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PSYCHOSOCIAL SUPPORT Presented by:

Ashley Denker, MSN, RNC-

MNN, IBCLC

OBJECTIVES

•Define perinatal mood & anxiety disorders

•Discuss causes and risk factors of perinatal mood & anxiety disorders

•Identify signs and symptoms of perinatal mood & anxiety disorders

•Describe interventions and communication techniques helpful when interacting with parents experiencing perinatal mood & anxiety disorders

PERINATAL MOOD & ANXIETY DISORDERS

PMADs affect more women than preeclampsia, postpartum hemorrhage, and gestational diabetes combined

•1/7 women will have a perinatal depressive episode during pregnancy or up to 12 months postpartum

•Association between mental illness and mortality is complicated

•Suicidal ideation occurs more often among pregnant women than non-pregnant women.

•Among postpartum women, suicide most commonly occurs in the late postpartum period (43 to 365 days).

(BECK, 2014; DAVIDSON ET AL., 2020; KENDIG ET AL., 2017; MCINTYRE ET AL., 2018; REVIEW TO ACTION, 2018))

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PMADS RESULT IN…

Adverse Maternal Outcomes Adverse Infant Outcomes

•Impaired sleep

•Poor nutrition

•Inadequate weight gain in pregnancy

•Increased incidence of substance abuse

•Missed prenatal and postpartum visits

•Decreased adherence to healthcare

providers advice

•Preterm birth

•Low birth weight

•Developmental and cognitive delays

•Delayed mental development in 2 year

olds

•Increased crying

•Interfered bonding

•Prediction of difficult temperament at 4

and 6 months of age

Insecure and impaired maternal-newborn attachment

(AWHONN, 2015; CHAN ET AL., 2013)

PERINATAL MOOD AND ANXIETY DISORDERS

Perinatal (peripartum) mood and anxiety disorders (PMADs):

•The onset of mood symptoms occurring during pregnancy or in the 4 weeks following delivery (American Psychiatric Association Diagnostic criteria)

• In reality, symptoms may occur up to 1 year after delivery

Proposed that postpartum psychiatric disorders be one diagnosable syndrome with 3 subclasses: 1. Adjustment reaction with

depressed mood (baby blues)

2. Postpartum mood episodes with psychotic features

3. Peripartum major mood episodes

(DAVIDSON ET AL., 2020; MATTSON & SMITH, 2015)

WHO’S AT RISK?

• Any new mother (or support person!)

• Personal or family history of depression, anxiety, OCD, or other mental illness

• Previous perinatal depression or anxiety

(MATTSON & SMITH, 2016)

PICTURE FROM HTTPS://WWW.MOTHERING.COM/ARTICLES/STUDY-TAKING-PROBIOTICS-DURING-PREGNANCY-MAY-REDUCE-POSTPARTUM-DEPRESSION-AND-ANXIETY/

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WHO’S AT RISK?

• Fatigue/physical exhaustion

•Breastfeeding issues

• Thyroid imbalances

•Diabetes (I, II, or GDM)

•Substance abuse

•Primiparity

•Postpartum blues

•Complications of delivery

•Newborn loss

•Adolescence

•Multiples•High risk pregnancy

• Infertility treatment

Psychological exacerbating factors:• Low maternal self esteem/self-efficacy

•Unwanted pregnancy/ambivalence

•Pressure to return to pre-pregnancy weight

•Sexual changes

•Newborn concerns • Infant temperament

•Maternal infant separation

•Stressful life event

•Childcare and financial stress

•Maternal role concerns

•Career vs. motherhood changes

•Relationships with father/partner/family

• Lack of social resources and support

• Intimate partner violence

(BECK, 2014; DAVIDSON ET AL., 2020; LOWDERMILK ET AL., 2016; MATTSON & SMITH, 2015)

WHO’S AT RISK?

Mothers whose infants are in the NICU:•27-57% reported anxiety symptoms

•Up to 40% experienced PPD

NICU exacerbating factors:

• Immature physical appearance of the newborn

•Worry about newborn’s wellbeing

•Perceived loss of maternal role to nurses & physicians

•Financial stress r/t healthcare costs

•Exposure to unfamiliar and intimidating technology

•Distressing signs and sounds

•Lack of familiarity with medical terminology

(BECK, 2014;; MCCABE-BEANE ET AL., 2018)

NEW MATERNAL ROLE

•After delivery, new mothers have to move quickly from self-concern to concern for her baby.

