PSYCHOSOCIAL PROBLEMS AFFECTING CHILDBEARING Guide Summary:

Postpartum Blues Postpartum Depression Postpartum Psychosis Schizophrenia

INTRODUCTION Any woman who is extremely stressed or who gives birth to an infant who in any way does not meet her expectations may have difficulty bonding with the infant. The average woman may have difficulty immediately after birth believing her child is real. She must not only gasped the fact that her baby has been born but also understand that her actual baby is different from her wished-for baby. A WOMAN WHOSE CHILD HAS DIED Why me? Out of all the women here, why did my baby die? DO NOT PLACE a woman whose child has died in a room with a woman who had a healthy baby.

Postpartum Blues
A normal feeling accompaniment to birth. Feelings of sadness immediately 1-10 days of the first 2 weeks of after childbirth May burst into tears easily or feel let down or irritable baby blues Caused by hormonal changes in estrogen and progesterone that occurs with the delivery of the placenta. Response to dependence and low self-esteem caused by exhaustion

ASSESSMENT (MATE GOD FIRST )

M-ood swings A-norexia/ loss of appetite T-earfulness E-xhaustion G-radual withdrawal O-ut of coping D-iscomfort

F-atigue, feeling of inadequacy I-rritability R-estlessness S-leep disturbance T-ension

INTERVENTIONS
Reassure that crying episodes are normal Support persons also needs reassurance Anticipatory guidance and individualized support help understand that this response is normal Let woman verbalize her feelings Allow her to make as many decisions as possible- sense of control

Postpartum Depression (PPD)/ Postpartum Mood disorder

Intense and pervasive sadness with severe mood swings and is more serious that postpartum blues. Immediate feelings of sadness after birth from 1-12 months Related to hormonal shifts: estrogen, progesterone, gonadotropin. Risk Factors: History of depression A troubled childhood Low self-esteem Stress in home/work Lack of effective support people

ASSESSMENT (SEMI DOWN )

S-leeping heavily E-xtreme fatigue M-anic mood depression I-nability to stop crying, irritability, insecurity, increased anxiety, inability to go back to sleep after feeding

D-iarrhea O-verall feeling of sadness W-eight gain and Food cravings N-ausea & vomiting, Negative thinking styles

INTERVENTIONS
Factors should be identified Pregnancy counseling Postpartal return visits Antidepressant therapy and anxiolytic drug therapy

Postpartum Psychosis (PPP)

Often characterized by depression, delusion, and thoughts by the mother of harming either the infant or herself Within first year after birth Majority of the woman had symptoms of mentally ill before pregnancy

ASSESSMENT (CEASE FIRE)

C-onfusion E-pisodes of tearfulness A-uditory hallucination S-uspiciousness E-motional liability F-atigue I-nsomia, Inability to move, Incoherence, Irrational statement R-estlessness E-xceptionally sad

INTERVENTIONS
Refer to professional psychiatric counselor Do not leave the woman Be an active listener and demonstrate caring attitude Observe for signs of depression Let mother have contact with baby if desired Psychiatric hospitalization Antidepressant, lithium, antipsychotic drugs, mood stabilizers (contraindicated to breastfeeding mothers) Psychotherapy after the period of acute psychosis

Schizophrenia
Disordered thinking, delusions, hallucinations, depersonalization, impaired reality testing, impaired interpersonal relationships. Cause: UNKNOWN Risk Factors: Genetic: 1% of population Biochemical: neurotransmitter dysfunction like dopamine and serotonin Interaction of predisposing risk and environmental stress

CLASSIFICATION OF SCHIZOPHRENIA

Catatonic
Stuporous state Excited state

Disorganized (Hebephrenic) Paranoid Undifferentiated (Residual)

ASSESSMENT
A-ssociative looseness, Ambivalence, Autism C-atatonic behavior D-isrupted thought process, Delusions F-lattened affect H-allucinations, Hygiene and Grooming affect P-ersonality changes (social withdrawal) U-nable to relate to others

INTERVENTIONS
Establish trusting relationship Provide consistent, honest interaction Alleviate clients anxiety Maintain biologic integrity Design realty-oriented activity Provide time for activities of daily living Encourage to make decisions and assume responsibility Praise client Antipsychotic agents