Building Better Mothers

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Building Better Mothers ?

• Resilience in Postpartum Depression

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Joanne MacDonald MD FRCPC

• Clinical Leader, Reproductive Mental Health
  Service
• Assistant Professor, Dalhousie University
  Department of Psychiatry
• IWK Health Centre
• 5850/5980 University Avenue
• PO Box 9700, Halifax
• Nova Scotia B3K 6R8
• [phone] Fax [phone]
• joanne.macdonald_at_iwk.nshealth.ca

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Motherhood
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Motherhood
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Good Mother/Bad Mother

• Strong societal/cultural/familial expectations
• Limited community development of parents/families
• Demands of workplace vs family
• Assumes knowledge of loving, family, attachment,
  nurturing
• We dont all start from the same place

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Joan Rivers

• Im going to sue my obstetrician. He was so
  dumb he forgot to cut the cord and for a year
  that kid followed me everywhere.

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Martin Mull

• Having children is like having a bowling alley
  installed in your head!

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Anne Roiphe

• Now that my children no longer wake me in the
  middle of the night, hungry or wet, with bad
  dream, I should, returned to myself, sleep
  soundly. But I dont. They are adults and still
  I am not myself. I remain a mother linked or
  is it chained by a thousand thoughts to her
  children.

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Dimensions of Depression in Mothers

• Nearly 50 pregnancies unplanned
• 1 in 10 pregnant women will experience Major
  Depression
• 60-70 have no prior history
• 1 in 5 postpartum women will experience
  Depression or Anxiety Disorder
• 1 in 1000 develop Postpartum Psychosis

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Symptoms

• Low energy
• Disturbed sleep
• Altered appetite
• Poor motivation
• Crying
• Worrisome thinking
• Difficulty concentrating
• This is pregnancy/coping with a newborn, right?

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What to Watch For

• Those symptoms becoming persistent, progressing,
  severe
• Loss of sense of connectedness to loved ones,
  activities, interests
• Intrusive, alarming fears or ideas of harm coming
  to loved ones
• New or increased degree of obsessionality/compulsi
  veness

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What to Watch For

• Significant atypical social withdrawal
• Loss of functional capacity
• Thoughts or expressions of loss of control
• Everyone would be better off without me around
  here

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Dimensions of Assessment

• Thorough general Mental Health Assessment - FD,
  Mental Health Clinic
• Past History of Mood Disturbance
• Past Gynecologic History, incl Menstrual Cycle
  mood sensitivity
• Family History of Mood Disorder, PPD, severe PMS
• Current Stressors/Triggers

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Dimensions of Assessment

• Available real supports
• Open exploration of expectations/readiness for
  parenting
• Marital/relationship dynamic
• Past trauma/losses reactivated
• Obstetrical history and trauma experience

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Dimensions of Assessment

• Knowledge base/resources
• Daily routine
• Schedule and characteristics of baby/other
  children
• Sense of safety/capacity/hope for improvement
• Sense of herself as mother/risk analysis

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Approach to Treatment

• Mothering and Family as a Work in Progress
• Endorsement of Well Mother critical to Well Baby
• Engagement of Extended Family/Friends
• Pivotal Point in Personal Development

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Approach to Treatment

• Genuinely Holistic/Multimodal
• Biological General Health Mood Disorder Dx
  role of Psychotropic Medications Safety Analysis

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Approach to Treatment

• Psychological The Story of This Woman, This
  Family Not Pass/Fail Identifying Strengths
  Vulnerabilities

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Approach to Treatment

• Social Changing Roles Loss of
  Identity/Autonomy Differing Needs for Support

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Our Treatment Team

• Dr. Joanne MacDonald, Dr. Mary-Ann Hudec, Dr.
  Shannon MacDonald, Dr. Normand Carrey
• Deborah Salyzyn, MN, Clinical Nursing Specialist
  in Mental Health
• Faye Morrison, RN, Intake Nurse
• Nena Nauss Coleen Flynn, MSW/Therapist
  Clinicians
• Kim Bernard, MSW, Addictions Services
• Residents in Psychiatry and Obstetrics, senior
  Medical Students
• Angela Thibault, Admin Assistant