•Difficulty with new, beginning skills may alter self-efficacy and maternal development

•Anxious mothers:•Less interactions with infant

•Decreased response to cues

•Less likely to initiate breastfeeding and/or breastfeed exclusively

•More likely to terminate breastfeeding earlier than intended

(MCINTYRE ET AL., 2018)

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SOCIAL COGNITIVE THEORY

High Self-efficacy:

• Persistence in a behavior

• Engagement in positive thought patterns promoting success

• Positive emotional reaction to new situations

Low Self-efficacy:

• Anticipation of failure

• Perception of new behaviors as daunting and overwhelming

• Engagement in negative thought patterns

• Negative emotional reaction to new situations

(DAVIDSON ET AL., 2020; HINIC, 2016)

Self-efficacy is the most influential cognitive determinant of behavior, especially as tasks increase in complexity.

SELF-EFFICACY

Positive Birth Experience:

• Emotion: satisfaction

• Feelings: •Mastery

•Self control

• Increased self-efficacy

Negative Birth Experience:

• Emotion: pain, anxiety, stress

• Feelings: •Anger

• Indignation

•Loss of control

•Disempowerment

•Failure

• Decreased self-efficacy

(DAVIDSON ET AL., 2020; HINIC, 2016)

SELF-EFFICACY VS. FAILURE

Mothers with PMADs have unrealistic expectations about every aspect of becoming a mother.

Results in:

•“Failure” when reality does not meet their expectations

•Inappropriate blame when pregnancy, labor, delivery or breastfeeding do not go according to plan

(BECK, 2014; HOWORTH, 2017; MATTSON & SMITH, 2015)

PICTURE FROM HTTP://GYMGABBLOG.COM/

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THEMES OF FAILURE

“Half of all new mothers had experienced regret,

shame, guilt or anger, mostly due to unexpected complications and lack of

support.”

TIME survey of 913 mothers

Message of failure extends throughout the entire perinatal period:

•Failure to conceive/infertile

• Incompetent cervix or uterus

•Failure to progress in labor

•Failed birth plan

•Lactation failures

•Failure to carry to term

(BECK, 2014; HOWORTH, 2017; MATTSON & SMITH, 2015)

WHAT ABOUT SIGNIFICANT OTHERS?

PMADs are significantly related between couples

• Experience the same hormonal shifts as mothers and same situational risk factors (sleep disturbance, etc.)

• Expected to participate in care of mother/baby without guidance

• When things go wrong:

•Feel abandoned, unimportant, uninformed

•Suppress anxiety, fear, distress to support spouse

(BECK, 2014)

SCREENING

•PMADs are often misdiagnosed or undiagnosed

•Screening for PMADs:•Postpartum depression• EPDS (Edinburgh Postnatal Depression Scale) – Score > 10 or affirmative response to #10

•Perinatal anxiety • Beck Anxiety Inventory – Score > 16

• PASS (Perinatal Anxiety Screening Scale

• Perinatal Scary Thoughts Algorithm

• https://postpartumstress.com/for-professionals/assessments/

Depression only screening fails to

identify 4.7-14.7% of parents

with clinically significant levels

of anxiety symptoms

(MCCABE-BEANE ET AL., 2018; THE POSTPARTUM STRESS CENTER, 2018)

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PMADS SCREENING

Screening focuses on the following three symptom characteristics:1. Frequency

2. Duration

3. Intensity

Of the women diagnosed with PMADs:• 27% have preexisting diagnosis

• 33% have onset in pregnancy

• 40% have onset postpartum

(KENDIG ET AL., 2017; SIMPSON & CREEHAN, 2014)

Edinburgh Postnatal Depression Scale (EPDS)

AN EMMY AWARD WINNING PERFORMANCE…

(MATTSON & SMITH, 2015)

Mother’s with PMADs are great at pretending.

PERINATAL MOOD & ANXIETY DISORDERS

PMADs

Anxiety Disorders

GAD

PanicOCD PTSD

Mood Disorders

PPD Bipolar II PPP

(BECK, 2014)

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POSTPARTUM BLUES

Is some anxiety normal? New mothers are often excessively concerned about details related to their infants.

