Bonding, Peripartum Mood Disorders, and the Parental Transition

NURS546

What is the difference in between bonding and attachment?

Attachment refers to relationship from infant to parent. Bonding rederfs to relationship from parent to infant.

What are some signs of infant attachment?

In the first hour: breast crawl, rooting and suckling, looking at parents face

What are some factors that facilitate bonding?

Physical proximity, prenatal attachment, support in labor, breastfeeding, rooming in, infant crying and mother’s attitudes and expectations about parenting.

What are the benefits of skin to skin contact?

Improves thermoregulation, reduces stress in parent and infant, reduces infants pain response, and helps with breastfeeding.

What are some factors that hinder initial bonding?

Physical separation (illness, incarceration, preterm birth/NICU, traumatic birth) and emotional separation (trauma, depression, grief, unwanted pregnancy, gender dissatisfaction, disappointment in baby appearance).

If you can get through a PP visit with a pattient and they never mention the baby, what does that point to?

Postpartum Depression

What happens to the brain in pregnancy?

Regions of the brain shift in size and connections, hormonal change: the medial preoptics area receives sensory stimulus from the baby, galanin neurons specialized for caregiver functions, receptors for estrogen, progesterone, oxytocin and prolactin directs or inhibits behaviors based on maternal hormones and stimulus from the baby.

When the brain changes does this cause the parent to love the infant?

No, this only creates behavior changes.

What happens with the amygdala in these brain changes?

Draws attention to and directs behavior based on stimuli. Amygdala is more activated in both parents and behavior is stimulated by baby crying. In non-parents, baby’s laughter directs behavior.

What happens to the brain in PPD?

Blunted dopamine response: decreased reward of parenting, decreased ability to gage correctly what the child needs. Increased amygdala activation: increased negative stimuli, decreased predictive ability of parent to know what the child needs

What is a medication that can treat PPD and how?

Zuranolone. Hormonally based medication that impacts the GABA receptors to inhibit the amygdala.

What is the timeline for baby blues and PPD?

Baby blues usually peaks 3-5 days after the delivery and usually resolves 10-12 days postpartum. PPD most often occurs in the first 3 months, it could’ve started before pregancy or during pregnancy, weaning baby off breast or when menses return.

What do we use to screen for depression and anxiety in the prenatal and postpartum period?

PHQ-9 and/or Edinburgh Depression Scale

What is bipolar disorder and how does it look in the perinatal period?

Brain condition that causes unusual shifts in mood, energy, activity leevels, and the ability to carry out tasks. Manic or hypomanic episodes.

How do we treat bipolar disorder?

Individual therapy and medication.

What does DIGFAST stand for?

D:Distractibility, poorly focused, multitasking.

I: Indiscretion, risky behaviors.

G: Grandiosity, increased self esteem.

F: Flight of ideas, racing thoughts.

A: Activity, increase in goal directed activity.

S: Sleep, decreased need for sleep.

T: Talkative

What are perinatal anxiety disorders?

A range of anxiety disorders, including generalized anxiety, panic, and social anxiety experienced during pregnancy or the postpartum period. These can happen immediately to 6 weeks postpartum, could also begin during pregnancy.

What do we use to screen for anxiety?

GAD-7

How do we treat perinatal anxiety disorders?

Individual therapy, dyadic therapy for mother and baby, and medication treatment.

What are some types of psychotherapy?

Cognitive Behavioral Therapy (CBT) (most common) and Dialectical Behavioral Therapy (CBT + mindfulness

What are the first line medications for Perinatal mood disorders?

Selective Serotonin Reuptake Inhibitors (SSRI’s), Selective Norepinephrine Reuptake Inhibitors (SNRI’s), and Norepinephrine-Dopamine Reuptake Inhibitors

What must we rule out before prescribing any medication for perinatal mood disorders?

Bipolar disorder

What are some side effects for the parent if taking medications for perinatal mood disorders?

GI upset, jitterness, headache, sexual side effects (1 in 6 women), and serotonin syndrome. (Always screen for history of mania)

Are there risks for these medications in pregancy?

No increased risk for miscarriage, stillbirth, autism, or congenital birth defects. Potentially increased risk for cardiac abnormalities with paxil (low), preterm birth (also increased with untreated depression), and persistent pulmonary hypertension in newborn

Should patients get off these medications while breastfeeding?

All SSRI’s and SNRI’s are below10% of maternal dose. No, but risk should be taken if on bupropion/wellbutrin.

Why is motherhood risky in the U.S.?

Least family resources, lowest public funding to child rearing, time pressures on parents, highest rates of poverty, no standard for vacation and sick days. Reflection of values: individualism and capitalism, family is not mentioned in constitution, no national family policy, etc.

What is postpartum psychosis?

Very rare, serious psychotic symptom follow childbirth. Onset is usually 24 hours to 3 weeks after delivery.

What are some strong risk factors for PPD and anxiety?

Anxiety/depression during pregnancy, stressful life events during pregnancy, low level of social support (single marital status), hx of depression/anxiety/ptsd, PPD after a prior pregnancy, identifying as a person of color.

What are some symptoms of postpartum psychosis?

Confusion, restlessness, disorganized behavior, delusional beliefs, hallucinations, disordered thinking, feeling of hopelessness, delusions about the infant.

Why are parenWhy can’t parents turn parenting off?

Default mode in the brain (neural networks) never turns off, even while completing a task.

What happens in the brain in healthy parenting transition?

Physiological state that is similar to obsessive compulsive disorder, increased sensitivity and attention (E, P, O, P), increased reward for attuning behavior to baby’s needs (dopamine).

Why is the parental motivation never satiated?

The baby (which causes dopamine to increase) is always changing.