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Our Partners

• Woman and her Supports
• Family Physicians
• Obstetrician/Gynecologists
• Obstetrical and Family Nursing
• Public Health Nursing and Enhanced Home Visitors
• Family Resource Centres
• Child Protection Services
• Addictions Services
• Parent Volunteer/Support/Education Agencies
• MISA
• Community Mental Health Services
• At Risk Youth/ Transition Shelters Agencies

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Treatment Components

• Ongoing mental health care, followup,
  reassessment
• Medications incl antidepressants, sleep
  medicines, antipsychotics, anxiolytics
• Risk/benefit analysis individualized
• Sleep cycle interventions

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Treatment Components

• Enhanced self-care nutrition, supplementation,
  fluids, moderate exercise
• Respite
• Combined Addiction/Mental Health Treatment
• Psychotherapies incl CognitiveBehavioral,
  Interpersonal, Emotional Regulation, Attachment
  Development, Marital

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Treatment Components

• Increase social connectedness
• Parenting support and education
• Skill development return to education, new
  activities, work roles
• Adjunct Modalities eg Massage Therapy,
  Mindfulness Training, Acupuncture, Physical
  Relaxation Strategies

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Mothers and Child Development

• Attachment to primary caregiver creates base for
  secure sense of self, emotional regulation,
  learning, connection to others
• Disturbances of Attachment linked to personality
  development, learning, behavioral control,
  self-worth, respect of others, capacity to
  self-regulate, tolerate limits

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Developing a Secure Base
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A. Slade, Yale Child Study Group

• The time between a womans discovery she is
  pregnant and the babys first smile is one of
  great crisis and opportunity . . .most important,
  it is the beginning of life for the baby, the
  beginning of a long complex journey, whose
  contours are established during the first months
  and years in the world.

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Every Woman Has a Story

• Understand story of this pregnancy, this baby
• Challenge myths of motherhood, culture of
  perfectionism
• Identify basic needs for baby as mirroring basic
  needs for mother takes time to establish rhythm
  and language with one another
• Crisis of opportunity to take time to take
  stock to look at whole self to embrace notion
  of recovery

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How would you weather a storm?
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The Story

• Every life transition creates likelihood to
  stumble and to move forward
• Spectrum from health to illness
• Imagine your best friend
• Importance of presence/intimacy in our lives
  generally
• Metaphors for life?

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Parenting as Harness Racing
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Parenting as Surfing
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Maya Angelou, in Mother A Cradle to Hold Me

• It is true
• I was created in you.
• It is also true
• That you were created for me.
• I owned your voice.
• It was shaped and tuned to soothe me.
• The scent of your body was the air
• Perfumed for me to breathe
• Mother,
• During those early, dearest days
• I did not dream that you had
• A large life which included me,
• For I had a life
• Which was only you.

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Motherhood as Empowering Experience

• Baby On Board!
• New, Intensely Held Views, Priorities, Likes,
  Dislikes, Focus
• Consolidation of Picture of the Self
• Integration vs. Competition Roles
• Like Mother, Like Father Parallel challenges and
  opportunities
• Most couples intend to be successful

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Build Capacity in the Couple
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Postpartum Depression as Experience of Resilience

• Success as a person/mother equals success in
  recovery
• Elements of awareness of self and others,
  action/intervention, tolerance, balance,
  self-care, realistic expectations, attunement to
  emotions, reciprocity with others, courage to
  try, belief in future

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Resources

• This Isnt What I Expected Valerie Raskin MD
• Meditations for New Mothers Beth Wilson Saavedra
• Down Came The Rain Brooke Shields
• Shouldnt I Be Happy Shaila Misri MD
• Becoming the Parent You Want to Be Laura Davis
  Janis Keyser
• The Mother of All (Pregnancy/Baby/Toddler) Books
  Ann Douglas

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Resources

• www.womensmentalhealth.org
• www.postpartum.net
• www.bcrmh.com
• www.motherisk.com