who comes to a mother’s
support group - risk factors
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Post Partum Continuum
Difficult conception/amniotomy
Caesarian/birth trauma
Multiple birth mothers
Isolated, lack of support/cross cultural pressures
Marital issues/financial difficulties/intimacy
Breastfeeding issues
Difficult child/bonding issues
Unexpressed feelings/anger/ sense of inadequacy/ grief
Sense of self/professional moms/motherhood myth
Nutritional concerns
Histories of abuse
Self or caregiver identified depression
Substance Abuse
Psychiatric History
Susan Dowd Stone, LCSW
Additional issues
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Adoptive parent
Gay parent
Single parent
Premature babies
Multiple young children
Unwanted pregnancy
Susan Dowd Stone, LCSW
Difficult conception
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Unsuccessful attempts to conceive are
accompanied by significant
psychological distress
– Little, B.B.; Yonkers, K.A.(2001)
Susan Dowd Stone, LCSW
Caesarian
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Caesarian mothers used to stay in the
hospital up to ten days
Recovery from major surgery
Support of nursing staff
Longer period of modeling
Not prepared/residual anger
If mother remained in hospital longer,
separations from baby less likely during this
important maternal sensitive period
Susan Dowd Stone, LCSW
Birth Trauma
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Protracted unexpected delivery
experiences during labor
Severe pregnancy complications may
increase the severity of postnatal
depressive symptoms by acting as
acute or chronic stressors.
-Veroux, H., Sutter, A., Glatigny, E., Minisini A. (2002)
Susan Dowd Stone, LCSW
Premature or ill babies
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May not be available to mother during
maternal sensitive period
Ill/premature babies more at risk for
maternal rejection, failure to thrive
and battering.
Mourning the idealized child
Susan Dowd Stone, LCSW
Multiple births
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Associated high risk
factor for PPD
Trauma related to
difficult conception
Raised possibility of
low birth weight/health
problems
Heightened exhaustion
for care
Difficulty breast
feeding
Susan Dowd Stone, LCSW
Isolation
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Woman’s perception of self as not
supported
Family lives far away/cross cultural
issues
Cut off from friends, no longer has
commonalities with friends
Difficulties with spouse
Afraid of judgments
Susan Dowd Stone, LCSW
Marital issues
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“…Many patients report
that marital stress is an
important aspect of
their illness.
Nevertheless, in the
usual patient oriented
and child oriented
regimes of treatment
the husband (partner)
receives scant
attention…”
– Hamilton & Harbinger,
Susan Dowd Stone, LCSW
(1992)
Support for partners
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Ongoing demands to
run the house, care for
the new baby the
mother and other
children
Jealousy
“…Marital problems
which appear to have
emanated from PPD
often persist long after
symptoms are
abated…”
- Hickman, (1982)
Susan Dowd Stone, LCSW
Family support
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“…I know I could have and
should have done more.
We as a family did not want
to accept mental illness in
our lives. Because of this
stigma, Sharon suppressed
her feelings after Garrett’s
birth. Had we ever
imagined infanticide or
suicide might result,
something would have been
done…”
–
Glenn Comitz, husband of a
woman imprisoned for
infanticide (Comitz, 1988,
Beyond the Blues)
Susan Dowd Stone, LCSW
Financial Difficulties
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The cost of childbirth and aftercare
already high, but psychiatric
interventions may be excluded due to
cost
Find inexpensive activities outings for
families
Financial burdens fall to working
partner
Susan Dowd Stone, LCSW
Restoration of Intimacy
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“Sex and affection were absent during
that time. Not tonight, not tomorrow
night, not next week, not ever!”
– A post partum husband complains In Post
Partum Psychiatric Illness (R. Hickman, 1992)
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Persistent discomfort
Susan Dowd Stone, LCSW
Breastfeeding Difficulties
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Sense of failure
Caesarian mothers more at risk
Convenience and guilt
Psychotropic medications
Susan Dowd Stone, LCSW
Motherhood – the
expectation
Susan Dowd Stone, LCSW
Difficult Child/Bonding
Susan Dowd Stone, LCSW
Technology and Attachment
Theory Literature
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Ultrasounds
Mother’s capacity to form relationships
Baby’s capacity to respond
Early separations
Sensitive/critical period
Susan Dowd Stone, LCSW
Unexpressed Feelings
Anger – in conjunction with or irrespective of
depressed mood
Graham, J.E., Lobel, M. DeLuca, R.S.
