Doula Training: Perinatal Mood Disorders and Substance Use | PDF

Doula Training & Mentorship Class 6: Perinatal Mood and Anxiety Disorders, Substance Use, Infant Loss Perinatal Mood and Anxiety Disorders  About PMADs Pregnancy can be a risk factor for the development of certain mood conditions. Although some fluctuations are normal during pregnancy, the develop...

Doula Training & Mentorship Class 6: Perinatal Mood and Anxiety Disorders, Substance Use, Infant Loss Perinatal Mood and Anxiety Disorders  About PMADs Pregnancy can be a risk factor for the development of certain mood conditions. Although some fluctuations are normal during pregnancy, the development of longer term symptoms is not normal and should be noted. PMADs can happen during or in the 12 months after pregnancy. Perinatal: the pregnancy period and up to 12 months following the birth of the fetus Content from this training has been adapted from Postpartum Support International PMHC training Types of PMADs Perinatal depression Perinatal anxiety Perinatal panic Perinatal OCD Perinatal PTSD Perinatal bipolar disorder Perinatal psychosis PMAD Risk Factors Having a chronic mood or anxiety disorder Having experienced a PMAD in a previous pregnancy Family history of mood or anxiety disorders Traumatic birth experience Clinical complications during pregnancy or postpartum Hormonal imbalance Low social support Pregnancy vs. Depression Pregnancy Depression Mood is labile, teary Mood is gloomy, irritable, agitated, enraged Self-esteem is unchanged Low self-esteem, guilt Sleep is uninterrupted unless bladder is full or Sleep is difficult to initiate or sustain experiencing heartburn, can fall asleep No suicidal ideation/intent Suicidal thoughts, plans or intentions Pleasure: joy and anticipation (appropriate Loss of interest in things that were once exciting worry) Appetite: increases Dysregulated appetite The Baby Blues: About Affects 60-80% of new mothers universally Due to hormonal fluctuation and acute sleep deprivation Lasts between two days and two weeks post-delivery Usually peaks 3-5 days after delivery Note, this is not considered a perinatal mood or anxiety disorder The Baby Blues: Symptoms Tearfulness, lability, reactivity, exhaustion Predominantly happy, self-esteem remains unchanged Unrelated to stress or psychiatric history If symptoms persist after two weeks postpartum, this is NOT the baby blues and should be further evaluated! Consider: Severity/intensity Timing/onset Duration/chronicity Major Unipolar Depression Five or more symptoms have been present during the same two-week period: Depressed mood most of the day, nearly everyday Loss of interest, joy, pleasure Significant weight change or appetite disturbance Sleep disturbances (insomnia or hypersomnia) Psychomotor agitation or retardation Fatigue or loss of energy Poor concentration, focus, indecisiveness Feelings of worthlessness Excessive or inappropriate guilt Recurrent thoughts of death or suicide Presentation of Perinatal Depression Overwhelmed, “feel like I can’t cope” Lack of feelings or connection toward the baby Inability to take care of oneself or one’s family Frequently co-morbid with anxiety Isolation, social withdrawal Agitation, irritability “This doesn’t feel like me” Increased somatic symptoms (headaches, back pain, GI distress, etc.) Let’s discuss! Perinatal Anxiety Prevalence: about 16% Must have three or more symptoms: Excessive anxiety and worry (often about one’s health or one’s baby) Difficulty controlling one’s worry Agitation, irritability, can escalate to rage (then spiral to guilt/shame) There is usually a trigger to the thought spiral or symptom onset Restlessness, inability to sit still, feeling on edge Poor concentration or mind going blank Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) Increased somatic symptoms (muscle tension, palpitations, racing heartbeat, shortness of breath, GI distress) PMADs and Partners New dads and anxiety: 4% - 16% during the prenatal period 2% - 18% during the postnatal period Partners are 50% more likely to experience a PMAD if the birthing person experiences a PMAD. Perinatal Panic Disorder Prevalence: about 16% Must have four or more symptoms: Episodes of intense fear or discomfort reaching a peak within minutes Shortness of breath, chest pain, sensations of choking or smothering, dizziness Hot or cold flashes, trembling, rapid heart