Perinatal Mental Health

Chapter 26 Perinatal Mental Health



Stress/anxiety and domestic abuse


Women are affected emotionally and socially on many levels. Women in abusive relationships are particularly vulnerable. Approximately 30% of domestic violence and abuse begins or escalates during pregnancy or following childbirth.



The transition to motherhood


Postnatally, parents may find coping with the demands of a new baby, infant feeding, financial constraints and adjusting to changes in roles and relationships particularly testing emotionally. Disturbed sleep is inevitable. Soreness and pain from perineal trauma will affect libido; so too will the feelings of exhaustion, despair and unhappiness that may be associated with the round-the-clock demands of caring for a new baby.



Normal emotional changes during pregnancy, labour and the puerperium


It is perfectly normal for women to have periods of self-doubt and crises of confidence. They may experience fluctuations between positive and negative emotions, as described below.




First trimester




image Pleasure, excitement, elation.


image Dismay, disappointment.


image Ambivalence.


image Emotional lability.


image Increased femininity.



Second trimester




image A feeling of wellbeing.


image A sense of increased attachment to the fetus.


image Stress and anxiety about antenatal screening and diagnostic tests.


image Increased demand for knowledge and information.


image Feelings relating to the need for increasing detachment from work commitments.



Third trimester




image Loss of or increased libido.


image Altered body image.


image Psychological effects from physiological discomforts such as backache and heartburn.


image Anxiety about labour (e.g. pain).


image Anxiety about fetal abnormality.


image Increased vulnerability to major life events.



Labour


For many women, labour will be greeted with varied emotional responses such as:



image great excitement and anticipation to utter dread


image fear of the unknown


image fear of technology, intervention


image fear of hospitals, illness and death


image tension, fear and anxiety about pain and lack of control


image concerns about the baby and ability of their partner to support/cope


image a fear of lack of privacy or embarrassment.


Women’s perceptions of control during labour are influenced by:



image continuity of care by the midwife


image one-to-one care in labour


image not being left for long periods


image being involved in decision making.



The puerperium


Normal emotional changes are complex and may encompass the following:



image Relief labour is over – others may convey a cool detachment from events.


image Contradictory and conflicting feelings from joy and elation to exhaustion and helplessness.


image Closeness to partner and/or baby or disinterest.


image Desire for prolonged skin-to-skin contact and early breastfeeding.


image Fear of the unknown and realisation of overwhelming responsibility.


image Exhaustion and increased emotionality.


image Pain (e.g. perineal, nipples).


image Increased vulnerability and indecisiveness.


image Loss of libido, disturbed sleep, anxiety.



Postnatal ‘blues’


This normal and transient phase is experienced by 50–80%, of women depending on parity. The onset typically occurs between 3 and 4 days postpartum, but may last up to a week or more, though rarely persisting for longer than a few days. The features of this state are mild and transitory and may include a state in which women usually experience labile emotions. The actual aetiology is unclear but hormonal influences seem to be implicated, as the period of increased emotionality appears to coincide with the production of milk. Although the condition is self-limiting, the midwife must be vigilant as persistent features could be indicative of depressive illness.



Emotional distress associated with traumatic birth events


Over recent years the label ‘post-traumatic stress disorder’ (PTSD) has emerged in midwifery practice. Many women will eventually overcome the stress, pain and trauma that might have been their birth experience. However, others may find their birth experience blights their life and affects relationships with their partner and baby.



Perinatal psychiatric disorders


Perinatal psychiatric disorders encompass those that develop during the perinatal period as well as pre-existing disorders. Midwives are recommended to routinely ask at early pregnancy assessment about previous mental health problems, their severity and care. For example:



image During the past months, have you often been bothered by feeling down, depressed or hopeless?


image During the past months, have you often been bothered by having little interest or pleasure in doing things?


A third question should be considerd if the woman answers ‘yes’ to initial question.



image Is this something you feel you need or want help with?

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Related posts:

  1. The Placenta
  2. Prolonged Pregnancy and Disorders of Uterine Action
  3. The Third Stage of Labour
  4. Problems of Pregnancy

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Jul 11, 2016 | Posted by in MIDWIFERY | Comments Off on Perinatal Mental Health

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