Perinatal health and wellbeing Flashcards

Question

Evolutionary perspective - Yerkes-Dodson anxiety

Answer 1

Performance reaches a peak, anxiety only improves performance to a certain extent Poor performance - little stress, not checking baby etc Optimal performance - Moderate stress. Preventing harm e.g. checking on baby when asleep Poor performance - too much stress. disrupt with daily functioning - OCD symptoms such as excessive need to check on the baby

Answer 2

Brain changes: Increased activation in the salience network e.g. amygdala Sole purpose is for protection from harm for the infant

Answer 3

Study found lower stress responses in late pregnancy compared with early pregnancy

Answer 4

Cope with stress more effectively during pregnancy - Avoidant (negative) coping strategies are used less e.g. smoking, acohol consumption - Engage in healthy coping strategies e.g. mindfulness - Avoidant strategies associated with reduced preparation for parenting, bonding problems, and less preventative health care

Answer 5

Exposure to high levels of maternal stress during pregnancy has the potential to adversely impact fetal development, birth outcomes, and mother-infant relationships

Answer 6

Recognising when to intervene and when normal becomes maladaptive `

Answer 7

9-16% prevalence from pregnancy through to post the first year postpartum Prevalence is higher in areas of high socioeconomic deprivation

Answer 8

"baby blues" and happiness are not mutually exclusive experiences - they can both be experienced at the same time. Newer studies use instruments that measure both positive and negative mood

Answer 9

Research and training focused primarily on PND Disorders that tend to be highly correlated with depression e.g. anxiety/PTSD/OCD tend to get masked by depression symptoms and incorporated into depression diagnoses Dependant on expertise and training of clinicians whether symptoms that fall outside of depression get flagged

Answer 10

Nicholson, 2001 Loss of autonomy, loss of time, loss of appearance, loss of sexuality, loss of occupational identity

Answer 11

Additional feelings of guilt, due to social norms that motherhood is this perfect and easy. Societies telling you you are not being the perfect mother - exacerbates these symptoms

Answer 12

Do housework Offer psychological support

Answer 13

GAD - Fear of miscarriage, fear of infant harm, fear baby will be born with abnormality OCD – Fetal exposure to alcohol, cigarettes in pregnancy, repeatedly checking infant, compulsively washing self or baby Social anxiety – Anxious about pregnant appearance, self-consciousness in public

Answer 14

Some research assumes that when anxiety is present, in any form, the woman is “pathologically anxious” But, some increases in anxiety are normal and adaptive Need to figure out where the cut-off point is for clinically concerning anxiety

Answer 15

Pre-existing, general measures are problematic: Includes somatic symptoms in general measures but these occur naturally in the postpartum, which might overinflate scores e.g. 'I don't feel well rested' Do not address specific maternal or infant focused anxieties - not accurately capturing anxiety

Answer 16

Pathologising something which is a normal experience and then making it worse by making it this taboo thing when to a certain extent it is a normal part of new motherhood

Answer 17

State trait anxiety inventory (STAI)

Answer 18

Terms often used interchangeably in perinatal literature To an extent whereby items on stress questionnaires overlap with items on anxiety questionnaires Excessive stress, per se, is not a mental illness, but excessive anxiety may well be Need to make sure we are conceptualising in a standardised way in order to make robust conclusions and make interventions to help people as health psychologists

Answer 19

The cumulative negative emotional impact of everyday events

Answer 20

Negative emotional impact, without an obvious identifiable cause (often the product of excessive stress)

Answer 21

Maternal stress, anxiety and/or depression during pregnancy increases risk of adverse psychosocial developmental outcomes Wide range of outcomes – lower birthweight, prematurity, challenging temperament, more sleep problems, lower cognitive performance, emotional problems

Answer 22

High degrees of anxiety slows down the process of labour as the cortisol counteracts oxytocin, making labour longer, weakens contractions and increases the risk of needing some kind of assisted birth e.g. c section

Answer 23

Maternal sensitivity is the ability of the mum to have a synchronous relationship with their baby - Poor mental health after birth can make it more challenging for a mother to think and respond to her infant in a sensitive and emotionally responsive fashion (i.e., ‘mind-mindedness, Meins, 2001) More difficult for mother to pick up on the infant's cues

Answer 24

Occurs in response to a very stressful, life-threatening, or traumatic event

Answer 25

DSM (1980) originally stated “the person must have experienced an event that was outside the usual range of human experience” Not birth then! Contributed to a lack of research into PTSD until recently

Answer 26

Revised in 1994 (DSM-IV) to accommodate the aspect of personal experience and interpretation “Person must believe her own or another person’s life was threatened and responded with intense fear, helplessness, or horror”

