Psychology of Puerperium and Menopause PDF

Psychology of puerperium  Outlines  Definition  Psychological adaptation during the postpartum period.  Psychological and physical stresses during postpartum.  Emotional needs of the woman during the postpartum period.  Factors contributing to emotional wellbeing durin...

Psychology of puerperium  Outlines  Definition  Psychological adaptation during the postpartum period.  Psychological and physical stresses during postpartum.  Emotional needs of the woman during the postpartum period.  Factors contributing to emotional wellbeing during the postpartum period.  The most common psychological problems during the postpartum period.  Introduction Becoming a mother is a life event that comes with different kinds of changes in the health of the mother, as well as social life and relationships, either with the baby or the father and other family members. The feeling of emotional change may occur during the first week or months of parenthood. The mother might constantly experience some changes and feelings that she did not have before.  Definition of terms 1-Puerperium: is defined as the period of adjustment after childbirth during which the mother’s reproductive system returns to its normal prepregnant state. It generally lasts six to eight weeks. 2- Role : is defined as the function assumed or part played by a person or thing in a particular situation.  Definition of terms 3-Attainment: is defined as the action or fact of achieving a goal that one has worked towards, especially a skill or educational achievement. 2.Maternal role attainment: is the process by which the mother achieves competence in the role and integrates the mothering behaviors into her established role set so that she is comfortable with her identity as a mother.  Psychological adaption during postpartum period  Emotional changes in the mother during the postpartum period (restorative/adaptive process), as described by Reva Rubin, pass through three phases. They are: - Taking-in phase. - Taking-hold phase. - Letting-go phase.  Taking-In (Turning in) Phase: -This phase is characterized by:  Nurturing and protective care.  It lasts for 2–3 days.  It is focused mainly on the mother’s need for food, fluids, and sleep.  The mother’s behavior is passive, as she takes in the physical care and attention of others.  A postpartum woman depends on others to meet her needs.  Taking-In (Turning in) Phase: -This phase is characterized by:  The postpartum woman becomes hesitant about making decisions.  Integration of the labor and birth experience into reality the major task of the mother at this time.  By describing to family and friends the birth experience, the mother realizes that the pregnancy is past and the infant is now a separate individual.  Taking-Hold Phase (Taking Responsibility as a mother):  This phase lasts about 10 days.  The mother becomes more independent as she takes an interest in and takes responsibility for her own physical care.  Her focus shifts to the care of her infant.  If she is breastfeeding, she may worry about her technique or the quality of her milk. If her baby spits up after a feeding, she may view it as a personal failure.  Taking-Hold Phase (Taking Responsibility as a mother):  She welcomes opportunities to learn about the behavior of infants and to practice caring for them.  Many factors enhance taking-hold behaviors, such as childbirth preparation classes, pain management practices, early newborn contact, rooming-in, and early discharge.  Letting-Go Phase  During the letting go phase, the woman finally accepts her new role and gives up her old roles, like being a childless woman or just a mother of one child.  Letting-Go Phase For some mothers, the newborn infant does not fit the expected baby they dreamed of and talked about during pregnancy. They may be disappointed in the gender, size, or other characteristics of the infant. Now they must let go of their expectations and accept the reality of their infant.  Binding in postnatal  Binding is active, intermittent, and accumulative it occurs in progressive stages over a period of 12–15 months. The origin and endpoint of the process are in the maternal identity itself.  Maternal identity and binding in to the child are two major developmental changes that depend on each other. Stages of binding in : Rubins described binding in three stages as follows: 1. Identification 2. Claiming 3. Polarization  I-identification:  The fantasies of the child during pregnancy are replaced postpartum by hard empirical data to identify the child.  Identification of the child organizes maternal behavior and maternal attitudes. The sex, size, and condition of the infant are paramount.  If sex, size, and condition are all fine, each one of these attributes of the child is received by the mother as a gift to her, a contribution by the infant itself to her. Binding-in through identification then accelerates and continues with intensity.  The identification process is operationally complete after four weeks with a normal, healthy baby.  Complete identification of the infant by the mother can be said to occur when the mother "knows" by looking, touching, hearing, or smelling whether he is well or not, whether he is hungry or satisfied, and whether he is comfortable or not.  2- Claiming  This stage is completed when the mother observes and examines the newborn child, the item in appearance or in behavior is "like" her husband's, "like" her other child's, "like" her own. The linking in association binds the newborn into the exclusive and intimate social sphere of her significant others.  3- Polarization  Polarization is the physical and conceptual separating-out process of the incorporated infant of pregnancy into a separate, external, and constant entity postpartum.  Emotional needs of the women during postpartum period:  There are many needs for postnatal woman such as : 1. Recognition of the effort made during labor: approval of behavior during labor as well as in the immediate postpartum period. 2. Support and encouragement in her care for the infant. 