Abuse Experiences, Perceptions, and Associated Decisions During the Childbearing Cycle

The study purpose was to generate a theoretical understanding of women’s experiences and perceptions of intimate partner abuse during the childbearing cycle. Dimensional analysis, a grounded theory method, was used. Twenty-one interviews were conducted with 12 women who were (a) currently in an abusive relationship with an intimate male partner and pregnant or postpartum (n = 5) or who had (b) experienced abuse by an intimate male partner during a past pregnancy or postpartum (n = 7). Disparities between the two concurrent phenomena of abuse and pregnancy led women to feel as though they were living two separate lives. Pregnancy provided the impetus for reinvesting in the partnered relationship and constructing a family. Leaving an abusive relationship was not considered unless the partner ended the relationship first or the woman perceived an increased risk of danger. Postpartum up to 2 years after birth was a critical transitional time for women.

Women's Experiences Being Diagnosed With Peripartum Cardiomyopathy: A Qualitative Study

INTRODUCTION

Cardiovascular disease has been identified as the leading cause of maternal mortality in the United States, with cardiomyopathy, including peripartum cardiomyopathy (PPCM), accounting for 12% to 16% of all pregnancy-related deaths. The purpose of this study was to describe women's experiences being diagnosed with PPCM.

METHODS

This investigation was conducted using a qualitative design. We collected publicly available narratives posted by 92 women with PPCM (mean [SD] age 29 [6] years, mean [SD] ejection fraction 25.5 [10.8]%) in 3 online support groups. Data were coded and thematically organized so as to produce a richly detailed account of this experience.

RESULTS

The experience of diagnosis was marked by the women's distinct memories of their initial symptoms and whether they were dismissed or taken seriously. The most commonly reported symptoms were extreme shortness of breath, orthopnea, tachycardia, palpitations, chest pain, cough, and edema. Nearly 40% of women experienced symptom dismissal by health care providers. One-fourth of women were initially given inaccurate diagnoses ranging from "new mom anxiety" to asthma. Women described their initial reaction to diagnosis as feeling terrified, devastated, and feeling a sense of doom. Women had difficulty caring for their newborns during the postpartum period, and they struggled with the medical advice they received to not get pregnant again.

DISCUSSION

Despite experiencing severe subjective and objective symptoms, nearly 40% of women with PPCM experienced symptom dismissal by health care providers, in part due to the overlap between normal symptoms of pregnancy or the postpartum period and symptoms of heart failure.

[Can men be included in the population subjected to puerperal psychosis? A case report]

INTRODUCTION

Puerperal psychosis (PP) is a psychiatric disorder that occurs in 1 out of 1000 pregnancies. Well known since antiquity, its symptoms have often been described in mothers, but few studies have successfully investigated a related disorder in fathers. The characteristic of this pathology is more related to its appearance than to its semiological description which is why its nosographic place is always discussed. The objective here is to focus on the definition of PP and to suggest an entity for both genders.

CASE REPORT

Our case report focused on the clinical description of an eighteen-year-old man suffering from an acute psychosis episode that occurred around the birth of his first child. Delusion followed a sudden decline in mood that lasted for a short period of time during the course of the third trimester of his wife's pregnancy. The delirium was rich with auditory and cenesthesic hallucinations, pregnancy and birth denial, feeling movements and hearing voices in his stomach. The symptoms disappeared after one month of treatment via an antipsychotic drug, risperidone.

CONCLUSION

We can confirm that the symptomatic description of the disorder in this patient fits the classical descriptions of PP. Two elements make the PP different from other acute psychoses: the context of pregnancy and delirium focused on the child which can lead to a child murder. The absence of a framework precisely defining the PP does not improve its prevention and can lead to legal attitudes rather than medical care. Men suffering from acute psychosis in a context of pregnancy are submitted to the same risks as women. It is necessary to emphasize descriptions of PP in men to redefine the disease and consider that this entity involves both men and women.