Frustration
Helplessness
Fear
Guilt
Grief
Anxiety
Embarrassment
Exhaustion
Susan Dowd Stone, LCSW
Lack of feelings
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“…Mothers are supposed to love their
babies! I don’t have any feelings
toward mine. I just feel numb. What’s
wrong with me?...”
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support group participant (Harberger P.N, Berchtold, N.G.
& Honikman, J.I.(1992)
Susan Dowd Stone, LCSW
Sense of self/professional
moms vs. stay at home
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Motherhood Myth
Sandwich
generation
Multi-tasking
Susan Dowd Stone, LCSW
Nutritional Concerns –
Eating Disorders
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Baby wellness
Return to pre-pregnancy weight
Nutritional consults for the mother
The role of diet/exercise in alleviating
mild symptoms of PPD
Susan Dowd Stone, LCSW
Eating Disorders
Negative Body Image
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Patient’s offspring may be seriously at
risk
May seem normal; often overlooked
Bingeing and purging not as evident,
could be seen as “pregnancy cravings”
or morning sickness
Susan Dowd Stone, LCSW
Histories of abuse
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Shame
Fear
Breaking the cycle
Susan Dowd Stone, LCSW
Self or caregiver identified
depression/anxiety
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Can’t “snap out of it”
Constant fears about baby/self
Unrealistic attributions
Susan Dowd Stone, LCSW
Case Stories
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Linda older mom with previous successful
career, difficulty conceiving, first child, cross
cultural issues
Paula mother of twins, financial difficulties,
marital issues, abuse history, poor
relationship with mother
Laura difficult conception and birth
antenatal depression, small birth weight,
bonding issues
Susan Dowd Stone, LCSW
Goals of a mother/baby
support group
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Information clearing house
Professional feedback/role playing
Non judgmental support system
Observational and clinical review of maternal/child relationship
Relaxation
Dispel motherhood myth of the maternal instinct
Strengthen marital support
Mobilize additional support systems
Reduce environmental stress
Rearrange priorities
Encourage networking/socialization
Amelioration of symptoms
Identify needs for additional treatment
Susan Dowd Stone, LCSW
Engaging the mothers
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Referrals from physician’s offices or in
hospital after birth: Inviting a new
mother
Visiting in rooms prior to discharge
Emphasizing the socialization part of
the group
Susan Dowd Stone, LCSW
Group Format
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Convenient Facility, parking
Ease of access, timing
Confidentiality assured
Sliding scale to increase access to help
but may be billed to insurance
company
Susan Dowd Stone, LCSW
Postpartum Group
Psychotherapy Format
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Group meets for one hour weekly
Facilitated by licensed professional
social worker with training in antenatal
mood disorders
If needed, participants may be
referred for individual counseling or
medication management
Susan Dowd Stone, LCSW
Community Referrals
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The importance of establishing
antenatal alliance
Encourage attendance ASAP
Extension of your area Obstetrical
Team
Susan Dowd Stone, LCSW
Mother-baby group
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Marketed as socialization group
Women more likely to attend if no
stigma
Opportunity to eye-ball new mothers
May offer interdisciplinary participation
Meets weekly for one hour
Day care may be provided
Susan Dowd Stone, LCSW
Excerpts from “Her Eyes are Wild”
- William Wordsworth 1798
“…Sweet babe, they say that I am mad
But nay, my heart is far too glad
And I am happy when I sing
Full many a sad and doleful thing…
A fire was once within my brain
And in my head, a dull, dull pain
And fiendish faces, one, two, three
Hung at my breast and pulled at me
Suck little babe, oh suck again
It cools my blood, it cools my brain
Thy lips I feel them baby, they
Draw from my heart the pain away…”
Soundbite Beethoven’s Symphony #9
Susan Dowd Stone, LCSW