There’s no such thing as a baby”

© 2018 Denver Public Health

Kelly Stainback-Tracy, MPH, IMHE(II) Denver Public Health

“There’s no such thing as a baby”:

The Importance of Maternal Mental

Health on Infant Development


Objectives

• Describe Pregnancy Related Depression (PRD) and related maternal mental health concerns

• Discuss ways that PRD impacts mothers and their infants

• Practice ways to start conversations with families when concerns are present

Gentle Reminder

Many people have experience with perinatal mental health concerns. Topics discussed may

illicit strong emotions. If this occurs, please take care of yourself in the way that is most helpful

and rejoin us when you are ready.

Parenthood

Parenthood


Agenda

• Overview of Pregnancy-Related Depression (PRD) and why it’s important – What is PRD?

– Ways in which PRD impacts mothers and infants

– Prevalence

• Colorado Public Awareness Campaign

• Pregnancy-Related Depression and Anxiety Symptoms Guidance Tool

• Referral Guidance Tool

• Practical Application Discussion


Postpartum Depression (PPD)

Pregnancy Related Depression (PRD)

Perinatal Mood and Anxiety Disorders (PMAD’s)

Maternal Mental Health Disorders


• “Baby blues” effects 80% of woman

• Begins between 1-5 days postpartum

• Symptoms are mild and may include mood swings, tearfulness, irritability, and fatigue

• Time limited

• Resolves without direct intervention

• Does not include thoughts of harm to self or baby

“Baby Blues” versus PRD


“Pregnancy-related depression (PRD) among women of reproductive age (ages 15-44) is a mood disorder that occurs during pregnancy or up to one year after

giving birth or experiencing pregnancy loss.”

What is Pregnancy-Related Depression?

Maternal Child Health Brief, CO Department of Public Health, 2014


Prevalence

• At least 1 in 7 mothers and 1 in 10 fathers experience serious

depression or anxiety during pregnancy or postpartum

• Difficulties can begin anytime in pregnancy or the first year postpartum (including loss)

• People may express their struggles differently (men vs. women)

• High comorbidity of Depression and Anxiety

• 1-2 out of 1,000 experience postpartum psychosis

• *Suicide is one of the three leading causes of maternal death


• Feeling sad or depressed

• Eating or sleeping too much or too little

• Feeling as if you are “out of control” or “going crazy”

• Losing interest in things you used to enjoy

• Feeling very worried or panicky

• Feeling irritable or angry with those around you

• Having upsetting thoughts that you can’t get out of your head

• Feeling as if you never should have become a mother or that someone else could care for your baby better than you

• Having difficulty bonding with your baby

• Worried that you might hurt your baby or yourself

• Mania, such as risky behaviors, rapid speech, and flight of ideas

Symptoms: Expected and Unexpected

How do REAL

moms talk

about PRD?

Isolated struggle

who am I now? weak

fight battle

my hormones feel out

of whack

drowning

having a hard time

I don’t want to be a

burden crazy

identity crisis

sleep deprived

I thought I was

the only one

failure suffocating

bad mom my fault


Biological • History of depression or

anxiety • Family history • Depression in previous

pregnancy • Teen pregnancy

Psychosocial • Isolation and lack of support • Economic instability • Poor relationship with partner • Unplanned/unwanted

pregnancy • Complications with pregnancy,

labor, delivery, or infant’s health

• Difficulty breastfeeding • Other major life stressors

Risk Factors for PRD


• Women of color experience pregnancy-related depression and anxiety at rates double the average for all women.

• The experience often reflects complex a complex array of stress factors related to systemic oppression, including

– lower education

– lower wages

– less social support

– community-level gaps in services for referral and treatment

– stigma

Race, Culture and Prevalence


"Mental health is a heavily stigmatized subject in the Hispanic culture and is easily denied and overlooked.

It's vital for moms to know they are not alone and that Colorado resources do exist for our community

and culture.“

~ Dr. Yajaira Johnson-Esparza, PhD, Salud Family Health Centers and member of CDPHE’s Spanish-Language Pregnancy-Related Depression Task Force


Caregiving

Safety Practices

Early Interactions

• Breastfeeding discontinuation

• Safe Sleep concerns

• Health Care Utilization patterns

• More likely to use physical punishment

• Less likely to use car seats/baby proofing

• Less responsive

• Intrusive

• Fluctuating/Inconsistent

McClean, et al, Maternal Depressive Symptoms at 2 to 4 months and Early Parenting Practices, JAMA Pediatrics, March 2006