Analysis of Chosen Variables Psychological Determining the Occurrence of Mood Disorders After Childbirth

BACKGROUND

Psychological factors are one of many that contribute to the increased risk of a psychiatric disorder's occurrence after childbirth.

OBJECTIVES

The aim of this work was to determine the relation between psychological variables, such as sense of self-efficacy and dispositional optimism, and the risk of mood disorder's occurrence in women after childbirth.

MATERIAL AND METHODS

Two hundred eighty five women, who gave birth in the University Hospital no. 2 in Bydgoszcz, took part in the study. To measure the risk occurrence of mood disorder symptoms after childbirth the Edinburgh Postnatal Depression Scale (EDPS) was used. Obtaining a score of 12 or more points out of 30 on the Edinburgh Postnatal Depression Scale was an indicator of mood disorders. To study psychological variables the General Self-Efficacy Scale (GSES) and Life Orientation Test (LOT-R) were used.

RESULTS

Twenty three point two percent of women obtained 12 or more points in the EDPS scale. The average result in GSES scale for all women who took part in the study was 30.80 and indicated a high estimation of women's own capabilities in dealing with new situations. Obtained results indicated a surprisingly small group of women with low estimation of their own capabilities (n = 15). However, negative correlation between EDPS and GSES parameters, on a statistically significant level (p < 0.0001) was found (r = 0.27). In the course of analysis of the results concerning optimism-pessimism dimension rated with LOT-R, the average result was calculated to be 15.6. In the same group, 61 women showed pessimistic tendencies, and 23 (34.8%) suffered from mood disorders. Scores obtained in EDPS negatively correlated with the results in LOT-R (r = -0.43) and are statistically significant (p < 0.0001).

CONCLUSIONS

In the first week after childbirth, one-fourth of women are in danger of the occurrence of mood disorders. There is a negative correlation between the sense of self-efficacy and dispositional optimism and risk of occurrence of mood disorders after childbirth.

Interpersonal Psychotherapy for Postnatal Anxiety Disorder

Interpersonal psychotherapy is one of two evidence-based formal psychotherapies for perinatal mood disorders. It is a time-limited, non-transference / cognitive-based therapy that focuses on communication and social support and can be easily conducted in a perinatal clinic setting. There is limited patient access to interpersonal psychotherapy in Hong Kong because the therapy is not widely disseminated. This case report aimed to illustrate the principles and techniques of interpersonal psychotherapy in perinatal psychiatry, and to raise interest among mental health professionals in Hong Kong in this evidence-based treatment.

Does childbirth cause psychiatric disorders? A population-based study paralleling a natural experiment

BACKGROUND

Childbirth is associated with increased risk of first-time psychiatric episodes, and an unwanted pregnancy has been suggested as a possible etiologic contributor. To what extent childbirth causes psychiatric episodes and whether a planned pregnancy reduces the risk of postpartum psychiatric episodes has not been established.

METHODS

We conducted a cohort study using data derived from Danish population registers, including all women having in vitro fertilization (IVF) treatment and their partners with recorded information in the IVF register covering fertility treatments in Denmark at all public and private treatment sites from January 1994 to December 2005. We compared parents and childless persons to examine whether childbirth is directly associated with onset of first-time psychiatric episodes, with incidence rate ratios (risk of first psychiatric inpatient or outpatient treatment) as the main outcome measures.

RESULTS

The incidence rate for any type of psychiatric disorder 0 to 90 days postpartum was 11.3 per 1000 person-years (95% confidence interval = 8.2-15.0), and 3.8 (3.4-4.3) among women not giving birth. IVF-treated mothers had an increased risk of a psychiatric episode postpartum (incidence rate ratio [IRR] = 2.9 [2.0-4.2]) compared with the risk of psychiatric episodes in childless women. Risk of psychiatric episodes later than 90 days postpartum was decreased (IRR = 0.9 [0.7-1.0]).

CONCLUSIONS

Using a study design paralleling a natural experiment, our results showed that childbirth is associated with first-time psychiatric disorders in new mothers, indicating that a planned pregnancy does not reduce risks of or prevent postpartum psychiatric episodes.

