Download Perinatal mental health

Effective Perinatal Care (EPC)
Perinatal
mental health
1
Case study
Effective Perinatal Care (EPC)
 You are visiting a mother called Amal is in the first
postpartum week; she feels persistently guilty and
negative towards herself, cries easily and feels tired
and agitated.
1. What might she be suffering from?
2. What other symptoms would you ask her about, to
confirm your diagnosis?
2
8C-2
Stress/anxiety
 Pregnancy and the puerperium are normal life events,
yet they are periods in a woman's life when her
vulnerability exposes her to a significant amount of
anxiety and stress.
 Stress during pregnancy is both essential and normal for
the psychological adjustment of pregnant women.
 Conversely, elevated levels of stress hormones and
unnecessary anxiety will stretch coping reserves, and
could prove crippling.
Effective Perinatal Care (EPC)
The psychological context of pregnancy and the
puerperium
8C-3
Stress/anxiety
 there are many factors that contribute to unhappiness in
women's lives and affect their emotional health and wellbeing.
 Understanding the root cause and expression of mental
distress in women is complex as the social circumstances
into which women live and children are born play a
major role in their health and well-being.
Effective Perinatal Care (EPC)
The psychological context of pregnancy and the
puerperium
8C-4
 Serotonin :
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Inhibits stress response
Regulates sleep
Pain sensitivity
Sexual functioning
Appetite
Effective Perinatal Care (EPC)
Neurotransmitters
 Diminished serotonin – result of stress?
8C-5
8C-6
Effective Perinatal Care (EPC)
- Postnatally, parents may find coping with the
demands of a new baby, e.g. infant feeding,
financial constraints, the whole process of
lifestyle adjustments and role changes, a real
strain.
- For new mothers, this will involve diverse
emotional responses ranging from joy and elation
to sadness and utter exhaustion.
Effective Perinatal Care (EPC)
Transition to parenthood
8C-7
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Difficult labor or unexpected outcome
Fatigue, pain and discomfort
Disturbed sleep
Twins or higher multiples
Breastfeeding
C-section
Change in libido
Effective Perinatal Care (EPC)
Who is at risk?
8C-8
– Having a baby, and particularly the transition to
parenthood that accompanies the first child, leads to
a significant shift in the couple's relationship. Social
networks are disrupted, especially those of the
Effective Perinatal Care (EPC)
Role change/role conflict
mother and the quality and quantity of social support
such networks can and do provide.
8C-9
– Effective communication during pregnancy and the
puerperium is essential. Yet poor communication is
still the single most common factor that is associated
with women's dissatisfaction with their care.
 Being provided with adequate information will serve
to:
Effective Perinatal Care (EPC)
Communication
 diminish women's anxiety levels and allay emotional
distress
 facilitate choice
 enable women to maintain control over decisionmaking.
8C-10
 Motherhood, it is thought, ensures that a woman
has fulfilled her biological destiny, confirms a
woman's femininity and raises her status in
society, but without financial gain.
 Instead of feeling elated by motherhood some
women experience displeasure, feelings of
unhappiness and feel dismayed or even
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’
Effective Perinatal Care (EPC)
The ideology of motherhood
8C-11
Facts about Motherhood
 Being a mother will complete me.
 Having a child will strengthen our relationship.
 Having a child will keep him around.
Effective Perinatal Care (EPC)
 I will fall in love with my baby immediately.
 Mothering is natural.
 Breastfeeding is natural, and it will be easy.
8C-12
 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.
Effective Perinatal Care (EPC)
Social support
8C-13
Psychiatric disorders are relatively common after childbirth
and may include:
postpartum ‘blues’, postpartum depression (PPD), and
postpartum psychosis.
Effective Perinatal Care (EPC)
Definition
8C-14
 Depression/Anxiety
 Obsessive/Compulsive Disorder
 Panic Attacks
 Post-traumatic Stress
 Bipolar
 Postpartum Psychosis
Effective Perinatal Care (EPC)
Spectrum of disorders
8C-15
 Occurs in about 80% of mothers
 Onset 1st week, lasts up to 3 weeks
 Mood instability, weepiness, sadness, anxiety,
lack of concentration
 Treatment supportive
 Not considered part of the spectrum of perinatal
mood disorders
Effective Perinatal Care (EPC)
Postnatal Blues
8C-16
Incidence: 15-20% of new mothers
Symptoms:
 Excessive worry or anxiety
 Irritability, short temper
 Feeling overwhelmed by responsibilities,
difficulty making decisions
 Sad mood, feelings of guilt, fear, phobias
 Hopelessness
 Sleep disturbances (insomnia or
hypersomnolence), fatigue
Effective Perinatal Care (EPC)
Depression and/or Anxiety
8C-17
Effective Perinatal Care (EPC)
 Somatic symptoms without apparent cause
 Discomfort around baby
 Lack of feelings towards baby
 Loss of focus and concentration
 Loss of interest and pleasure
 Changes in appetite – significant wt gain or
loss
8C-18
Incidence: 3-5% of new mothers
Risk factors: Personal or family hx OCD
Symptoms:
– Intrusive, repetitive and persistent thoughts or
mental pictures
– Thoughts often about harming the baby
– Tremendous sense of horror and shame
– Behaviors to reduce anxiety and protect baby
– Counting, checking, cleaning, other repetitive
behaviors
Effective Perinatal Care (EPC)
Obsessive-Compulsive Disorder
8C-19
Incidence: 10% of postpartum women
Risk Factors:
 Personal or family hx of anxiety or panic
disorder
 Thyroid dysfunction
Effective Perinatal Care (EPC)
Panic Disorder
Symptoms:
 Episodes of extreme anxiety
 chest pain
 Sensations of choking, smothering, dizziness
8C-20
Effective Perinatal Care (EPC)
 Hot or cold flashes, trembling, tachycardia,
numbness or tingling
 Restlessness, agitation, irritability
 During attack, may fear she is going crazy,
losing her mind
 Panic attack may wake her up from sleep
 Excessive worry or fear (incl. fear of another
panic attack)
8C-21
Incidence: up to 6% of postpartum women
Risk factors: Past traumatic events
Symptoms:
 Recurrent nightmares
 Extreme anxiety
 Reliving past traumatic events (sexual,
physical, emotional, childbirth)
Effective Perinatal Care (EPC)
Posttraumatic Stress Disorder
8C-22
Incidence: no data
Risk factors: personal or family hx of bipolar
disorder
Symptoms:
 Mania – racing thoughts, high energy and little
sleep, compulsive activity
 Depression
 Rapid and severe mood swings
Effective Perinatal Care (EPC)
Bipolar Disorder
8C-23
Incidence: 0.1-0.2%
 Onset usually 2-3 days postpartum
 5% suicide and 4% infanticide rate
Risk factors:
 Personal or family hx psychosis, bipolar,
schizophrenia
 Previous hx postpartum psychosis or
bipolar episode
Effective Perinatal Care (EPC)
Postpartum Psychosis
8C-24
 Visual or auditory
hallucinations
 Delusional thinking
 Delirium or mania
 Very obviously
psychotic
Effective Perinatal Care (EPC)
Symptoms:
8C-25
 ACOG/APA guidelines (2009)
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Psychotherapy
Pharmacotherapy
Individualized plan of care
Consider continuing medications during pregnancy to
avoid risk of relapse (bipolar, psychosis, severe
depression)
Effective Perinatal Care (EPC)
Medical Management
8C-26