•Postpartum Blues:

•Experienced by up to 85% new mothers

•Begins 2-4 days PP, resolves 10-14 days PP

•May be more severe in primiparas

•Key features: episodic tearfulness & rapid mood changes

•Other s/s: overwhelmed, inability to cope, fatigued, anxious, irritable, oversensitive

(DAVIDSON ET AL., 2020; LOWDERMILK ET AL., 2016)

GENERALIZED ANXIETY DISORDER

6-10% mothers experience GAD in the postpartum period

•Definition: Excessive worrying about multiple problems• Issues of concerns are realistic

•Level of worry is unrealistic

(BECK, 2014; LOWDERMILK ET AL., 2016)

GENERALIZED ANXIETY DISORDERPRESENTATIONConstant worry

Feeling that something bad is going to happen

Patient may request a lot of “extra” care but does not feel comforted by it

Racing thoughts

Disturbances of sleep

Withdrawal

Disoriented, agitated, uncooperative

Loss of ability to cope or orientation to reality

Low self-efficacy

Physical symptoms:

Headaches

Dizziness

hot flashes

Nausea

heart palpitations

GI disturbances

Fatigue

Tense posture, clenched hands, pain out of context

Restlessness or inability to sit still(BECK, 2014; DAVIDSON ET AL., 2016; MATTSON & SMITH, 2015)https://www.youtube.com/watch?v=U8ZSUzJ0KqU

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PANIC DISORDER

“Extreme anxiety”

•Mothers with panic disorder in pregnancy are 4.2x more likely to develop PPD

•Panic attack: brief (5-15mins), intense episodes of fear or discomfort

•Diagnosed if panic attacks are recurrent or associated with a continuing fear of future attacks

• Resulting in anxiety b/w attacks

(BECK, 2014; DAVIDSON ET AL., 2016; LOWDERMILK ET AL., 2016; MATTSON & SMITH, 2015)

PANIC DISORDER PRESENTATION

•Intense and Excessive fear/worry

•Sense of doom

•Tachycardia

•Hyperventilation

•Chest pain, SOB, faintness, fear, terror, choking feeling, sweating, numbness, derealization

•Diminished cognitive ability

(BECK, 2014; DAVIDSON ET AL., 2016; MATTSON & SMITH, 2015)

OBSESSIVE COMPULSIVE DISORDER (OCD)

“Scary thoughts disorder”

• 3-5% women experience postpartum

• “Most misdiagnosed and misunderstood“ of all the PMADs

•Often confused with PPP

•Obsessions & compulsions

(BECK, 2014; DAVIDSON ET AL., 2020; MATTSON & SMITH, 2015; POSTPARTUM SUPPORT INTERNATIONAL)

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POST TRAUMATIC STRESS DISORDER (PTSD)

• 1-6% mothers experience PTSD

• Caused by real or perceived trauma during delivery or postpartum

• 2011 study of 902 mothers:

• 9% mothers met full PTSD criteria

• 18% demonstrated elevated levels of PTSD symptoms

•Stressors:

Prolapsed cord, should dystocia, abruption, Hellp, preeclampsia, eclampsia, hemorrhage, extensive

vaginal trauma, unplanned c/s, operative vaginal delivery, NICU admission/transfer, feelings of powerlessness & lack of control, disruption in relationship with provider or staff, poor communication, lack of support/reassurance during delivery, previous trauma

(BECK, 2014; DAVIDSON ET AL., 2016; MATTSON & SMITH, 2015)

PTSD THEMES

Perception of relationship and communication are extremely influential!

•Mother’s perception of lack of caring

•Failure of staff to communicate with mother

•Betrayal of trust and powerlessness

•Celebration of a healthy baby was the focus

(BECK, 2014)

PTSD CLINICAL PRESENTATION

•Early: dazed look or withdrawal

• Intrusive re-experiencing of a past traumatic event

•Flashbacks or nightmares

•Avoidance behaviors

•Persistent increased arousal

• Irritability, difficulty sleeping, hypervigilance, exaggerated startle response

•Anger

•Anxiety and panic attacks

•Feeling a sense of unreality, numbness, and detachment

•Obsession over L/D details

• Isolate themselves from infants and support

(BECK, 2014; DAVIDSON ET AL., 2016; MATTSON & SMITH, 2015)

