1 PSYCHOSOCIAL SUPPORT Presented by: Ashley Denker, MSN, RNC- MNN, IBCLC OBJECTIVES •Define perinatal mood & anxiety disorders •Discuss causes and risk factors of perinatal mood & anxiety disorders •Identify signs and symptoms of perinatal mood & anxiety disorders •Describe interventions and communication techniques helpful when interacting with parents experiencing perinatal mood & anxiety disorders PERINATAL MOOD & ANXIETY DISORDERS PMADs affect more women than preeclampsia, postpartum hemorrhage, and gestational diabetes combined • 1/7 women will have a perinatal depressive episode during pregnancy or up to 12 months postpartum • Association between mental illness and mortality is complicated • Suicidal ideation occurs more often among pregnant women than non- pregnant women. • Among postpartum women, suicide most commonly occurs in the late postpartum period (43 to 365 days). (BECK, 2014; DAVIDSON ET AL., 2020; KENDIG ET AL., 2017; MCINTYRE ET AL., 2018; REVIEW TO ACTION, 2018))
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PSYCHOSOCIAL SUPPORT Presented by:
Ashley Denker, MSN, RNC-
MNN, IBCLC
OBJECTIVES
•Define perinatal mood & anxiety disorders
•Discuss causes and risk factors of perinatal mood & anxiety disorders
•Identify signs and symptoms of perinatal mood & anxiety disorders
•Describe interventions and communication techniques helpful when interacting with parents experiencing perinatal mood & anxiety disorders
PERINATAL MOOD & ANXIETY DISORDERS
PMADs affect more women than preeclampsia, postpartum hemorrhage, and gestational diabetes combined
•1/7 women will have a perinatal depressive episode during pregnancy or up to 12 months postpartum
•Association between mental illness and mortality is complicated
•Suicidal ideation occurs more often among pregnant women than non-pregnant women.
•Among postpartum women, suicide most commonly occurs in the late postpartum period (43 to 365 days).
(BECK, 2014; DAVIDSON ET AL., 2020; KENDIG ET AL., 2017; MCINTYRE ET AL., 2018; REVIEW TO ACTION, 2018))
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PMADS RESULT IN…
Adverse Maternal Outcomes Adverse Infant Outcomes
•Impaired sleep
•Poor nutrition
•Inadequate weight gain in pregnancy
•Increased incidence of substance abuse
•Missed prenatal and postpartum visits
•Decreased adherence to healthcare
providers advice
•Preterm birth
•Low birth weight
•Developmental and cognitive delays
•Delayed mental development in 2 year
olds
•Increased crying
•Interfered bonding
•Prediction of difficult temperament at 4
and 6 months of age
Insecure and impaired maternal-newborn attachment
(AWHONN, 2015; CHAN ET AL., 2013)
PERINATAL MOOD AND ANXIETY DISORDERS
Perinatal (peripartum) mood and anxiety disorders (PMADs):
•The onset of mood symptoms occurring during pregnancy or in the 4 weeks following delivery (American Psychiatric Association Diagnostic criteria)
• In reality, symptoms may occur up to 1 year after delivery
Proposed that postpartum psychiatric disorders be one diagnosable syndrome with 3 subclasses: 1. Adjustment reaction with
depressed mood (baby blues)
2. Postpartum mood episodes with psychotic features
3. Peripartum major mood episodes
(DAVIDSON ET AL., 2020; MATTSON & SMITH, 2015)
WHO’S AT RISK?
• Any new mother (or support person!)
• Personal or family history of depression, anxiety, OCD, or other mental illness
• Previous perinatal depression or anxiety
(MATTSON & SMITH, 2016)
PICTURE FROM HTTPS://WWW.MOTHERING.COM/ARTICLES/STUDY-TAKING-PROBIOTICS-DURING-PREGNANCY-MAY-REDUCE-POSTPARTUM-DEPRESSION-AND-ANXIETY/
(BECK, 2014; DAVIDSON ET AL., 2016; MATTSON & SMITH, 2015)
OBSESSIVE COMPULSIVE DISORDER (OCD)
“Scary thoughts disorder”
• 3-5% women experience postpartum
• “Most misdiagnosed and misunderstood“ of all the PMADs
•Often confused with PPP
•Obsessions & compulsions
(BECK, 2014; DAVIDSON ET AL., 2020; MATTSON & SMITH, 2015; POSTPARTUM SUPPORT INTERNATIONAL)
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POST TRAUMATIC STRESS DISORDER (PTSD)
• 1-6% mothers experience PTSD
• Caused by real or perceived trauma during delivery or postpartum
• 2011 study of 902 mothers:
• 9% mothers met full PTSD criteria
• 18% demonstrated elevated levels of PTSD symptoms
•Stressors:
Prolapsed cord, should dystocia, abruption, Hellp, preeclampsia, eclampsia, hemorrhage, extensive
vaginal trauma, unplanned c/s, operative vaginal delivery, NICU admission/transfer, feelings of powerlessness & lack of control, disruption in relationship with provider or staff, poor communication, lack of support/reassurance during delivery, previous trauma
(BECK, 2014; DAVIDSON ET AL., 2016; MATTSON & SMITH, 2015)
PTSD THEMES
Perception of relationship and communication are extremely influential!
•Mother’s perception of lack of caring
•Failure of staff to communicate with mother
•Betrayal of trust and powerlessness
•Celebration of a healthy baby was the focus
(BECK, 2014)
PTSD CLINICAL PRESENTATION
•Early: dazed look or withdrawal
• Intrusive re-experiencing of a past traumatic event
•Sharing feelings•Using touch•Silence •Providing information
•Paraphrasing •Asking relevant questions
(BECK, 2014; DAVIDSON ET AL., 2016; SIMPSON & CREEHAN, 2014)
Therapeutic communication is not about problem solving, but about validating feelings.