[Anxiety disorders during pregnancy and the post-partum period]

BACKGROUND

Although anxiety disorders are more prevalent during the perinatal period, little attention has been given so far to the influence that pregnancy and the post-partum period can have on anxiety disorders.

AIM

To review the literature concerning the prevalence, presentation and treatment of anxiety disorders during pregnancy and the post-partum period and to identify the risk factors involved.

METHOD

We reviewed the literature in order to find articles concerning the influence of the post-partum period on various types of anxiety disorders.

RESULTS

Having selected the most relevant articles, we discuss the findings in relation to specific types of anxiety disorder.

CONCLUSION

Women are more vulnerable to anxiety disorders during the perinatal period. Because anxiety disorders can have a significant impact on the mother and her foetus/infant it is important that anxiety disorders are identified and treated at the earliest opportunity.

The nature and severity of urinary incontinence in post-natal women

This study investigated the frequency, nature and experience of urinary incontinence in post-natal women. Surveys were completed by 224 women, 50% of whom indicated that they had experienced accidental urine loss. The majority of women who had experienced any symptoms were moderately to greatly bothered by them. A variety of strategies were used to manage the problem; however, 42% of the women who experienced accidental urine loss had taken no action to ease the problem. Women received information about urinary incontinence and pelvic floor exercises from a variety of health care professionals, but this was not consistently provided. The implications of these findings are discussed.

A psychiatric medication decision support guide for social work practice with pregnant and postpartum women

In their work in human services organizations and community agencies across service sectors, social workers encounter pregnant and postpartum women experiencing mental health challenges. This article offers an evidence-informed Decision Support Guide designed for use by social workers working with pregnant and postpartum women who are struggling with complicated decisions about psychiatric medication use. The guide is built on contemporary notions of health literacy and shared decision making and is informed by three areas: (1) research into the lived experiences of pregnant and postpartum women and health care providers around psychiatric medication decision making, (2) a critical review of existing decision aids, and (3) feedback on the strategy from social work practitioners who work with pregnant and postpartum women. Emphasizing the relational nature of social work in supporting effective health-related decision making, the guide relies on maintaining a collaborative practice milieu and using a decision aid that engages clients in discussions about mental health during and around the time of pregnancy. The guide offers social workers a practice tool to support responsive and compassionate care by embracing their roles in problem solving and decision making, providing emotional and psychosocial support, and making appropriate referrals to prescribers.

[Postpartum psychiatric disorders]

The postpartum period represents a very particular time in women's life, the beginning of a new bond, the maternity. As many times, beginnings are such turbulent, intense. In this period the women suffers deep changes in their hormonal status, with its body and changes and affective oscillations. Women are often so labile at this time, ranging from happiness to deep sadness. The vast majority suffers the blues, a benign form of mild depressive state. On the other hand, 20% may have a major depressive episode, and a much less percentage will suffer the most disruptive postpartum syndrome, the postpartum psychosis. In this paper it will be described the symptomatology of such cases, the most important treatment approaches and will focus on the clinical dilemma of using psychotropic medications during breastfeeding.

The role of intimate partner violence and other health-related social factors on postpartum common mental disorders: a survey-based structural equation modeling analysis

BACKGROUND

Although studies suggest the relevance of intimate partner violence (IPV) and other health-related social characteristics as risk factors for postpartum mental health, literature lacks evidence about how these are effectively connected. This study thus aims to explore how socio-economic position, maternal age, household and marital arrangements, general stressors, alcohol misuse and illicit drug abuse, and especially psychological and physical IPV relate in a framework leading to postpartum common mental disorder (CMD).

METHODS

The study was carried out in five primary health care units of Rio de Janeiro, Brazil, and included 810 randomly selected mothers of children up to five postpartum months waiting for pediatric visits. The postulated pathways between exposures and outcome were based on literature evidence and were further examined using structural equation models.