Anxiety Panic Attacks

Depression Considering

Suicide

Anger Rage

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PTSD NURSING CONSIDERATIONS

•Obvious: prevention of trauma whenever possible

•Demonstrate you care for the mother

•Communicate effectively and consistently

•Protect the mother’s dignity

•Provide autonomy and control

•Do not treat invasive procedures as normal and routine

•Be alert for early s/s

•Take a careful history on admission

• Does she have any fears about giving birth

• Ask if previous births were perceived as traumatic

•Provide opportunities for the mother to talk about her birth experience

(BECK, 2014)

TREATMENT FOR ANXIETY DISORDERS

•Pharmacological

•SSRIs

• sertraline (Zoloft) – most common

• citalopram (Celexa)

• Both safer and better studied

•Benzodiazepines

• lorazepam (Ativan), alprazolam (Xanax),

clonazepam (Klonopin)

•Psychotherapy

•Cognitive-behavioral therapy (CBT)

• Especially for OCD and panic disorder

•Interpersonal therapy

•Psychosocial interventions

•Peer support

•Nondirective counseling

(AWHONN, 2015; MARCHESI ET AL., 2015)

PERINATAL MOOD & ANXIETY DISORDERS

PMADs

Anxiety Disorders

GAD

PanicOCD PTSD

Mood Disorders

PPD Bipolar II PPP

(BECK, 2014)

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POSTPARTUM DEPRESSION (PPD)

19.2% of women have depressive episodes during the first 3 months PP

•If diagnoses, risk of reoccurrence with next childbirth is 30-50%

•Onset occurs anytime during the first 12 months PP

• Peaks 3 months PP – 12.9%

• 4-7 months PP – 9.9-10.6%

•Duration – 6 months or longer

• Correlates with length of delay of adequate treatment

(BECK, 2014)

PPD DIAGNOSIS

DSM-5 requires the presence of 5 or more symptoms during the same 2 week time period

•At least 1 symptom must be either:• Depressed mood

• Loss of interest or pleasure

•Other symptoms include:• Significant weight loss when not dieting

• Insomnia or hypersomnia

• Psychomotor agitation or retardation

• Fatigue

• Feelings of guilt or worthlessness

• Indecisiveness or decreased concentration

• Recurrent suicidal ideation (BECK, 2014; LOWDERMILK ET AL., 2016)

Common s/s in men: • Fatigue

• Frustration

• Anger

• Irritability

• Indecisiveness

• Withdrawal

PPD PRESENTATION

•Intense and persistent sadness with severe and labile mood swings

• Fears, anger, anxiety, hopelessness persisting > 1-2 weeks PP

• Rarely disappear with outside help

•Irritability - with little provoking

•May escalate to violent outbursts or dissolve into uncontrollable sobbing

•Often directed at significant others

•Oversensitivity to light, noise, and other stimuli

•Guilt about depressive feelings and feelings of inadequacy

• Feed into worries about being an incompetent and inadequate mother

(BECK, 2014; LOWDERMILK ET AL., 2016)

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PPD PRESENTATION

•Sleep disturbances:

• Increased yearning for

• Sleeping heavily but awakening instantly with any infant noise

• Inability to go back to sleep after infant feedings

•Rejection of baby

• “PPD overtook their minds and bodies, preventing them from reaching out to their infants and depriving them of any feelings of joy”

•Overwhelmed with responsibilities of caring for baby

• Attitudes: disinterest, annoyance with care demands, blaming, failure to respond to cues

• Awkward in responses to baby when observed

(BECK, 2014; LOWDERMILK ET AL., 2016)

PPD PRESENTATION

Depressed mothers are more likely to: • have fewer interactions with their infants

• decreased response to infant cues

• breastfeeding challenges

• ALL increase long-term poor emotional, cognitive, and behavioral health outcomes of the child

(MCINTYRE ET AL, 2018)

Picture from: https://www.mothering.com/articles/study-taking-probiotics-during-pregnancy-may-

reduce-postpartum-depression-and-anxiety/

BIPOLAR II DISORDER

•“Postpartum depression imposter”

•Manic-depressive disorder

•Childbirth is a specific trigger for hypomanic episodes

•Occurs in 10-20% of women

•Most typical time for hypomanic episodes is postpartum

•Perinatal episodes tend to be depressive

•Often misdiagnosed – “treatment resistant depression”

(BECK, 2014; LOWDERMILK ET AL., 2016)

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BIPOLAR II DIAGNOSIS

Clinical course of recurring mood episodes consisting of one or more major depressive episodes and at least one hypomaniac episode.

