Pregnant and Postpartum Mood and Anxiety Disorders Affect the Whole Family Supported by funds received from the California Department of Public Health Maternal Child and Adolescent Health Division ID: 806543
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Slide1
Feelings in Motherhood
Pregnant and Postpartum Mood and Anxiety Disorders Affect the Whole Family
Supported
by funds received from the California Department of Public Health, Maternal, Child and Adolescent Health
Division.
Slide2Sentimientos en La MaternidadPostpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Los trastornos del estado de ánimo y
la
ansiedad durante el embarazo y el posparto afectan a toda la familia
Apoyado por fondos recibidos del Departamento de Salud Pública, División de Salud Materno Infantil y Adolescente de California.
Slide3Introduction Moms may start to feel changes in their emotions anytime
during the pregnancy and up to 12 months after they have their baby.
It is normal for moms to have high hormone levels during a healthy pregnancy. 24 hours after delivery, hormone levels drop back to where they were before becoming pregnant.
Moms may feel different emotions during these times that can be from changes in hormone levels, uneven body chemicals, or simply from things happening in a mom’s life.
Moms can feel more sensitive and have mood
swings that are high and low.
Moms need to know when they may need help, so let’s review some common things to watch for during and after pregnancy.
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide4IntroducciónLas mamás pueden empezar a sentir cambios en sus emociones en cualquier momento durante el embarazo y hasta 12 meses después
de tener a su bebé. Es normal que las mamás tengan niveles hormonales altos durante un embarazo saludable.
24 horas después de aliviarse las hormonas regresan a los niveles hormonales que existían antes
del embarazo.
Las mamás
pueden
sentir diferentes emociones durante esta época que provienen de los
cambios hormonales,
desbalances químicos en su cuerpo o simplemente por cosas que están ocurriendo en la vida de la mamá. Las mamás pueden
sentirse más
sentimentales y
tener cambios de humor con altas y bajas.Es importante que las mamás sepan cuando es necesario buscar ayuda. Así que vamos a repasar cuales cosas son importantes de tener en cuenta durante y después del embarazo.
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide5Baby Blues How Many Moms…About 8 out of 10 moms get “baby blues” which are mild mood swings and crying because of the stress of caring for a new baby and hormonal changes in your body.
What are the things to watch for?Feeling worriedFeeling unhappy
Feeling tired or low on energyWhat to do?
Baby blues are normal and no treatment is needed. Baby blues can last up to 2-3 weeks after you have your baby.
This is an important time to ask for support from your friends and family.
If it does not go away or you are not able to care for yourself and your baby, you may have something more serious and need treatment.
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide6Depresion despues del parto
Cuantas Mamás
…Un promedio de
8 de cada 10 mamás, sufren de la depresión después del parto resultando en leves cambios de humor y tristeza (llorando, etc..), por sentirse estresada con el cuidado del nuevo bebe igual que por los cambios hormonales que pasan en su cuerpo.
Cuales cosas hay que tener en cuenta?
Sentimientos de preocupación
Sentimientos de infelicidad
Sentimientos
de
cansancio y falta de energía.Que hacer?Sentir esto es normal y no requiere tratamiento. Estos sentimientos pueden durar 2-3 semanas después del nacimiento de su bebe. Durante este tiempo es importante pedirle ayuda a tus familiares y amigos.
Si lo que sientes no se quita o no puedes cuidar de ti o de tu bebe, es posible que tengas algo mas serio y ocupes tratamiento.
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide7DepressionDepression is the most common problem
during and after pregnancy.How Many Moms…
About 2 out of 10 moms get depression during pregnancy and/or after they have their baby.
What are the things to watch for?
Feeling angry or irritable
Lack of interest in the baby
Changes in appetite
Sleeping too much or not enough
Crying and sadness
Feelings of guilt, shame, or hopelessnessLoss of interest or pleasure in things you used to enjoyPossible thoughts of harming the baby or yourselfThese things can start during pregnancy or during the first year after you have your baby
What to do?
Depression can be treated.
If these things are happening or you experience them in the future, please tell your doctor right away. Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide8DepresiónLa depresión es el problema más común durante y después del embarazo.
Cuantas Mamás…Un promedio de 2 de cada 10 mamás sufren de la depresión durante el embarazo o después de tener a su bebe.Cuales son las cosas que debemos de tener en cuenta?
