CHOP Team Contributes to Series on Mood and Pregnancy

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For some women, the experience of achieving and maintaining pregnancy is largely uneventful. But others may face significant challenges, such as pregnancy loss, traumatic birth, preterm birth, or hospitalization of the newborn in a NICU. These events may cause women to develop mental health symptoms.

A two-part series on mood and pregnancy in the Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN) features contributions from team members from the Center for Fetal Diagnosis & Treatment at Children's Hospital of Philadelphia. Joanna C.M. Cole, PhD, clinical psychologist and Manager of Psychosocial Services, served as guest editor of the series.

The purpose of this series is to help frontline obstetric and neonatal nurses recognize triggers for psychological distress, and to provide methods to screen women and support those who experience mental health challenges in the perinatal period.

In Part 1, the researchers address models of best practice for collaboration between mental health and nursing care. In Part 2, the researchers address methods for assessment and intervention and supportive resources for women who experience perinatal distress symptoms.

Articles contributed by Center for Fetal Diagnosis & Treatment:

Mental Health Screening, Treatment, and Referral During the Perinatal Period
Joanna C.M. Cole, Guest Editor
As many as 1 in 7 women experience depression, anxiety, and/ or traumatic stress during the perinatal period. Maternal depression is a well-recognized problem; however, the prevalence of anxiety and traumatic stress reactions during pregnancy and the postpartum period is an indication that a certain amount of psychiatric morbidity may in fact be caused by unrecognized and undiagnosed posttraumatic stress disorder. Methods to assess and treat perinatal distress are gaining attention in medical and psychotherapeutic arenas.

A Proposed Model for Perinatal Palliative Care
Joanna C. M. Cole, Julie S. Moldenhauer, Tyra R. Jones, Elizabeth A. Shaughnessy, Haley E. Zarrin, Aimee L. Coursey, and David A. Munson
Perinatal palliative care allows for an active partnership among a pregnant woman, her family, and her multidisciplinary treatment team, and addresses her specialized medical care, emotional, social, and familial needs when a life-limiting fetal diagnosis is confirmed. In this article, authors highlight the multidisciplinary care model used within a perinatal palliative care program. A case study provides a unique perspective on support needed for parents who anticipate that their newborn may die before or shortly after birth.

Universal Postpartum Mental Health Screening for Parents of Newborns With Prenatally Diagnosed Birth Defects
Joanna C. M. Cole, Michelle Olkkola, Haley E. Zarrin, Kelsey Berger, and Julie S. Moldenhauer
Few researchers have shown effective implementation of postpartum mental health screening and referral in obstetric nursing. In this article, authors describe the implementation of a nurse-led project to screen parents for depression and traumatic stress in the postpartum period after visiting their newborns in the NICU. Findings indicate that incorporating the screening process into routine nursing practice with immediate mental health triage and referral made the program feasible. The risk factors identified add to the growing knowledge about parents of newborns in the NICU.

Other articles:

  • Comprehensive Integrated Care Model to Improve Maternal Mental Health: In this article, authors describe an integrated care model in a perinatal psychiatry program to improve access to care for women who experience mood changes during the perinatal period. A nurse-practitioner trained in psychiatry and obstetrics is embedded in the obstetric clinic, and perinatal nurses, often the first professionals to recognize women who are experiencing mood changes, can easily refer women for follow-up. Barriers, lessons learned, and goals for implementation are described.
  • Effect of Previous Posttraumatic Stress in the Perinatal Period: This article explores supportive psychotherapy as a plausible intervention that nurses and other maternity care providers can use with women who experience anxiety and depression in the perinatal period. Authors reviewed literature on the effect of traumatic experiences that pre-date conception, pregnancy, and the postpartum period and concluded that women's health care providers should evaluate for PTSD in routine mental health assessments during and after pregnancy, especially with a reported history of trauma or the presence of a mood or anxiety disorder.
  • Anxiety Screening During Assessment of Emotional Distress in Mothers of Hospitalized Newborns: This analysis examines the incremental identification of emotional distress in mothers of hospitalized newborns by screening for anxiety in addition to depression, and to provide practical information about anxiety screening scales to facilitate instrument selection and screening implementation by nurses in the NICU. Results showed that the addition of anxiety screening scales helped to identify emotionally distressed women who would have been missed during routine depression-only screening.
  • History and Purpose of Postpartum Support International: Postpartum Support International provides training for professionals and supports families who experience perinatal mood and anxiety disorders. This article describes Postpartum Support International, which was founded in 1987 to increase awareness among public and professional communities about the emotional difficulties women experience during and after pregnancy. Authors recommend strategies with which health care professionals can support families, reduce stigma, and offer resources for treatment and support.
  • A Secondary Analysis of Mistreatment of Women During Childbirth in Health Care Facilities: The disrespectful and abusive treatment of women during childbirth in health care facilities has been called a blind spot in respectful, women-centered care. This blind spot is present in rich and poor countries. The purpose of this study was to conduct a secondary data analysis of a primary qualitative study of women's experiences of traumatic childbirth in high-income countries. Findings confirm results from studies of mistreatment of women during childbirth in health care facilities in low- and middle-income countries. Prevention and elimination of mistreatment of women during childbirth are the ethical responsibility of all obstetric health care providers.
  • A Nurse-Based Model of Psychosocial Support for Emotionally Distressed Mothers of Infants in the NICU: Depression and anxiety symptoms are prevalent among mothers of infants hospitalized in the NICU, particularly early in the hospitalization. However, emotional distress is often not identified, and even when it is detected, mothers are not always able to access support. The Family-Centered Developmental Care philosophy, widely adopted by NICUs, calls for an expanded focus on the well-being of the entire family. In this article, authors describe an innovative, nurse-delivered program for emotionally distressed mothers of infants in the NICU that includes screening and an empirically sup- ported counseling approach: Listening Visits.

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