•To meet diagnostic criteria, symptoms must includes:

•Major depressive disorder must last at least 2 weeks

• Hypomaniac episode must last at least 4

days

•Hypomaniac symptoms:

• Inflated self-esteem or grandiosity

• Decreased need for sleep

•More talkative than usual or pressure to keep talking

• Flight of ideas or subjective experience

that thoughts are racing

• Distractibility

• Increase in goal-directed activity

• Excessive involvement in activities that have a high potential for painful consequences

(BECK, 2014)

TREATMENT FOR MOOD DISORDERS

•Pharmacological – (indicated and most effective for severe mood disorders)• Antidepressants

• SSRIs first line

• At least 2 weeks for any effect, and 4-6 weeks for full effect

• If symptoms improve after 6 week trial period, continued for at least 6 months to prevent relapse

• Lithium – first line treatment for PPP

•Psychotherapy – (preferable for mild to moderate mood disorders)• Cognitive-behavioral therapy (CBT)

• Interpersonal therapy

• Group therapy (peer support)

•Complimentary and Alternative Medicine Therapies (CAM)• Bright light therapy, exercise, massage, acupuncture

(AWHONN, 2015; LOWDERMILK ET AL., 2016)

POSTPARTUM PSYCHOSIS (PPP)

•Psychiatric emergency

•Defined as:

• The presence of one or more episodes of abnormally elevated energy levels, cognition, and mood

• And one or more depressive episodes

•Sudden onset

•Often presents within days - 2 weeks PP

•Or can be later in the course of illness as depression

•Predictors: bipolar II disorder and personal or family history of PPP

(BECK, 2014; LOWDERMILK ET AL., 2016)

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PPP PRESENTATION

Common features: •Hallucinations

•Delusions (suspicious, anxious)

•Agitation

• Inability to sleep

•Bizarre irrational behavior

•Paranoia (distrust, detachment)

•Depersonalization

•Suicidal thoughts

•Method, availability, specificity, & lethality

Mania (elevated mood) includes 3 of the following:

•Grandiosity

• Decreased need for sleep

• Pressured speech

• Flight of ideas

• Distractibility

• Excessive involvement in pleasurable activities without regard for negative consequences

•Mothers require constant supervision when caring for infant

(MATTSON & SMITH, 2015)

PPP MANAGEMENT

•Inpatient psychiatric care

•Antipsychotics

•Mood stabilizers – Lithium

•Antidepressants not recommended

• Risk of rapid cycling

•Contact with infant is usually beneficial

•Psychotherapy after psychosis has passed

Nursing Interventions:

•Foster supportive and caring environment

•Active listening

• Do not depend on mothers to volunteer information or ask for help

• “Many women feel depressed after having

a baby and some feel so badly that they think about hurting themselves or their baby. Have you had these thoughts?”

•If indication of PPP, ask the mother:

• “What are you thinking?”

• “What are you going to do?”

•Mental health consult before D/C

(LOWDERMILK ET AL., 2016)

OCD VS. PPP

OCD:

•Mothers know that their thoughts are bizarre

•Worried, concerned

•The risk of them acting on their thoughts it extremely low

PPP:

•Unaware that thoughts are strange

•No feelings, concerns

•Don’t try to fight the thoughts

(MATTSON & SMITH, 2015)

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PMADS AND BREASTFEEDING

Increased pressure, stress, anxiety

•Results in disruption in breastfeeding hormones and physiological process

•Reduces milk transfer and production

•Mothers with PMADs often have unrealistic breastfeeding expectations

(BECK, 2014; DAVIDSON ET AL., 2016; SIMPSON & CREEHAN, 2014)

PICTURE FROM HTTPS://WWW.INSTAGRAM.COM/P/BXHAF3WGPSV/?UTM_SOURCE=IG_EMBED

PMADS AND BREASTFEEDING

Be sensitive regarding breastfeeding•May be therapeutic or harmful

•May be the only thing in their control

Be attentive to positive and/or negative themes

(BECK, 2014; DAVIDSON ET AL., 2016; SIMPSON & CREEHAN, 2014)

PMADS AND BREASTFEEDING

Use of SSRIs should generally not be discouraged.•sertraline (Zoloft) preferred r/t shorter half-life

•citalopram (Celexa) and fluoxetine (Prozac) have a longer half-life

•Lithium should not be used while breastfeeding.

