Littérature scientifique sur le sujet « Psychosocial aspects of childbirth and perinatal mental health »

Pregnancy is a transitional period involving the most complex experiences in a woman’s life, during which the woman’s psychological status can be affected by a wide range of psychosocial variables. However, positive interpersonal relationships appear to constitute a supportive network that significantly influences perinatal mental health. Therefore, the presence of a supportive partner works psycho-protectively against the difficulties and pressures created by the transition to maternity. The aim of this study was to review systematically the influence of the partner on the woman’s psychology during the perinatal period. Fourteen research articles from PubMed/Medline, Google Scholar and PsycINFO were included in the review from a total of 1846 articles. Most studies have shown a correlation between the support from the partner and prenatal depression and anxiety. Support from the spouse during childbirth is related to the extent to which women feel safe during labor as well as the stress during childbirth. The role of the partner is very important in the occurrence of perinatal mental disorders in women. Of course, more research needs to be done in the field of perinatal mental health. The risk factors that lead to mental disorders need to be clarified and the role of the partner in the perinatal period requires reinforcement and needs to be given the necessary importance.

Abstract BodyThe risk of mothers to develop a severe mental illness is dramatically increased in the first three months after giving birth. Childbirth has the strongest relationship with postpartum affective psychosis, a condition that is characterized by an acute onset of florid symptoms, usually within 2 weeks of delivery, and atypical features, such as rapidly fluctuating psychotic symptoms, florid motor symptoms, perplexity and high risks to the mother and her baby. Follow up data of women with a first episode suggest that some women only become ill in the context of childbirth whereas in others it is an expression of a lifelong bipolar disorder. Whether this reflects two distinct forms of the disorder or different degrees of vulnerability requires future study. The profound hormonal and metabolic as well as psychosocial changes in the perinatal period give rise to a number of hypotheses that seek to explain the pathogenesis of postpartum psychosis. Current research findings on biological and psychosocial risk factors will be discussed as well as what is currently known about responses to treatment.DisclosureNo significant relationships.

IntroductionDyspareunia is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Dyspareunia after childbirth is quite common and have a range of repercussions to women's lives, including their sexual functioning. It could be affected by different risk factors. While role of obstetric factors including mode of delivery has been largely investigated, the influence of psychosocial factors remains unclear.AimsOur purpose was to determine frequency of postpartum dyspareunia and identify related psychosocial factors.MethodsThirty women between 2 and 6 months postpartum were recruited in consultation of maternity and neonatology center of Tunis. Data were taken from medical file and questionnaire designed to record psychosocial data and postpartum sexual function.ResultsThe mean age of women was 28.74 ± 8.4 years. Dyspareunia was reported by 43.33% of women. Dyspareunia was not associated to professional status. On the other hand, dyspareunia was significantly associated to fatigue (P = 0.024), lack of familial support (P = 0.03), conjugal conflicts (P = 0.01).ConclusionWe have found an association between dyspareunia after childbirth and several psychosocial factors, pointing out the influence of social and psychological aspects in the sexual function in women. Thus, management of sexual disorders should take in consideration psychological dimension and involve an appropriate psychological care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionPsychiatric illness and suicide in particular have been a leading overall cause of maternal mortality in the United Kingdom. Although the most recent Confidential Enquiry into Maternal and Child Health indicated that this is no longer leading causes, mental health problems before and after childbirth have a significant impact on the health of women, family relationships and children's subsequent development.AimsTo identify the current practice for management and prevention of perinatal mental illness within a community mental health setting.To identify the extent to which policy recommendations from NICE “Antenatal and postnatal mental health” been implementedMethodsThe audit included all women who are pregnant, breastfeeding or who are planning to become pregnant and referred to the CMHT between November 2008 to April 201020 Cases identified by asking all team members to recall relevant clients.Results65% of those referred were in the antenatal period and 25% were in the post natal period. 40% of those referred had a pre existing mental illness and 60% were new onset during antenatal & postnatal period.The main diagnosis was depression and anxiety disorders.55% of those referred to the CMHT were on Psychotropic medications. However following the assessment and follow up by CMHT, only 25% of those referred needed to be on the psychotropics.Good compliance was achieved in the documentation of past psychiatric history and family history, provision of appropriate psychosocial interventions and specific considerations for the use of antidepressant medication during pregnancy and the postnatal period.