3. Ask for help from family and friends if available, and accept any offers of help. Most people are keen to help.  Emotional needs of the women during postpartum period: 4-Attention from family members, particularly from the husband, is very significant, as most of the attention in the immediate postpartum period is directed suddenly toward the newborn. 5-Someone to listen and help them solve their dependency- independency conflict. 6-Physical needs of comfort, nourishment, and hygienic care should be properly fulfilled.  Psychological & physical stressors during post-partum. Stressors in pregnancy, labor, and the early postpartum period (49.3%) included physical and emotional difficulties and insensitive treatment by health professionals. Stressors related to adjusting to life with a baby (35.8%) included difficulties coping with a new baby, parenting, juggling responsibilities, changes to physical health, and loneliness. Stressors related to the baby's health (32.4%) included infant digestive problems, acute health problems, long-term impact, and neonatal intensive care unit experiences.  Psychological & physical stressors during post-partum. Stressors related to breastfeeding (23.7%) included pressure to breastfeed, feeling like a 'bad mom' for not breastfeeding, or wanting to breastfeed but not being able to. Other stressors related to changing relationships (18.2%) are with their partner, children, and other family members. Cross-cutting themes that emerged in different stressor categories were women making negative self-appraisals (e.g., a bad mom, failure), feeling guilty, and lack of support from others.  Factors contributing to emotional well-being during postpartum period 1. Physiological factors:  General health status.  Prenatal complications.  Postnatal complications.  Physiological changes in p.p.  Baby condition (health status and sex).  The parent's reaction to the gender of the baby may be a potential risk factor for postpartum strains.  Factors contributing to emotional well-being during postpartum period 1. Psychological factors: -  Level of trait anxiety.  Past experiences.  Emotional stability.  Available coping mechanisms.  Self-system (self-idea, self-concept, self-esteem).  Motivation for motherhood.  Degree of comfort with the maternal role.  Degree of control.  Previous pregnancy: psychological strains or losses  Factors contributing to emotional well-being during postpartum period 1. Social factors:  Socioeconomic status.  Availability and type of social support.  Social contradiction with an established role.  Postpartum sociocultural problems.  Postpartum psychological problem There are two common psychological problems during postpartum period namely postpartum blues and depression. 1. postpartum blue: is defined as the gap between the ideal and reality: the new mother’s self-expectation may exceed her capabilities, resulting in cyclic feelings of depression. It begins within a few days of childbirth. 2. Postpartum depression: is a feeling of extreme sadness and loss of interest in usual activities during the first few weeks or months after delivery. It is characterized by episodes of irritability, guilt, exhaustion, anxiety, sleep disorders, and somatic symptoms.  Predisposing factors of postpartum Psychosocial problems:  Fatigue after labor and delivery.  Ambivalence toward the woman’s own care for a newborn requires continuous attention.  Unplanned unwanted pregnancy.  Sleep deprivation.  Lack of support from family and friends.  Poor marital adjustment.  Changes in home and work routines.  Financial stress.  Unrealistic expectations of oneself.  Societal or cultural pressure to "bounce back" quickly after pregnancy and childbirth.  Anger, loss, or guilt, especially for parents of premature or sick infants.  Management of postpartum psychological problems  Encourage the woman to get enough sleep.  Encourage the woman to take time to relax and do her preferred activities.  Attention from family members, particularly from the husband, is very significant, as most of the attention in the immediate postpartum period is directed suddenly toward the newborn.  Reaching out to other new parents.  Physical needs of comfort, nourishment, and hygiene should be properly fulfilled.  Reassurance that symptoms are very common and will resolve on their own  If symptoms do not resolve within two weeks or if they interfere with functioning, individuals are encouraged to contact their healthcare provider. Early diagnosis and treatment of more severe postpartum psychiatric conditions, such as postpartum depression, postpartum anxiety, and postpartum psychosis, are critical for improved outcomes for both the parent and child.  Family roles in prevention of Postpartum psychological problems  One of the roles of the family is to maintain the mother’s health after childbirth by:  Giving love to the mother after giving birth so that the mother feels cared for, delivering for control.  Encouraging the mother to eat nutritious food.  Allowing adequate rest.  Maintaining personal hygiene and helping to care for the baby.  Family roles in prevention of Postpartum psychological problems  Husbands have a vital role in maternal health and a safe postnatal period.  Involvement in the health education process because of the potential benefits to maternal and child health outcomes.  Continues reassurance and emotional support.  Assist in baby care. Psychology of menopuse  Outlines 1. Definition 2. Mechanism of menopause 3. Behavioral and psychological symptoms of menopause. 4. Losses during the menopausal period. 5. Psychological and social aspects of menopause. 6. The developmental tasks of menopause. 7. The fertility –menopause dichotomy. 8. Spiritually oriented cognitive-behavioral therapy with menopause. . Definition of terms  Mechanism of menopause Menopause-related estrogen decline may trigger mood dysregulation by impeding the production of major neuroprotective factors (e.g., brain- derived neurotrophic factor) and, by altering neurotransmission, it interferes with the synthesis of catecholamines such as noradrenaline and upregulates (serotonin) receptor. Therefore, menopause can be associated with a variety of symptoms ,such as physiological, psychological and behavioural. A. Psychological and emotional symptoms: Some of the psychological symptoms that may accompany menopause include  Irritability.  