Answer 27

Trauma prior to birth e.g. childhood sexual abuse Trauma exposure during birth (e.g., Stillbirth, assisted or emergency births, perceived threat, care and support during birth) Pre-birth mental health difficulties and trait anxiety (Czarnocka & Slade, 2000) Perceived low support from partner and/or staff (Czarnocka & Slade, 2000) Perceived blame and low-perceived control in labour (Czarnocka & Slade, 2000)

Answer 28

Subjective birth experience is more important than objective severity of birth

Answer 29

Psych: Intrusive images of labour and birth Fear and avoidance of giving birth in the future Poor self-image and feeling inadequate Postnatal depression (PND) Isolation and loneliness Avoidance of medical treatments like smear tests

Answer 30

Fear of childbirth after having a previous traumatic birth

Answer 31

Relationship difficulties Lack of interest in, and avoidance of, sex and shunning physical contact

Answer 32

Difficulty in feeding Difficulty with bonding with your baby, and guilt as a result

Answer 33

Misdiagnosis of PTSD with PND is common, due to overlapping symptoms Are often co-morbid

Answer 34

Slade et al, 2016: Something you can't avoid the triggers for - if baby triggers the symptoms you can't avoid your baby. Re-experiencing symptoms, such as upsetting thoughts, images and nightmares about the event - Hard not to relive symptoms when you are required to care for the product of your symptoms (i.e., your baby) 24/7 Avoidance and numbing, such as trying to avoid thoughts or reminders of the event - Tricky as you can’t avoid your baby! Hyperarousal symptoms such as sleep disturbances, being overly vigilant, and irritable - Confounded by the normal by-products of the postpartum – adaptive anxiety, blues, lack of sleep etc..

Answer 35

Intervening early, within the first 72 hours of the perceived traumatic birth, tends to be effective in terms of reducing PTSD symptoms within the first 6 weeks postpartum

Answer 36

It is relatively short term so we don't know the longer term impacts of these interventions in terms of preventing distress and what the effects are in terms of subsequent reproductive decision making

Answer 37

A severe mental illness with dramatic onset shortly after birth. Usually categorised by dissociation with reality

Answer 38

Hallucinations Delusions Mania Low mood - most cases of postpartum psychosis represent a variant of bipolar disorder

Answer 39

The woman doesn't need to have had a history of bipolar or schizophrenia or psychosis to have an onset of postpartum psychosis - the experience of birth in and of itself can trigger and psychosis.

Answer 40

The mother's hallucinations tend to be focused around one's baby Increase risk of child abuse and neglect

Answer 41

New motherhood is dichotomised into 'good vs bad' mothering practices Most explicitly seen via infant feeding - 'Breast is best' - Breast feeding doesn't work for the majority of women in the UK Co-sleeping 'Gentle parenting' Often there is no ‘this’ or ‘that’ Discrepancy between one’s actual and ideal self Belief that one is a ‘bad mother’ (Murphy, 1999)

Answer 42

Elevated depression and parenting stress Exhaustion and anxiety

Answer 43

Child behavioural development difficulties Poorer breastfeeding outcomes Poor maternal-infant attachment

Answer 44

Transdiagnostic phenomena, meaning that they both contribute to the onset and the maintenance of a variety of different and psychiatric disorders. Depression and anxiety both predicted by guilt and shame - intervene and put support in place as preventative action

Answer 45

multiple pregnancies preeclamsia diabetes bleeding growth restriction infection genetics

Answer 46

age, , poverty, unmarried, ethnic background – African American women have twice the rate of prematurity

Answer 47

smoking, alcohol use, substance use, and stress

Answer 48

Women across all types of high risk pregnancy have higher levels of depression and anxiety than healthy pregnant controls BUT their levels of cortisol remained the same (King et al. 2010) Suggests it is the perceived stress of high risk pregnancy that contributes to the onset of symptoms

Answer 49

Lifecourse rupture - they see it as this isn't how parenting is supposed to be. disrupts ability to bond with their baby

Answer 50

Lower use of health promoting behaviours – diet, exercise, attendance at prenatal appts Lower quality of maternal-foetal attachment particularly in hospitalised women

Answer 51

NICU admission often results in mother-infant separation which disrupts attachment Kangaroo care: The practice of skin to skin contact between an infant and parent in NICU

Answer 52

Associated with better infant health outcomes and lower risk of mortality, and… Improves parenting competence, knowledge about infant care, responsiveness, lowers depression, promotes breastfeeding Effects continue after discharge Improves infant sleep, reduces crying, inhibits pain response, shortens length of NICU stay Humanises NICU experience (less traumatising)

Answer 53

Pregnancy loss up to 20 weeks gestation

Answer 54

These infants experience higher mortality, morbidity, and adverse outcomes across the life span Grief over the loss of the parental role: intensity of grief similar to the grief of parents whose infant died in the new born period

Answer 55

pregnancy loss > 20 weeks gestation

Answer 56

Death of a live born infant during the first 28 days after birth

Answer 57

For many, parenthood is a key development in one’s adult identity Perinatal loss interrupts reproductive story and changes the concept of parental identity Grief during an already emotionally vulnerable period