Perinatal mental health (PMH) has been a growing field of practice for psychiatry in the last decades. It focuses on mental health during pregnancy, childbirth and the postpartum period including the distinctive presentations of mental illness and well‐being challenges associated with parenting experiences. Mental health problems in pregnancy and the postnatal period can have significant differences and challenges to its approach compared to other periods of life. Working in PMH requires specific and updated know­ ‐ledge regarding carers’ experiences and manifestations of mental illness in this particular life stage and psychotropic management during pregnancy and breastfeeding, as well as regarding the mother/parent and baby relationship and bond, and the baby’s safeguarding along several developmental issues. For all this, PMH specialist services and multidisciplinary teams with specific training have been developing to cater to this need in several countries around the world. To provide a broadened overlook on the matter, some key aspects of PMH will be discussed below in this perspective.

Objective: to analyze the psychopathological structure, risk factors and tretment of depressive disorders in women in the postpartum period.Patients and methods. A prospective cohort study included 150 women in the postpartum period (0-3 days after birth), aged 18 to 41 years, with follow-up every two weeks for six months. The evaluation included clinical interviews, Montgomery-Asberg Depression Rating Scale, and the 17-item Hamilton Anxiety Rating Scale.Results and discussion. 11.3% of women developed depression within six weeks after childbirth. Among them, 94.2% presented with mild depression, and 5.8% - moderate. Risk factors associated with postpartum depression included: periods of low mood and anxiety before and during the current pregnancy, traumatic situations during pregnancy, unwanted pregnancy, pathology of pregnancy and childbirth, cesarean section, perinatal status, lack of breastfeeding. All women with postpartum depression were treated with rational-emotive and cognitive-behavioral therapy. A short course of pharmacotherapy was prescribed to 17.6% of them to correct insomnia and anxiety symptoms. Psychotherapy was highly efficient in the treatment of postpartum affective disorders.Conclusion. The postpartum depression prevalence was 11.3%. The severity of postpartum depression was predominantly mild, and the symptoms regressed during treatment within five months in all women.

<p><strong>Background:</strong> Perinatal mental health disorders are considered to be a major public health concern. Left untreated, maternal psychopathology can extent to the rest of the family unit, and increase the risk of psychological and psychiatric co-morbidity in the child. Thus, a better understanding of the overall burden of these disorders is fundamental to inform policy makers and produce practice change. Worldwide, perinatal mental health disorders are known to affect approximately 20% of pregnant and postnatal women. However, the prevalence of these disorders in Malta, an island in the center of the Mediterranean Sea with approximately 4,000 births annually, remains unknown. The primary objective of this cross-sectional study will be to address this gap in knowledge and define the local prevalence of perinatal psychopathology.</p><p><strong>Methods:</strong> A representative sample of 300 postnatal women from birth up to one year after childbirth, resident in Malta, will be recruited through a stratified random technique. Participation will involve two phases. In the first stage, selected participants will be asked to self-complete the Edinburgh postnatal depression scale (EPDS), the generalized anxiety disorder-7 item (GAD-7), the Yale Brown obsessive compulsive scale (YBoCS), the Post-Traumatic Stress Disorder Checklist for DSM-V (PCL-5), and the difficulties in emotional regulation scale (DERS) questionnaires. In the second stage, those women who score equal or above the cut-off values in any of these questionnaires, will be assessed using the diagnostic mini-international neuropsychiatric interview (MINI) to confirm or refute a diagnosis of a mental health disorder.</p><p><strong>Conclusions: </strong>In addition to determining the local prevalence, scores from the self-report instruments will be correlated with MINI diagnostic outcomes to determine the best cut-off value for a provisional diagnosis for each of these tools. Basic demographic details and psychosocial characteristics will be recorded.</p>

