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Telling Birth Story



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Telling Birth Story

  1. 1. Telling the Birth Story Implementing a Facility Based PPD program Susan Dowd Stone, MSW, LCSW Managing Director Blue Skye Consulting, LLC <ul><li>The role of a mother’s support group in the identification and amelioration of high risk factors in post partum women </li></ul>
  2. 2. Primary Prevention <ul><li>“… Prevention is the great challenge of postnatal illness because this is one of the few areas of psychiatry in which primary prevention is feasible…” </li></ul><ul><li>Hamilton & Harberger (1992) </li></ul>
  3. 3. The Obstetric Network <ul><li>It is essential to integrate a psychiatric dimension into this network to break the vicious circle of mood disorders that women experience during pregnancy and motherhood </li></ul><ul><li>- Harris, Bryan (2002) </li></ul>
  4. 4. The efficacy of post partum support groups <ul><li>A psychoeducation group for women with low post partum mood can significantly reduce depressive symptoms </li></ul><ul><li>Honey, J.L, Bennett, P, Morgan M. (2002) </li></ul><ul><li>A program of supportive group therapy for post partum mothers can significantly lower or eliminate depressive episodes </li></ul><ul><li>Lane, B., Roufeil, M.M., Williams, S., Tweedie, R..(2001) </li></ul><ul><li>Post partum mothers attending a group integrating supportive educational and cognitive behavioral components yielded significant reductions in symptom frequency and intensity after 4 – 6 weeks. </li></ul><ul><li>Chabrol, H., Teissedre, F., Saint Jean, M., Teisseyre, N., Sistac, C, Michaud, C., Roge, B.(2002) </li></ul>
  5. 5. Undetected depressive illness despite antenatal screening attempts <ul><li>Premorbid undiagnosed mood disorders </li></ul><ul><li>Inaccurate self-report </li></ul><ul><li>Fear of involvement of child protection agencies </li></ul><ul><li>Ability to mask symptoms especially if highly functional </li></ul><ul><li>Motherhood myth </li></ul><ul><li>Severe life events </li></ul>
  6. 6. Post Partum Continuum Post Partum Responses Healthy Rebound “ Baby Blues” Post Partum Depression Post Partum Psychosis
  7. 7. Who comes to the mother’s support group <ul><li>Post Partum Continuum </li></ul><ul><li>Difficult conception/amniotomy </li></ul><ul><li>Caesarian/birth trauma </li></ul><ul><li>Multiple birth mothers </li></ul><ul><li>Isolated, lack of support/cross cultural pressures </li></ul><ul><li>Marital issues/financial difficulties/intimacy </li></ul><ul><li>Breastfeeding issues </li></ul><ul><li>Difficult child/bonding issues </li></ul><ul><li>Unexpressed feelings/anger/ sense of inadequacy/ grief </li></ul><ul><li>Sense of self/professional moms/motherhood myth </li></ul><ul><li>Nutritional concerns </li></ul><ul><li>Histories of abuse </li></ul><ul><li>Self or caregiver identified depression </li></ul><ul><li>Substance Abuse </li></ul><ul><li>Psychiatric History </li></ul>
  8. 8. Additional issues <ul><li>Adoptive parent </li></ul><ul><li>Gay parent </li></ul><ul><li>Single parent </li></ul><ul><li>Premature babies </li></ul><ul><li>Multiple young children </li></ul><ul><li>Unwanted pregnancy </li></ul>
  9. 9. Difficult conception <ul><li>Unsuccessful attempts to conceive are accompanied by significant psychological distress </li></ul><ul><ul><li>Little, B.B.; Yonkers, K.A.(2001) </li></ul></ul>
  10. 10. Caesarian <ul><li>Caesarian mothers used to stay in the hospital up to ten days </li></ul><ul><li>Recovery from major surgery </li></ul><ul><li>Support of nursing staff </li></ul><ul><li>Longer period of modeling </li></ul><ul><li>Not prepared/residual anger </li></ul><ul><li>If mother remained in hospital longer, separations from baby less likely during this important maternal sensitive period </li></ul>
  11. 11. Birth Trauma <ul><li>Protracted unexpected delivery experiences during labor </li></ul><ul><li>Severe pregnancy complications may increase the severity of postnatal depressive symptoms by acting as acute or chronic stressors . - Veroux, H., Sutter, A., Glatigny, E., Minisini A. (2002) </li></ul>
  12. 12. Premature or ill babies <ul><li>May not be available to mother during maternal sensitive period </li></ul><ul><li>Ill/premature babies more at risk for maternal rejection, failure to thrive and battering. </li></ul><ul><li>Mourning the idealized child </li></ul>