Answer 58

A significant and disruptive event or series of events that disrupts the expected trajectory of a person's life, potentially leading to changes in their social roles, identities, or health Perinatal loss Complications

Answer 59

In pregnancy Historically, attachment was thought to be a leaned process, developed through mother-infant interaction Perinatal loss thought of as “non event”, unlikely to have serious consequences But mothers who have miscarriage experience grief

Answer 60

The weeks gestation didn't seem to play a role in terms of the amount of grief that a person felt if they lost their baby during pregnancy, it was more linked to the “assignment of personhood". Mother asked what they felt they lost (pregnancy, baby, a baby named…, a child who would….) Whether or not a memorial was held Higher scores on this measure significantly predict intensity of grief response and emotional reactions in subsequent pregnancy

Answer 61

increased distress

Answer 62

Pregnancy and parenting prior to age 20 is associated with compromised biopsychosocial outcomes Competing biological demands of maturing and carrying a baby simultaneously Social tension between adolescence and pregnancy/parenting More common in low SES groups and in individuals with depression – is teenage pregnancy, per se, that causes poorer outcomes? Or the groups of people it tends to occur in?

Answer 63

Less prenatal care, low birthweight infants, preterm birth, c-section birth - could this be due to lower SES area - wider societal issues with socioeconomic deprivation Ongoing maternal growth is a risk factor for low birthweight

Answer 64

Mother: Less likely to perform well in school, negative impact on relationships, reduced parenting skills Infant: Poor educational attainment, increased risk of mental health problems, increased risk for child abuse

Answer 65

Synthesised findings from qualitative studies and found Motherhood as Positively transforming New life, new identity, new understanding of importance of relationships Baby was a stabilising influence - Stopping risk-taking behaviours, working harder at school/college

Answer 66

Social support is a key mediator of risk factors. Positive relationships allow them to be positive with their infants

Answer 67

Non-planned pregnancy is associated with poorer mental health outcomes in non-Western cultures E.g. Shameful for women to become pregnant before marriage in Japan

Answer 68

In some Asian cultures fathers are not involved in the birth process at all, in others the father speaks for the mother during birth Chinese and Japanese women report that minimal noise and verbal expression of pain is accepted during childbirth – it is shameful to scream and uses up needed energy need to provide care that is sensitive and inclusive

Answer 69

We live in a very interconnected world and we need to be able to provide care that is sensitive and inclusive to people that don't meet our Eurocentric views

Answer 70

Biomedical model and the medicalisation of pregnancy dominate Western cultures Doctors and hospitals primarily responsible for prenatal and postpartum care Routine antenatal care in the absence of a problem Contributed to high rates of assisted birth (induction/c section), and women lacking control over their pregnancy and postpartum choices Increase in help seeking behaviours and health care utilisation

Answer 71

In some Eastern cultures, pregnancy is viewed as a normal experience which does not require intervention unless there is a problem The elder of the family provide information and guidance during this time Stigma around mental health conditions more generally Less likely to seek help, particularly for adjustment issues In many Eastern culures pregnancy is often viewed as a natural process, potentially leading to less emphasis on medical interventions compared to Western approaches. This perspective may stem from a belief that pregnancy is a natural state and not necessarily a risky condition, potentially influencing decisions about seeking or utilizing medical care during pregnancy.

Answer 72

Nothing around childbirth in sex education in the uk - not educated on what to expect

Answer 73

Not educated on what to expected - scared - more cortisol - inhibits oxytocin - slows down labour - more traumatic - tell internet - perpetuates this fear based response

Answer 74

It helps: - regulate body temperature - regulate heart rate -regulate breathing - improves weight gain - may reduce pain during medical procedures.

Answer 75

- promotes bonding - increases confidence in caring for the baby - can stimulate milk production for breastfeeding mothers.

Answer 76

"Baby blues" aren't a medical diagnosis. They're mainly caused by hormonal changes after birth, especially the drop in oestrogen and progesterone when the placenta is delivered. These symptoms usually go away within about a month. Clinical depression, however, lasts longer and can't just be explained by hormones — for example, dads can experience it too

Answer 77

Infant feeding problems Previous traumatic experiences of fatherhood Relationship quality

Answer 78

PPD/PPA occurs in the absence of these hormonal changes

Answer 79

Human Chorionic Gonadotropin

Answer 80

In Western cultures, the biomedical view of pregnancy often leads to increased interventions during labor and delivery, viewing pregnancy as a medical condition requiring intervention rather than a natural process. This perspective, often influenced by factors like private practice and medicolegal pressures, can lead to higher rates of medical interventions even in normal pregnancies, raising questions about the effectiveness and necessity of these interventions.

Perinatal health and wellbeing Flashcards

(109 cards)