•Remember, weigh the risks and benefits to both mother and baby.

•Mothers should be taught to monitor infants for s/s irritability, poor feeding, and alterations in sleep pattern.

(LOWDERMILK ET AL., 2016; MARCHESI ET AL., 2015)

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PMADS AND BREASTFEEDING NURSING CONSIDERATIONS

•Traumatized mothers need more intensive one-on-one support to help them establish breastfeeding

•Promote relaxation and reduce stress

•Reminder that any amount of breastmilk provided is beneficial to baby

•Short term goals boost self-efficacy

•Reassure it is the mother’s right to choose not to breastfeed, without any judgment or guilt

(BECK, 2014; DAVIDSON ET AL., 2016; SIMPSON & CREEHAN, 2014)

HOW CAN I MAKE A DIFFERENCE?

“When a woman births, not only is a baby being born but so is a mother. How we treat her will affect how she feels about herself as

a mother and as a parent.Be gentle. Be kind. Listen.”

Ruth Ehrhardt

The Basic Needs of a Woman in Labour

PICTURE FROM HTTPS://BLOGS.PSYCHCENTRAL.COM/PSYCHOANALYSIS-NOW/2014/10/A-MOTHERS-PRENATAL-DEPRESSION-CAN-HARM-HER-BABY/

THE BASICS

• Treat every mother as if she were diagnosed with a PMAD or a survivor of a previous traumatic event

• Foster a sense of value in new mothers (and their support person) through both your words and actions

•Encourage and empower

(BECK, 2014; DAVIDSON ET AL., 2016)

PICTURE FROM HTTPS://I.PINIMG.COM/ORIGINALS/D1/FC/39/D1FC397B91137F1A51E891DDC1A798F7.JPG

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COMMUNICATION

With mothers, support persons, and families:

•Utilize a calm, caring, confident, and nonjudgmental approach

•Provide clear and concise information

•Explain, explain, explain

•Ask permission to perform cares, even if routine

• Include parents in the decision making process

•Active, open communication & collaborative relationships

•Maintain consistency in providers, when at all possible

(BECK, 2014; DAVIDSON ET AL., 2016; SIMPSON & CREEHAN, 2014)

THERAPEUTIC COMMUNICATION

•Helps to dispel anxiety for mother and support persons

•Encourages the expression of thoughts and feelings

•Should be utilized during EVERY visit/interaction (prenatal, hospital, postpartum)

•Active listening•Sharing observations•Sharing empathy•Sharing hope

•Sharing feelings•Using touch•Silence •Providing information

•Paraphrasing •Asking relevant questions

(BECK, 2014; DAVIDSON ET AL., 2016; SIMPSON & CREEHAN, 2014)

Therapeutic communication is not about problem solving, but about validating feelings.

LISTEN & ACKNOWLEDGE

Listen:

•Sharing birth story may be therapeutic

•Pay attention to themes

Acknowledge:

•Be a witness to fears, pain, and other

symptoms.

•Remind that feelings aren’t facts

•Hear and validate anxiety and concerns

(BECK, 2014; DAVIDSON ET AL., 2016; SIMPSON & CREEHAN, 2014)

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PROVIDE SUPPORT

Patient’s and support persons report feelings of abandonment.

•Offer methods to promote relaxation, comfort and self care

• Identify and reduce the source of distress if possible

•Encourage mom to identify and use coping mechanisms that have worked well in the past

•Frequent attention and therapeutic interaction

•Reassure she is not a bad mother

•Do not offer general or false reassurance

(BECK, 2014; DAVIDSON ET AL., 2016; SIMPSON & CREEHAN, 2014)

PICTURE FROM HTTP://WWW.ALIFEWITHALITTLE.COM/CATEGORY/POST-PARTUM-DEPRESSION/

PROMOTE BONDING

Facilitate the maternal newborn attachment process

•Maximize mother-infant contact

•Assist mothers to understand normal newborn behaviors and cues

•Teach and empower parents to provide newborn cares

•Maximize time for parent-infant interaction

•Provide frequent (daily at minimum) information about infant’s condition if separated in NICU or newborn nursery

(MATTSON & SMITH, 2015; SIMPSON & CREEHAN, 2014; SONG ET AL., 2015)

POST-DISCHARGE CARE

•Establishing seamless transition in care and follow-up among health care providers is critical for mothers experiencing PMADs.