Impact on Parenting


Depression and breastfeeding

• Postpartum depression is associated with suboptimal breastfeeding behavior – Shorter breastfeeding duration

– Shorter duration of exclusive breastfeeding

• No clear directionality – Breastfeeding may be protective for development for maternal

depression

– Presence of depression may impact breastfeeding behavior

• Women with depression were more likely to cite “too many household duties” as a primary reason for breastfeeding cessation

- Bascom, EM and Napolitano, Journal of Human Lactation, 2015


Depression and breastfeeding

• Some evidence that breastfeeding reduces maternal stress and is protective of maternal mood when it is going well

• Difficulty with breastfeeding, including pain, may contribute to maternal stress and/or depressive symptoms

- Tackett, K. International Breastfeeding Journal, 2007


• When interacting with depressed moms, infants are often fussier, more avoidant, and less likely to make positive facial expressions and vocalizations

• Mother-infant dyads can also have difficulty being in tune with one another

Mismatched interactions


Maternal depression may impact:

- Infant regulation

- Infant social and emotional development

- Infant learning, including motivation for challenge and mastery

- Impacts can extend through school age and beyond

Impact on Infant

Summarized in Field, 1995


Lifecourse perspective

• Untreated perinatal mental health struggles have the potential to effect health and development throughout the lifespan


Breastfeeding and Mother-

Infant Interactons

• Breastfeeding appears to protect infants of depressed mothers from some of these changes

• Depressed, breastfeeding mothers were more likely to look at, talk to, and touch their babies during feeding interactions

• Supports the rationale to intervene quickly when breastfeeding problems arise

- Jones, NA, et. al, Biological Psychology 2004.


• Infants with mothers who were no longer depressed at 6 months

– Were no longer depressed

– Normal development at 1 year

• Infants with mothers who remained depressed after 6 months

– Developed “depressed” style of interacting

– Lower scores on Bayley and lower percentiles on growth scales at 1 year

Early detection is important

Summarized in Field, 1995


• Mental health intervention and support

• Also:

– Social support

– Re-engaging in activities that used to be pleasurable

– Feelings of competence and confidence, especially around parenting

– Sleep

• A message of hope:

– “You are not alone. You are not to blame. With help, you will be well.” ~ Postpartum Support International

What Helps?


In 2015, 13.3% of women indicated that, in the past 12 months, there was a time they did not get needed counseling

health services. Of these women….

Uncomfortable talking with a health professional about personal problems

48.4%

35.4% Concerned about what would happen if someone found out they had a problem

Colorado Health Access Survey (CHAS), 2015

Stigma as a barrier


• State and local MCH partnership: PRD as priority

• Healthcare provider education & PRD Guidance dissemination

• Strengthening screening practices & referral networks

• PRD Public Awareness Campaign

MCH Pregnancy-Related Depression Priority

Addressing Stigma: Pregnancy Related

Depression Public Awareness Campaign

• Supports mothers in recognizing they are not alone and encourage

help seeking behavior

• Includes call to action

• Posters, rack cards business cards and fact sheets available

Spanish Language Campaign


Colorado Pregnancy-Related Depression

and Anxiety Guidance

• 2012 CDPHE & HealthTeamWorks convened stakeholders and experts to develop guide

• Guide is designed for a wide variety of users

• Updated in 2016


Taking care of the mind and the body


Starting the Conversation

• Caring responses: ▫ Listen

▫ Support feelings

▫ Empathize – It sounds like things have been really hard

▫ Provide information – fact sheets and flyers reinforce

the concept that the mother is not alone.


Referral Guidance

• Acknowledge screen results • Explore options • Identify needs that can be addressed through medical and integrated

behavioral health care • Determine if referral to community resources is needed


Referral Considerations


• Simplify the referral process

• Leverage care coordination services

• “No wrong door”

Referral options


Making a referral

• Ensure patient understands referral

• Maximize opportunity for patient follow through and coordination of care


• You are a support person for the family

• You support the development of the infant through responsive interactions

• Your interactions with families matter!

YOU as a Resource!


How does this information impact how you think about providing services for families?

How might you use the materials discussed

today in your work? Within your current role, what opportunities are

there to incorporate or improve maternal mental health education, screening, and/or referral into your work?

Discussion


Kelly Stainback-Tracy, MPH, PT

Perinatal/Infant Mental Health Specialist

Denver Public Health

303 602 8725

[email protected]

Questions?

mailto:[email protected]


Thank You!

There’s no such thing as a baby”

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