  13. 13. Multiple births <ul><li>Associated high risk factor for PPD </li></ul><ul><li>Trauma related to difficult conception </li></ul><ul><li>Raised possibility of low birth weight/health problems </li></ul><ul><li>Heightened exhaustion for care </li></ul><ul><li>Difficulty breast feeding </li></ul>
  14. 14. Isolation <ul><li>Woman’s perception of self as not supported </li></ul><ul><li>Family lives far away/cross cultural issues </li></ul><ul><li>Cut off from friends, no longer has commonalities with friends </li></ul><ul><li>Difficulties with spouse </li></ul><ul><li>Afraid of judgments </li></ul>
  15. 15. Marital issues <ul><li>“… Many patients report that marital stress is an important aspect of their illness. Nevertheless, in the usual patient oriented and child oriented regimes of treatment the husband (partner) receives scant attention…” </li></ul><ul><ul><li>Hamilton & Harbinger, (1992 ) </li></ul></ul>
  16. 16. Support for partners <ul><li>Ongoing demands to run the house, care for the new baby the mother and other children </li></ul><ul><li>Jealousy </li></ul><ul><li>“… Marital problems which appear to have emanated from PPD often persist long after symptoms are abated…” </li></ul><ul><li>- Hickman, (1982) </li></ul>
  17. 17. Family support <ul><li>“… I know I could have and should have done more. We as a family did not want to accept mental illness in our lives. Because of this stigma, Sharon suppressed her feelings after Garrett’s birth. Had we ever imagined infanticide or suicide might result, something would have been done…” </li></ul><ul><ul><li>Glenn Comitz, husband of a woman imprisoned for infanticide (Comitz, 1988, Beyond the Blues) </li></ul></ul>
  18. 18. Financial Difficulties <ul><li>The cost of childbirth and aftercare already high, but psychiatric interventions may be excluded due to cost </li></ul><ul><li>Find inexpensive activities outings for families </li></ul><ul><li>Financial burdens fall to working partner </li></ul>
  19. 19. Restoration of Intimacy <ul><li>“Sex and affection were absent during that time. Not tonight, not tomorrow night, not next week, not ever!” </li></ul><ul><ul><li>A post partum husband complains In Post Partum Psychiatric Illness (R. Hickman, 1992) </li></ul></ul><ul><li>Persistent discomfort </li></ul>
  20. 20. Breastfeeding Difficulties <ul><li>Sense of failure </li></ul><ul><li>Caesarian mothers more at risk </li></ul><ul><li>Convenience and guilt </li></ul><ul><li>Psychotropic medications </li></ul>
  21. 21. Motherhood
  22. 22. Difficult Child/Bonding
  23. 23. Technology and Attachment Theory Literature <ul><li>Ultrasounds </li></ul><ul><li>Mother’s capacity to form relationships </li></ul><ul><li>Baby’s capacity to respond </li></ul><ul><li>Early separations </li></ul><ul><li>Sensitive/critical period </li></ul>
  24. 24. Unexpressed Feelings <ul><li>Anger – in conjunction with or irrespective of depressed mood </li></ul><ul><li>Graham, J.E., Lobel, M. DeLuca, R.S. </li></ul><ul><li>Frustration </li></ul><ul><li>Helplessness </li></ul><ul><li>Fear </li></ul><ul><li>Guilt </li></ul><ul><li>Grief </li></ul><ul><li>Anxiety </li></ul><ul><li>Embarrassment </li></ul><ul><li>Exhaustion </li></ul>
  25. 25. Lack of feelings <ul><li>“… Mothers are supposed to love their babies! I don’t have any feelings toward mine. I just feel numb. What’s wrong with me?...” </li></ul><ul><ul><li>support group participant (Harberger P.N, Berchtold, N.G. & Honikman, J.I.(1992) </li></ul></ul>
  26. 26. Sense of self/professional moms vs. stay at home <ul><li>Motherhood Myth </li></ul><ul><li>Sandwich generation </li></ul><ul><li>Multi-tasking </li></ul>
  27. 27. Nutritional Concerns <ul><li>Baby wellness </li></ul><ul><li>Return to pre-pregnancy weight </li></ul><ul><li>Nutritional consults for the mother </li></ul><ul><li>The role of diet/exercise in alleviating mild symptoms of PPD </li></ul>
  28. 28. Eating Disorders Negative Body Image <ul><li>Patient’s offspring may be seriously at risk </li></ul><ul><li>May seem normal; often overlooked </li></ul><ul><li>Bingeing and purging not as evident, could be seen as “pregnancy cravings” or morning sickness </li></ul>
  29. 29. Histories of abuse <ul><li>Shame </li></ul><ul><li>Fear </li></ul><ul><li>Breaking the cycle </li></ul>