RESULTS

Direct pathways to postpartum CMD arose from a latent variable depicting socio-economic position, a general stressors score, and both IPV variables. Notably, the effect of psychological IPV on postpartum CMD ran partly through physical IPV. The effect of teenage pregnancy, conjugal instability and maternal burden apparently happens solely through substance use, be it alcohol misuse, illicit drug abuse or both in tandem. Moreover, the effect of the latter on CMD seems to be entirely mediated through both types of IPV.

CONCLUSION

Although the theoretical model underlying the analysis still requires in-depth detailing, results of this study may have shed some light on the role of both psychological and physical IPV as part of an intricate network of events leading to postpartum CMD. Health initiatives may want to make use of this knowledge when designing preventive and intervention approaches.

Postpartum anxiety in a cohort of women from the general population: risk factors and association with depression during last week of pregnancy, postpartum depression and postpartum PTSD

BACKGROUND

In contrast to postpartum depression, postpartum anxiety receives less attention, especially in the general population. Acknowledging the phenomenon is important, as it may lead to significant distress and impair maternal functioning.

OBJECTIVES

To explore the phenomenon in a cohort of women in the general population and to investigate possible associated factors.

METHODS

Within the first days after childbirth, women at Chaim Sheba Medical Center maternity ward were interviewed. Questionnaires included psychosocial variables, feelings and fears during pregnancy and childbirth, and the Edinburgh Postnatal Depression Scale (EPDS) (referring to the last week before delivery). A month later, subjects completed the EPDS, a modified Spielberger Anxiety Scale and the Posttraumatic Stress Diagnostic Scale via telephone.

RESULTS

40.4% had high anxiety scores. A significant association was noted between postpartum anxiety and depression during the last week of pregnancy, postpartum depression, as well as postpartum PTSD. Anxiety scores were almost 50% higher in those who suffered from postpartum PTSD compared to those who experienced postpartum depression. Associations were also found with fear of the birth, fear of death during delivery (mother and fetus), feeling lack of control during labor and less confidence in self and medical staff. Of women who developed postpartum anxiety, 75% reported feeling anger, fear or emotional detachment during childbirth. No association was found with birth complications.

CONCLUSIONS

Anxiety symptomatology appears to be a common manifestation after childbirth. It is therefore important to inquire about depression and fears during pregnancy and childbirth and subjective experience in order to anticipate postpartum anxiety symptoms, even by means of a brief screening test. The finding that postpartum PTSD was associated with the severity of postpartum anxiety may be used in the future as a potential identifier of PTSD symptoms in women with high anxiety scores.

The relation between prepregnancy sexuality and sexual function during pregnancy and the postpartum period: a prospective study

This study examined the relation between sexual functions of women in prepregnancy (before conception) and during pregnancy and the postpartum period. This study was conducted on 59 healthy pregnant women. Participants were followed from the eighth week of gestation to 6 months after delivery. Sexual function during pregnancy and the postpartum period was shown to have a significant linear correlation with prepregnancy sexuality. There was no relation between pregnancy and postpartum sexuality. All of the participants who had prepregnancy sexual dysfunction continued to experience it during pregnancy, and the majority of them had a significant level of sexual dysfunction in the postpartum period. Our results showed that prepregnancy sexuality plays an important role in maintaining sexuality during pregnancy and the postpartum period.

Multimodal Sensory Distortions in Postpartum Exacerbation of Schizophrenia

BACKGROUND

Sensory distortions of body image commonly occur during migraine, seizures, nondominant cortical infarcts and hallucinogen abuse.

METHODS

We report the case of a 30-year-old woman with paranoid schizophrenia presenting with postpartum onset multimodal sensory distortions in the absence of any neurological disorders or substance use.

RESULTS

Her symptoms involved persistent facial/body metamorphopsia (distorted images) and vocal paracousis (distorted voices), in the absence of visual hallucinations, illusions or agnosia. Neuropsychological assessments revealed deficits on visual processing tasks. Neuroimaging, electroencephalography and ophthalmological evaluation revealed no abnormalities. The multimodal sensory distortions responded to antipsychotic treatment, paralleling improvement in other schizophrenia psychopathology, over a period of one month.