•Who will be treating the mother beyond the postpartum period? • OB provider?

• Primary care provider?

• Mental health provider?

•Bridge the gap of care• Support continuity of care

• Minimize disruption of psychotherapy and pharmacotherapy

•Do not expect mothers with PMADs to “advocate for themselves!”

•See resources tab for action plan and community resources

(KENDIG ET AL., 2017)

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REFERENCES

Association of Women’s Health, Obstetric and Neonatal Nurses (2015). Mood and anxiety disorders in pregnant and postpartum women. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 44(5), 687-689. Doi: 10.1111/1552-6909.12734

Beck, C. T. (2014). Postpartum mood and anxiety disorders: Case studies, research, and nursing care (3rd

ed.). Washington D.C.: AWHONN.

Chan, C. Y., Lee, A. M., Lam, S. K., Lee, C. P. Leung, K. Y., Koh, Y. W., & Kum Tang., C. S. (2013). Antenatal anxiety in the first trimester: Risk factors and effects on anxiety and depression in the third trimester and 6-week postpartum. Open Journal of Psychiatry, 3, 301-30. Doi 10.4236/ojpsych.2013.33030

Davidson, M., London, M., & Ladewig, P. (2020). Olds’ maternal-newborn nursing & women’s health across the lifespan (11th ed.). Pearson Education, Inc.

Dube, R. (2016, October 14). ‘Pinterest stress’ afflicts nearly half of moms, survey says. Retrieved from https://www.today.com/parents/pinterest-stress-afflicts-nearly-half-moms-survey-says-1C9850275

Howorth, C. (2017, October 30). Motherhood is hard to get wrong. So why do so many moms feel so bad about themselves? Time. Retrieved from http://time.com/4989068/motherhood-is-hard-to-get-wrong/

(MATTSON & SMITH, 2015)

REFERENCES

Kendig, S., Keats, J. P., Hoffman, M. C., Kay, L. B., Miller, E. S., Moore Simas, T. A., Frieder, A., Hackley, B., Indman, P., Raines, C., Semenuk, K., Wisner, K. L., & Lemieux, L. A. (2017). Consensus bundle on maternal mental health: Perinatal depression and anxiety. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 46(2), 272-281. Doi: 10.1016/j.jogn.2017.01.001

Mattson, S. & Smith, J. E. (2016). Core curriculum for maternal newborn nursing (5th ed.). St. Louis, MO: Elsevier.

Marchesi, C., Ossola, P., Daniel, B. D., Tonna, M., & De Panfilis, C. (2015). Clinical management of perinatal anxiety disorders: A systematic review. Journal of Affective Disorders, 190 (2016), 543-550. doi: 10.1016/j.jad.2015.11.004

McCabe-Beane, J. E., Stasik-O’Brien, S. M., & Segre, L. S. (2018). Anxiety screening during assessment of emotional distress in mothers of hospitalized newborns. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 47(1), 105-113. Doi: 10.1016/j.jogn.2017.01.013

McIntyre, L. M., Griffen, A. M., & BrintzenhofeSzoc, K. (2018). Breast is best…except when it’s not. Journal of Human Lactation, 1-6. Doi: 10.1177/0890334418774011

Review to Action (2018). Report from nine maternal mortality review committees. Retrieved from http://reviewtoaction.org/Report_from_Nine_MMRCs

Simpson, K. R. & Creehan, P. A. (2014). Perinatal Nursing (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Song, J., Kim, T., & Ahn, J. (2015). A systematic review of psychosocial interventions for women with postpartum stress. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 44(2), 183-191. Doi 10.1111/1552-6909.12541

The Postpartum Stress Center, LLC. (2018). Clinical tools for your practice. Retrieved from https://postpartumstress.com/for-professionals/assessments/

(MATTSON & SMITH, 2015)