Sentimientos de enojo o irritaciónFalta de interés en el bebeCambios de apetito
Durmiendo demasiado o no lo suficiente
Estar triste y llorar
Sentimientos de culpa, vergüenza y sin esperanzas
Perdida de interés o placer en las cosas que antes
si
disfrutabasPensamientos en como lastimar a tu bebe o a ti misma Estas cosas pueden pasar durante el embarazo, o durante el primer año después del nacimiento de su bebe
Que hacer?
La depresión es tratable
Si estas cosas te están pasando o te llegan a pasar en el futuro, por favor notifíqueselo a su medico lo antes posible.Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide9AnxietyHow Many Moms…About 1 out of 10 moms get anxiety during pregnancy and/or after they have their baby.
Moms can have anxiety alone or with depression.What are the things to watch for?Constant worry
Feeling that something bad is going to happenUnable to stop anxious thoughts that are in your mindChanges in appetite
Sleeping too much or not enough
Not able to sit still
Dizziness, hot flashes, and nausea
Serious things are feelings of panic and chest pain
These things
can start during pregnancy or during the first year after you deliver your baby
What to do?Anxiety can be treated.If these things are happening or you experience them in the future, please tell your doctor right away.
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide10AnsiedadCuantas Mamá
s…1 de cada 10 mamás sufren de ansiedad durante el embarazo o después de tener a su bebe.Las mamá
s que sufren de ansiedad pueden tener solamente ansiedad o la ansiedad puede venir acompañada con la depresión.Cuales son las cosas que debemos de
tener en cuenta?
Preocupación constante
Sintiéndose que algo malo va a suceder
Pensamientos incontrolables
Cambios de apetito
Durmiendo
demasiado o no lo suficienteNo poderse estar quieta o tranquilaMareos, bochornos, o nauseasCosas serias como sentimientos de pánico y dolor de pecho
Estas cosas pueden pasar durante el embarazo, o durante el primer año después del nacimiento de su bebe
Que hay que hacer?
La ansiedad es tratableSi estas cosas te están pasando o te llegan a pasar en el futuro, por favor notifíqueselo a su medico lo antes posible.Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide11Obsessive Compulsive Disorder (OCD)How Many Moms…About 5 out of 100 moms of moms will get obsessive compulsive disorder.
What are the things to watch for?Scary images and thoughts that keep happening such as; the thought of hurting your baby These thoughts can come out of nowhere and are not in your controlAlways feeling like you have to do certain things such as; cleaning, checking, counting, or reorganizing things over and over again
Feeling very worried about these thoughts or behaviorsFear of being left alone with the baby
Being overly protective of the baby
Moms with obsessive compulsive disorder know that their thoughts are strange and are not likely to act on them
What to do?
OCD can be treated.
If these things are happening or you experience them in the future, please tell your doctor right away.
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide12Trastorno Obsesivo Complusivo (TOC)
Cuantas Mamas…Como 5 de cada 100 mamás sufrirán de
Trastorno Obsesivo Compulsivo (TOC)Cuales son las cosas que hay que tener en cuenta
?
Pensamientos e imágenes de cosas feas; como diferentes maneras de como lastimar a su bebe.
Estos pensamientos vienen de la nada y no son controlables
Sentir
l
a necesidad de hacer ciertas cosas repetidamente, como limpiar, organizar, sin poder parar.
Sentirse preocupada sobre estos pensamientos y comportamientos.Sentir temor de quedarse sola con su bebeTendencia de sobre
protejer
al bebe.
Mamás con trastorno obsesivo compulsivo saben que sus pensamientos son raros y que no actuaran a ellos.Que hacer?TOC puede ser tratatoSi estas cosas te están pasando o te llegan a pasar en el futuro, por favor notifíqueselo a su doctor lo antes posible.Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide13Postpartum Stress DisorderHow Many Moms…About 9
out of 100 moms get postpartum post-traumatic stress disorder (PTSD).
This type of stress is related to problems from a difficult delivery of the baby or if the mom experienced previous abuse in her life.What are the things to watch for?
Repeating thoughts about what happened during the delivery or abuse
Flashbacks or nightmares
Avoiding people, places and/or things that remind you of the delivery or abuse
Anxiety
Unable to sleep
Serious things are feelings of panic and chest
painFeeling isolated and that you don’t belong
What
to do?
PTSD can be treated.If these things are happening or you experience them in the future, please tell your doctor right away. Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide14Trastorno de estré
s posparto (TEPT)Cuantas mamás...
Como 9 de cada 100 mamás sufren del trastorno de estrés postraumático de posparto. (TEPT)
Este tipo de problema sucede después de tener un parto difícil o si la mamá ha sufrido de algún abuso en su vida.