rate, numbness or tingling sensations Restlessness, agitation, irritability Excessive worry or fear Persistent fear of dying, going crazy or losing control Often no identifiable trigger to the thought spiral or symptom Perinatal Obsessive-Compulsive Disorder Prevalence: about 32%; 65% have co-morbid depression Obsessions are defined by: Recurrent and persistent thoughts, urges, or impulses that are intrusive and unwanted and cause marked anxiety or distress Individual attempts to ignore or suppress thoughts, urges, or images to neutralize them with some other thought or action Compulsions are defined by: Repetitive behaviors that the individual feels driven to perform in response to obsession Behaviors or mental acts are aimed at preventing or reducing anxiety or distress  Perinatal OCD Presentation Intrusive, repetitive thoughts – usually of harm coming to baby Caught in a spiral of “what if” thinking Tremendous guilt and shame Horrified by these thoughts Hypervigilance Mothers engage in behaviors to avoid harm or minimize triggers Common fears: Deliberate harm Contamination Accidental harm Ordering/arranging Religious Checking Perinatal Post-Traumatic Stress Disorder Prevalence: 16% in high risk samples (Medicaid population) Symptoms to follow a traumatic event that last for more than one month after the event Birth Trauma An event occurring following the labor and birth process that can involve actual or threatened serious injury or death to the mother or her infant or the woman being stripped of her dignity The birthing person may experience intense fear, helplessness, loss of control and horror Potentially Traumatic Perinatal Events Emergency cesarean delivery Traumatic vaginal birth Postpartum hemorrhage Fetal anomaly diagnosis in Prematurity or stillbirth pregnancy Unexpected NICU admission Witnessing partner’s birth Forceps/vacuum extraction experience Severe preeclampsia Shoulder dystocia Third or fourth degree tear Long labor process Hyperemesis gravidarum Failed pain medication or poor response to anesthesia Bipolar Disorder Hypomania episodes At least one lifetime episode of Up to 4 days in length mania Often improves functioning Elevated mood symptoms Euphoria or agitation Mania episodes Decreased need for sleep Severe symptoms Racing thoughts Functioning is impaired Increased productivity At least 7 days in length or Noticed by others requires hospitalization or Pressured speech psychotic symptoms Increased energy (hallucinations, paranoia, or disorganized thinking) Psychosis Risk Factors Prevalence First baby 1-2 in 1,000 postpartum women develop it Discontinuation of mood stabilizer Of those affected: Obstetric complications 5% die by suicide Perinatal or neonatal loss 5% commit infanticide 50% of first-time mothers who experience Previous bipolar episodes, psychosis had no previous psychiatric psychosis or postpartum psychosis hospitalization Family history of bipolar disorder Onset usually within the first two weeks after or postpartum psychosis birth Sleep deprivation Postpartum Psychosis Presentation Clinical Features Postpartum Psychosis Symptoms Onset Usually within 2 weeks postpartum Cognitive Poor concentration, impaired sensorium, disorientation Behavioral Agitated, hyperactive, emotionally distant, aloor, lack of self-care Mood Elated, labile, dysphoric or less often depressed Speech Rambling Thought Content* Thought broadcasting (thoughts can be heard by others), ideas of reference (false beliefs that random events are directly related to the individual), persecutory, jealousy, paranoia of being controlled, delusion of grandiosity Thought Process* Disorganized thinking, flight of ideas Perceptions* Hallucinations * Acute dysfunction of the brain Let’s discuss! Let’s discuss! Substance Use Disorder Drug and/or alcohol usage during pregnancy and postpartum Requires ongoing clinical and behavioral management You should not try to manage this on your own as a doula! Infant Loss Can be due to a known genetic condition or anomaly Can occur due to stillbirth (born deceased) Can occur immediately postpartum (complications that were not treatable or curable) Can occur due to accidental death (SIDS) Bereavement doula services are more common Until Next Class… Things to think about Things to do How might screening for Research the statistics in black PMADs help improve vs. white prevalence of PMADs outcomes?