LISTEN & ACKNOWLEDGE
Listen:
•Sharing birth story may be therapeutic
•Pay attention to themes
Acknowledge:
•Be a witness to fears, pain, and other
symptoms.
•Remind that feelings aren’t facts
•Hear and validate anxiety and concerns
(BECK, 2014; DAVIDSON ET AL., 2016; SIMPSON & CREEHAN, 2014)
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PROVIDE SUPPORT
Patient’s and support persons report feelings of abandonment.
•Offer methods to promote relaxation, comfort and self care
• Identify and reduce the source of distress if possible
•Encourage mom to identify and use coping mechanisms that have worked well in the past
•Frequent attention and therapeutic interaction
•Reassure she is not a bad mother
•Do not offer general or false reassurance
(BECK, 2014; DAVIDSON ET AL., 2016; SIMPSON & CREEHAN, 2014)
PICTURE FROM HTTP://WWW.ALIFEWITHALITTLE.COM/CATEGORY/POST-PARTUM-DEPRESSION/
PROMOTE BONDING
Facilitate the maternal newborn attachment process
•Maximize mother-infant contact
•Assist mothers to understand normal newborn behaviors and cues
•Teach and empower parents to provide newborn cares
•Maximize time for parent-infant interaction
•Provide frequent (daily at minimum) information about infant’s condition if separated in NICU or newborn nursery
(MATTSON & SMITH, 2015; SIMPSON & CREEHAN, 2014; SONG ET AL., 2015)
POST-DISCHARGE CARE
•Establishing seamless transition in care and follow-up among health care providers is critical for mothers experiencing PMADs.
•Who will be treating the mother beyond the postpartum period? • OB provider?
• Primary care provider?
• Mental health provider?
•Bridge the gap of care• Support continuity of care
• Minimize disruption of psychotherapy and pharmacotherapy
•Do not expect mothers with PMADs to “advocate for themselves!”
•See resources tab for action plan and community resources
(KENDIG ET AL., 2017)
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REFERENCES
Association of Women’s Health, Obstetric and Neonatal Nurses (2015). Mood and anxiety disorders in pregnant and postpartum women. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 44(5), 687-689. Doi: 10.1111/1552-6909.12734
Beck, C. T. (2014). Postpartum mood and anxiety disorders: Case studies, research, and nursing care (3rd
ed.). Washington D.C.: AWHONN.
Chan, C. Y., Lee, A. M., Lam, S. K., Lee, C. P. Leung, K. Y., Koh, Y. W., & Kum Tang., C. S. (2013). Antenatal anxiety in the first trimester: Risk factors and effects on anxiety and depression in the third trimester and 6-week postpartum. Open Journal of Psychiatry, 3, 301-30. Doi 10.4236/ojpsych.2013.33030
Davidson, M., London, M., & Ladewig, P. (2020). Olds’ maternal-newborn nursing & women’s health across the lifespan (11th ed.). Pearson Education, Inc.
Dube, R. (2016, October 14). ‘Pinterest stress’ afflicts nearly half of moms, survey says. Retrieved from https://www.today.com/parents/pinterest-stress-afflicts-nearly-half-moms-survey-says-1C9850275
Howorth, C. (2017, October 30). Motherhood is hard to get wrong. So why do so many moms feel so bad about themselves? Time. Retrieved from http://time.com/4989068/motherhood-is-hard-to-get-wrong/
(MATTSON & SMITH, 2015)
REFERENCES
Kendig, S., Keats, J. P., Hoffman, M. C., Kay, L. B., Miller, E. S., Moore Simas, T. A., Frieder, A., Hackley, B., Indman, P., Raines, C., Semenuk, K., Wisner, K. L., & Lemieux, L. A. (2017). Consensus bundle on maternal mental health: Perinatal depression and anxiety. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 46(2), 272-281. Doi: 10.1016/j.jogn.2017.01.001
Mattson, S. & Smith, J. E. (2016). Core curriculum for maternal newborn nursing (5th ed.). St. Louis, MO: Elsevier.
Marchesi, C., Ossola, P., Daniel, B. D., Tonna, M., & De Panfilis, C. (2015). Clinical management of perinatal anxiety disorders: A systematic review. Journal of Affective Disorders, 190 (2016), 543-550. doi: 10.1016/j.jad.2015.11.004
McCabe-Beane, J. E., Stasik-O’Brien, S. M., & Segre, L. S. (2018). Anxiety screening during assessment of emotional distress in mothers of hospitalized newborns. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 47(1), 105-113. Doi: 10.1016/j.jogn.2017.01.013
McIntyre, L. M., Griffen, A. M., & BrintzenhofeSzoc, K. (2018). Breast is best…except when it’s not. Journal of Human Lactation, 1-6. Doi: 10.1177/0890334418774011
Review to Action (2018). Report from nine maternal mortality review committees. Retrieved from http://reviewtoaction.org/Report_from_Nine_MMRCs
Simpson, K. R. & Creehan, P. A. (2014). Perinatal Nursing (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Song, J., Kim, T., & Ahn, J. (2015). A systematic review of psychosocial interventions for women with postpartum stress. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 44(2), 183-191. Doi 10.1111/1552-6909.12541
The Postpartum Stress Center, LLC. (2018). Clinical tools for your practice. Retrieved from https://postpartumstress.com/for-professionals/assessments/