CONCLUSIONS

Prominent and persistent multimodal sensory distortions like metamorphopsia and paracousis in the presence of psychotic symptoms warrant a detailed neurological and general medical work-up. These symptoms presenting in the absence of neurological or substance use disorders may be a component of schizophrenia.

Women's perceptions and experiences of severe maternal morbidity--a synthesis of qualitative studies using a meta-ethnographic approach

BACKGROUND

maternal mortality is a relatively rare event in high-income countries and some middle-income countries. There is however a rising trend in the overall rate of severe maternal morbidity in many of these countries due to the increasingly complex obstetric and medical needs of women who become pregnant. With the aim to identify how women's experiences of health services following severe maternal morbidity could be improved, we explored women's perceptions and experiences of severe maternal morbidity (defined as major obstetric haemorrhage, severe preeclampsia, eclampsia, HELLP syndrome, critical care unit admission) by synthesising evidence from qualitative studies.

METHODS

a systematic search of the literature was conducted using multiple databases, including MEDLINE, PsycINFO, EMBASE, CINAHL, British Nursing Index (BNI), Web of Science and Scopus, using predetermined search strategies. Studies were selected based on pre-defined inclusion and exclusion criteria. The methodological quality of selected qualitative studies was assessed using relevant CASP appraisal tools. Evidence synthesis was undertaken using meta-ethnography. The synthesis involved three steps: (1) ascertaining how studies were related or dissimilar through comparison; (2) translating one study's findings into another and (3) synthesis of the translation.

FINDINGS

12 studies met inclusion criteria. Synthesis of these studies showed that women's experiences of severe maternal morbidity can be broadly categorised into three areas: experiencing the event of severe maternal morbidity, the immediate reaction to the event (physical experience, perception/interpretation of their situation, and emotion), and the aftermath (either a negative or positive experience), which are all interconnected. Women's experiences of severe maternal morbidity may be influenced by other factors such as the individuals' personal characteristics, pre-existing health conditions, feeling safe within the care provided, availability and accessibility of high quality health care, and their wider social support networks. Importantly, women's perceptions and experiences of severe maternal morbidity could be compounded by inadequate clinical management and care.

CONCLUSIONS

an experience of severe maternal morbidity and its subsequent management are physically and emotionally distressing, conjuring negative feelings and emotions and possibly poor postnatal outcomes. Findings suggest the importance of ensuring that the safety and quality of intrapartum interventions and models of postnatal care are enhanced, to reduce or prevent subsequent implications of an acute medical event on women and their families.

Apathetic syndrome from carotid dissection: a dangerous condition

Isolated behavioural disturbances can mimic psychiatric diseases and delay diagnosis of acute brain disease. We reported the case of a patient with carotid dissection manifesting only with apathetic syndrome that was initially considered as a possible postpartum depression, causing a threatening diagnostic delay.

Use of electroconvulsive therapy (ECT) in postpartum psychosis--a naturalistic prospective study

Postpartum psychosis (PPP) is a severe psychiatric condition requiring rapid restoration of health in view of significant risks to both mother and the infant. Electroconvulsive therapy (ECT) is often used for treatment of severe PPP. The aims of the study were to describe the indications for ECT among women admitted with PPP to a psychiatric hospital in India. It also aimed at assessing whether women with PPP who received ECT differed in their clinical history, diagnosis, severity of illness, psychopathology, drug dosage, and duration of hospital stay, compared to women who did not receive ECT. Infants of mothers who were breast-feeding their infants while receiving ECT were assessed for adverse effects. This was a naturalistic prospective study of 78 women admitted with PPP, 34 (43.6 %) of whom received ECT. Presence of catatonia, augmentation of medications, and suicidality were common indications for ECT. Catatonic symptoms were significantly higher among women who received ECT. There was no significant difference in duration of hospitalization or severity of psychopathology between women who did and did not receive ECT. Transient side effects to ECT were observed in few women, with no adverse effects noted in infants who were breast-fed. The current study supports the use of ECT as an effective and safe treatment for women with severe PPP.