Cuales son las cosas que hay que tener en cuenta?
Pensamiento repetidos reviviendo lo que pasó durante el parto o del abuso sufrido
Pensamientos recurrentes o pesadilla
Preocupación con evitar a la gente, lugares o cosas que le recuerden al parto o al abuso
Ansiedad
El no poderse dormirCosas serias como sentimientos de pánico y dolor de pecho
Sintiéndose aislada y como que no perteneces
Que hacer?
TEPT puede ser tratableSi estas cosas te están pasando o te llegan a pasar en el futuro, notifíqueselo a su Medico lo antes posible.
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide15PsychosisHow Many Moms…Psychosis is rare, it happens to about 1 or 2 moms out of 1,000.
What are the things to watch for?Delusions- you strongly believe something that is not true such as; you believe that God told you to harm your babyHallucinations- you see or hear things that are not there such as; you see and/or hear angels in your house Feeling very irritated
Not able to sit still or pay attentionNot able to sleep
Paranoid or suspicious
Rapid mood swings
N
ot able to talk and share your feelings
These things usually start two (2) weeks after you deliver your baby
What to do?
Psychosis can be treated, however, it is an emergency. Please call 9-1-1 immediately.If these things are happening or you experience them in
the future, please tell your doctor right away.
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide16La PsychosisCuantas Mam
ás…La Psychosis es rara, y le
ocure a 1 o 2 mamas de cada 1,000.
Cuales son los
sintomas
?
Delirio – Creer firmemente algo que no es verdad, tal como creer que Dios te ha dicho que lastimes a tu bebe.
Alucinaciones -
Oir
o ver cosas que no existen, como ver o escuchar ha angeles en tu casa.Sentirse muy irritadaNo poder estar quieta o poner
atencion
No poder dormir
Ser muy suspicaz o tener paranoiaFrecuentes cambios de humor No poder hablar y compartir tus sentimientosEstas cosas comienzan usualmente 2 semanas después del nacimiento de su bebe. Que hacer?La psychosis es tratable, sinembargo es una emergencia, por favor llame al 9-1-1 immediamente
Si esto le esta pasando o lo experimenta en un
future
, notifíqueselo a su Medico lo antes posible.
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide17Tips on Staying Well
Please don’t be afraid to ask for help, you are not alone. These changes are common and can be treated. Get support from family and friends. Dads
can have emotional changes too, and may need help and treatment. It is important to be there for each other.
Talk
to a counselor or doctor who understands
what you are going through.
Don’t give
up!
I
t may take more than one try to get the help and treatment you need.
Join a support group in your area or online.
Keep active by walking, or any exercise that makes you feel better.
Try to sleep for a at least four (4) hours at one time each day; this will help you to think clear and feel like yourself.Rest when your baby rests. Eat a healthy diet every day.Drink eight (8) glasses of water every day.Keep taking your prenatal vitamins every day. Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide18Consejos para mantenerse bien
Por favor no tengas miedo de pedir ayuda, no estas sola. Estos cambios son comunes y pueden ser
tratados.
Obtenga apoyo
de tu familia y amigos
Los
papás
también pueden tener cambios emocionales, y es posible que también ocupen ayuda y tratamiento. Es importante que se apoyen uno al otro.
Hable con
un consejero o doctor que entienda lo que usted estas
pasando
No
se rinda! Puede tomar mas de un intento para obtener la ayuda y el tratamiento que usted necesite.Busque un grupo de apoyo cerca de usted o un sitio web de ayuda en línea.Manténgase activa, caminando o participando de cualquier ejercicio que le haga sentir bien.
Trate
de dormir al menos cuatro 4 horas
corridas diario,
esto
le hará
sentir mejor y
le ayudará a pensar
más claramente.
Descanse
cuando
su bebe
duerma.
Coma
una dieta saludable.
Tome
al menos ocho 8 vasos de agua al día.
Sigua
tomando
sus vitaminas
prenatales diario.
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide19Staff Instructions OnlyThis section will guide you how to talk to your patient, how to screen, and when to refer.
This section is not to be shared with the patient. Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide20How to Talk to Your Patient
Don’t be afraid to ask sensitive questions. Most moms feel relieved when they talk about their feelings. Don’t try to talk her out of how she feels such as saying, “things aren’t that bad,” “you should be happy that you are pregnant,” or “you are fine and just think happy thoughts.” These kind of statements can make the mom feel like she is not a good mom leading to increased feelings of guilt and shame. Moms will often not open up once they feel this way.
