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