A systematic review of the relationship between severe maternal morbidity and post-traumatic stress disorder

BACKGROUND

The incidence of severe maternal morbidity is increasing in high-income countries as a consequence, in part, of increased obstetric intervention and increasingly complex medical needs of women who become pregnant. Access to emergency obstetric care means that for the majority of women in these countries, an experience of severe maternal morbidity is unlikely to result in loss of life. However, little is known about the subsequent impact on postnatal psychological health resulting in an evidence gap to support provision of appropriate care for these women. There has recently been increasing recognition that childbirth can be a cause of post-traumatic stress disorder (PTSD). The combination of experiencing a life-threatening complication and its management may culminate in psychological trauma. This systematic review examined the association between women's experience of severe maternal morbidity during labour, at the time of giving birth or within the first week following birth, and PTSD and its symptoms.

METHODS

Relevant literature was identified through multiple databases, including MEDLINE, PsycINFO, EMBASE, CINAHL, British Nursing Index, Web of Science, Cochrane library and the British Library, using predetermined search strategies. The search terms included "post-traumatic stress disorder", "PTSD", "stress disorders, post-traumatic", "maternal morbidity", "pregnancy complications" "puerperal disorders", "obstetric labo(u)r complication", "postpartum h(a)emorrhage", "eclampsia". Studies identified were categorised according to pre-defined inclusion and exclusion criteria. The quality of included studies was assessed using the relevant CASP appraisal tools.

RESULTS

Eleven primary studies met review criteria. Evidence of a relationship between severe maternal morbidity and PTSD/PTSD symptoms was inconsistent and findings varied between studies. Nevertheless, there is some evidence that severe pre-eclampsia is a risk factor for PTSD and its symptoms, an association possibly mediated by other factors such as fetal/neonatal condition.

CONCLUSIONS

Despite the absence of robust evidence regarding the relationship between severe maternal morbidity and PTSD/PTSD symptoms, it is crucially important that clinicians and policy makers are aware of a potential higher risk of PTSD among women who experience severe morbidity. Further studies are now needed to confirm this risk as well as to understand underlying mechanisms in order to minimise the longer term psychiatric impact of severe maternal morbidity.

[Psychosocial factors predicting postnatal anxiety symptoms and their relation to symptoms of postpartum depression]

OBJECTIVES

To study perinatal anxiety symptoms in a sample of Mexican mothers. A) To evaluate the effect of certain psychosocial factors during pregnancy on anxiety symptoms at two postpartum time intervals; and B) to determine whether this symptomatology is related to symptoms of postnatal depression.

MATERIAL AND METHODS

In this secondary data analysis, 156 women were interviewed during pregnancy (T1): 149 were interviewed again at 6 weeks postpartum (T2) and 156 at 4-6 months postpartum (T3). Subjects were selected from women seeking prenatal attention at three health centers in Mexico City who presented with depressive symptomatology and/or previous history of depression. Two models were subjected to multivariate regression analysis to determine the influence of psychosocial factors in pregnancy (age, education, partner status, social support [APGAR], stress events, self-esteem [Coopersmith], depressive symptomatology [BDI-II], and anxiety [SCL-90]) on anxiety symptomatology (SCL-90) in T2 and T3. Two additional linear regression analyses were performed to evaluate the influence of prenatal anxiety symptomatology (SCL-90) on postpartum depression symptoms (BDI-II), one for each postnatal period (T2, T3).

RESULTS

The variables that predicted postpartum anxiety symptomatology in T2 were anxiety symptoms and lack of social support; in T3 they were anxiety symptoms, lack of a partner, and lack of social support. Prenatal anxiety symptoms predicted postpartum depressive symptomatology at both postpartum intervals (T2, T3).

CONCLUSIONS

Untreated prenatal anxiety symptomatology is predictive of symptoms of anxiety and depression in the postpartum period, suggesting the need for timely detection and treatment. Women lacking social support or partners are a population particularly vulnerable to anxiety symptoms, and merit interventions that address these issues.