It is very important to be aware of your body language and facial expressions. Maintain good eye contact, face the patient, and really listen to what she has to say.
Try to stay neutral and treat this like you would any other OB/GYN educational topic.
Remember, if you are comfortable with the discussion, the mom will sense that, and be more open with you.
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide21Why Screen? Moms are most vulnerable to psychiatric and emotional problems during pregnancy and the first 12 months after delivery. In fact, postpartum depression is the most under diagnosed OB/GYN complication in the United States.
The consequences to moms and families who are not screened and treated for emotional stress and perinatal mental health disorders are significant. These include: lack of bonding between mother and baby leading to developmental delays, lack of effective communication in families which leads to familial breakdown and instability within the home. Worst case scenario children are abused and/or neglected, removed from the home and/or a fatality can occur.
You can make a huge difference in a family’s life by taking the time to screen and identify moms who may need treatment for a perinatal mental health disorder (depression, anxiety, obsessive/compulsive disorder or psychosis).
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide22Screening ToolsTools
Both the Edinburgh Perinatal Depression Screening Tool (EPDS) and Patient Health Questionnaire (PHQ-9) are approved to use in the perinatal population. Both are free, translated into many languages, and easy to complete.
EPDS addresses the anxiety component of perinatal mental health disorders as well as depressive things and suicidal thoughts.
PHQ-9 does not have the anxiety component but includes suicidal thoughts.
Web link for tools:
http://www.postpartum.net/professionals/professional-tools
/
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide23Timing- When to ScreenFirst prenatal visit
At least one in the second trimester At least
one in the third trimesterFirst postpartum OB/GYN visit
6 week postpartum OB/GYN visit
Repeat screening at 6 and/or 12 months at OB/GYN, Pediatric, or Primary Care settings
3, 9, 12 months at Pediatric visits
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide24How to Score Your ToolEPDS and PHQ-9 is considered positive
if the total score is 10 or more. A positive score means a mom is at high risk for emotional stress and/or a perinatal mental health disorder.
EPDS and PHQ-9 is considered negative
if the total score is
9 or less.
If
the mom’s score is 9 or less, continue to follow the tool screening schedule. However, it is very important to check the
last question
of each tool which asks about suicidal thoughts. If the mom states that she is having suicidal thoughts
at all
, then her screen is considered positive.
What to do with positive screens?
Notify the provider immediately for direction for mental health referral or 9-1-1 call in the event of emergencyDocument in the chart; screening, notification of provider, and all referrals/inventions madePostpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide25Referenceshttps://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml
http://www.postpartum.net/
Gavin, N. I., Gaynes
, B. N.,
Lohr
, K. N., Meltzer-Brody, S
.,
Gartlehner
, G., &
Swinson, T. (2005). Perinatal depression: A systematic
review of prevalence and incidence. Obstetrics
and Gynecology
, 106, 1071–1083.House, S.J et.al. (2016). Obsessive-compulsive disorder in pregnancy and the postpartum period: course of illness and obstetrical outcome. Archive of Women's Mental Health, 19:3–10.Speisman
, B.B
. (2011). Postpartum
Obsessive‐Compulsive
Disorder. Journal
of obstetric, gynecologic, and neonatal
nursing , 40:6, 680-690.
Gjerdingen
D
, et al. (2009).
Stepped care treatment of postpartum depression: impact on treatment, health, and work outcomes. J Am Board Fam
Med, 22
: 473-82
.
O’Hara, M. W., & Swain, A. M. (1996). Rates and risk
of postpartum
depression-A meta-analysis. International Review
of Psychiatry
, 8, 37–54
.
Gaynes
BN
, et al. (2005). Perinatal
Depression: Prevalence, Screening Accuracy, and Screening Outcomes.
Evidence Report/Technology
Assessment No. 119. (Prepared by the RTI-University of North
Carolina Evidence-based
Practice Center, under Contract No. 290-02-0016.) AHRQ Publication No.
05- E006-2
. Rockville, MD: Agency for Healthcare Research and Quality.
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide26Riverside University Health System Public Health Department Public Health Nursing/Maternal Child & Adolescent Health Department
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net
Slide27Tab Titles (reference)IntroductionBaby BluesDepressionAnxiety
OCDPostpartum Stress DisorderPsychosisTips
Staff
Postpartum Support International Helpline: 800.944.4PPD(4773) www.postpartum.net