Feelings of sadness.  Anxiety without apparent reason that the woman can identify.  Fatigue.  Tension.  Depressed feelings are a normal part of the grief reaction to any loss e.g: the end of fertility.  Emotional lability: "rapid mood swings, e.g. crying one moment and laughing the next.  Feelings of wanting to be alone (lonleness).  Feeling of dissatisfaction. A. Behavioral & cognitive symptoms:  Lack of motivation.  Decrease in stamina.  Aggressiveness.  Seeing only the negative.  Memory problem (Forgetfulness and reductions in attention).  Being impatient with other people.  Losses during menopausal period There are many losses during the menopausal period, such as: a. Loss of maternal role: At a time when families are increasingly mobile, children after marriage leave home and may move to another city or country, which increases the distance between the mother and their children. This leads to a loss of continued contact with them and with friends.  Losses during menopausal period There are many losses during the menopausal period, such as: b.Health loss (declining in function): - Normal changes in appearance that are associated with the menopausal period invariably have a negative effect and result in the loss of youthful attractiveness and appearance. Also, menopausal women are at greater risk for both acute and chronic illnesses. - The women often fear that their illness or disability will interfere with their independence and make them dependent on their families.  Losses during menopausal period There are many losses during the menopausal period, such as: C-Loss of spouse (widowhood): - The death of a husband is a common event that alters family life for many menopausal women. It has a traumatic and depressing effect on the surviving partner. - If the transitional phase of grief in this stage of life is not appropriately handled, it will lead to an increasing incidence of depression. - The reaction to this loss may vary according to the nature and meaning of the relationship as well as the unique characteristics of the bereaved.  Losses during menopausal period There are many losses during the menopausal period, such as: d-Loss of meaning in life: Awareness of mortality Widowhood, the death of friends, and the decline of functions increase menopausal women's awareness of mortality. During the early years, women intellectually understand that they will never live forever, but their behaviors often deny this reality. e-Mobility and independence: Mobility and independence bring limitations not only in relation to women’s movements, such as sitting down, standing up, and walking, but also in relation to the use of private and public transportation.  Losses during menopausal period There are many losses during the menopausal period, such as: F-Loss of friendship: The circle of friends diminishes as age increases and friends die. Children are grown and gone; friends and husbands may be deceased; hearing and speech deficits can foster loneliness.  All of these losses cause stress. Excessive stress can aggravate the menopausal process because it may lead to physical disease and may result in a grieving process or progress to depression.  Developmental tasks of menopause. Factor affecting the development of menopausal task: Methods of accomplishing menopausal development tasks vary depending on: 1. Marital status: Married, single, or divorced, has children or is childless. 2. Previous life experiences and coping styles. 3. Adaption: - Good adaptation produces a secure person who can continue to grow and change. - Poor adaptation can occasion such responses as depression, suicide, Anxiety and 4-General health status: physical and psychosomatic illness. 5-Level of anxiety.  The general developmental tasks of menopause General tasks of menopause include the following: 1. Reexamination of values and aspiration 2. Maintenance of family supports and boundaries 3. Redefinition of the self 4. Planning for the future and aging  The general developmental tasks of menopause - Reexamination of values and aspiration:  The menopausal woman focuses more on "what's really important to her" instead of "what is expected of her by society and others." Internal values become more important.  Some values will be reinforced in this re-examination and will provide even stronger guidance for menopause living.  Psychological and social aspects of menopause 1. Psychological factors Personal psychological vulnerability: Various personal factors of an individual female may affect her menopausal experience. Such as follows:  Past experience of mood disorders.  Woman’s attitude to menopause and aging: women with more negative attitudes toward the menopause in general report more symptoms during the menopausal transition.  Coping mechanism.  Neuroticism: refers to a broad personality trait dimension representing the degree to which a person experiences the world as distressing, threatening, and unsafe. o Women with high level of neuroticism are more sensitive to their bodily signals and more often attribute such signals to illness or its treatment.  Psychological and social aspects of menopause  Temperament: o Women with high level of emotional reactivity can either develop or practice behaviors that increase the risk of ill health or concentrate more than others on bodily sensations.  Spiritually oriented cognitive-behavioral therapy with menopause Cognitive behavioral therapy (CBT) is a goal-oriented psychotherapy that takes a hands-on, practical approach to changing patterns of behavior and thinking. It can be used for anxiety, sleep issues, and to improve mood in menopausal women. Spirituality can be defined as the thoughts, feelings, and behaviors of a person relating to the sacred. 46 47 47