  30. 30. Self or caregiver identified depression/anxiety <ul><li>Can’t “snap out of it” </li></ul><ul><li>Constant fears about baby/self </li></ul><ul><li>Unrealistic attributions </li></ul>
  31. 31. Goals of a mother/baby support group <ul><li>Information clearing house </li></ul><ul><li>Professional/peer feedback/role playing </li></ul><ul><li>Non judgmental support system </li></ul><ul><li>Observational and clinical review of maternal/child relationship </li></ul><ul><li>Relaxation </li></ul><ul><li>Dispel motherhood myth of the maternal instinct </li></ul><ul><li>Strengthen marital support </li></ul><ul><li>Mobilize additional support systems </li></ul><ul><li>Reduce environmental stress </li></ul><ul><li>Rearrange priorities </li></ul><ul><li>Encourage networking/socialization </li></ul><ul><li>Amelioration of symptoms </li></ul><ul><li>Identify needs for additional treatment </li></ul>
  32. 32. Engaging the mothers <ul><li>Referrals from physician’s offices or in hospital after birth: Inviting a new mother </li></ul><ul><li>Visiting in rooms prior to discharge </li></ul><ul><li>Emphasizing the socialization part of the group </li></ul>
  33. 33. Telling the Birth Story Group Format <ul><li>Convenient Facility, parking </li></ul><ul><li>Ease of access </li></ul><ul><li>Babies and younger children welcome at some meetings </li></ul><ul><li>Confidentiality assured </li></ul><ul><li>Free of charge or sliding scale to increase access to help </li></ul>
  34. 34. Community Referrals <ul><li>The importance of establishing antenatal alliance </li></ul><ul><li>Encourage attendance ASAP </li></ul><ul><li>Extension of your area Obstetrical/Pediatric Team </li></ul>
  35. 35. Excerpts from “Her Eyes are Wild” - William Wordsworth 1798 <ul><li>“… Sweet babe, they say that I am mad </li></ul><ul><li>But nay, my heart is far too glad </li></ul><ul><li>And I am happy when I sing </li></ul><ul><li>Full many a sad and doleful thing… </li></ul><ul><li>A fire was once within my brain </li></ul><ul><li>And in my head, a dull, dull pain </li></ul><ul><li>And fiendish faces, one, two, three </li></ul><ul><li>Hung at my breast and pulled at me </li></ul><ul><li>Suck little babe, oh suck again </li></ul><ul><li>It cools my blood, it cools my brain </li></ul><ul><li>Thy lips I feel them baby, they </li></ul><ul><li>Draw from my heart the pain away…” </li></ul><ul><li>Soundbite Beethoven’s Symphony #9 </li></ul>
  36. 36. Susan Dowd Stone, MSW, LCSW President, Postpartum Support International <ul><li>Facilitated PPD program at HUMC </li></ul><ul><li>Contributor, Government PPD Educational Webinar </li></ul><ul><li>Chair, PSI International Conference June ’06 </li></ul><ul><li>“ Perinatal Mental Health: </li></ul><ul><li>Community Solutions, Interventions and Treatment Options” </li></ul><ul><li>Contributing author on PPD treatment </li></ul><ul><li>NJ State Certified Instructor on PPD programs </li></ul><ul><li>Managing Director, Blue Skye Consulting </li></ul><ul><li>560 Sylvan Avenue, NE, Englewood Cliffs, NJ 07632 </li></ul><ul><li>201-567-5596 </li></ul><ul><li> </li></ul><ul><li>[email_address] </li></ul>

Editor's Notes

  • Good evening (morning) It has been a wonderful experience working with Kathy and Denyse on the development of this project and I would like to thank them for entrusting me with this role as the facilitator of the mother baby support group. One of the common themes which has been expressed by the many women attending the group has been the exceptional nursing they have received on the mother/baby unit. I would also like to thank Sarah Schleifer for her ongoing clinical guidance and supervision with these important and precious dyads and her caution regarding research results and methods. You have just been given a thorough overview of the history, clinical symptoms and social relevance of post partum illness – I would like to expand that awareness by offering empirical validation for professionally run support maternal support groups, and create for you the picture of the woman who attends such groups – every mother brings a different constellation of symptoms suffered, but all are in search of comprehending and healing their symptoms. I also want to welcome you into the continuum care by making you aware of how to utilize and connect with this resource, extending its benefits to your patients.
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