Background: This study investigates if a non-randomized controlled perinatal health intervention which offers (a) long-term midwife-led breastfeeding support and (b) psychosocial support of women, is associated with the initiation, exclusivity and duration of breastfeeding. Methods: A sample of 1080 women who attended a 12-month intervention before and after childbirth, during a five-year period (January 2014–January 2019) in a primary mental health care setting in Greece, was examined. Multiple analyses of variance and logistic regression analysis were conducted. Results: The vast majority of women (96.3%) initiated either exclusive breastfeeding (only breast milk) (70.7%) or any breastfeeding (with or without formula or other type of food/drink) (25.6%). At the end of the 6th month postpartum, almost half of the women (44.3%) breastfed exclusively. A greater (quantitatively) midwifery-led support to mothers seemed to correlate with increased chance of exclusive breastfeeding at the end of the 6th month postpartum (p = 0.034), and with longer any breastfeeding duration (p = 0.015). The absence of pathological mental health symptoms and of need for receiving long-term psychotherapy were associated with the longer duration of any breastfeeding (p = 0.029 and p = 0.013 respectively). Conclusions: Continuous long-term midwife-led education and support, and maternal mental well-being are associated with increased exclusive and any breastfeeding duration.

From the middle of the twentieth century till the present, a great deal has been accomplished in perinatal and reproductive psychology and psychotherapy, from working with pregnant women and diadas to a systematic approach to psychological problems of reproduction function. At the present stage, this independent area, which integrates issues of the early development of the child’s 165 psyche and the implementation of reproductive function at all stages of the reproductive cycle, has its field of application, methodological and theoretical basis and methodological support. Perinatal psychology has become a part of reproductive psychology, it is the central core in which the problems of the early development of a child and the implementation of reproductive function of parents overlap. This part includes the period from preparation for conception till the end of the diadic relationship, and combines the problems of a child and parents, implementing a diadic approach. Reproductive psychology and psychotherapy includes a broader range of issues: reproductive ontogeny, social and psychological aspects of reproductive behaviour, motherhood and fatherhood (including children's birth planning, conception, pregnancy, childbirth, upbringing of the child), as well as reproductive health problems (reproductive psychosomatic). The methodological basis of reproductive and perinatal psychology are classical and modern theories of early development, evolutionary and systemic approach, diadic approach, theory of functional systems, teaching about dominance and psychosomatic approach. The reproductive sphere is defined as a functional system that combines physiological, mental and behavioural mechanisms for the implementation of reproductive function, it has a system structure and is regulated by the reproductive dominance, including sequence of subdominants according to the dynamics of the reproductive cycle. The theory of functional systems and the concept of dominance make it possible to merge the idea about the stages of the reproductive cycle into a holistic system and to implement a holistic approach to a person at different times of realization of his main life task – birth and upbringing of children. The circle closes: human reproductive sphere has its ontogeny and its implementation as continuity “from birth to birth”: from their birth to the birth of their children. In accordance with the complexity of psychological issues, an integrative approach is used in practice. С середины ХХ века до настоящего времени в перинатальной и репродуктивной психологии и психотерапии был пройден большой путь от работы с беременными и диадой до системного подхода к психологическим проблемам репродуктивной функции. На современном этапе это самостоятельное направление, которое объединяет проблематику раннего развития психики ребенка и реализации репродуктивной функции на всех этапах репродуктивного цикла, имеет свою область применения, методологическое и теоретическое обоснование и методическое обеспечение. Перинатальная психология стала частью репродуктивной психологии, она является центральным ядром, в котором пересекаются проблемы раннего развития ребенка и осуществления репродуктивной функции родителями. Эта часть включает период от подготовки к зачатию до окончания диадических отношений и объединяет проблемы ребенка и родителей, реализуя диадический подход. Репродуктивная психология и психотерапия включает более широкий спектр вопросов: онтогенез репродуктивной сферы, социально-психологические аспекты репродуктивного поведения, реализацию материнства и отцовства (включая планирование рождения детей, зачатие, беременность, роды, воспитание ребенка), а также нарушения репродуктивного здоровья (репродуктивную психосоматику). Методологической основой репродуктивной и перинатальной психологии являются классические и современные теории раннего развития, эволюционно-системный подход, диадический подход, теория функциональных систем, учение о доминанте и психосоматический подход. Репродуктивная сфера определяется как функциональная система, объединяющая в себе физиологические, психические и поведенческие механизмы для реализации репродуктивной функции, она имеет системное строение и регулируется репродуктивной доминантой, включающей последовательность субдоминант в соответствии с динамикой репродуктивного цикла. Теория функциональных систем и понятие доминанты позволяют объединить представление об этапах репродуктивного цикла в целостную систему и осуществить целостный подход к человеку в разные периоды реализации его главной жизненной задачи – рождения и воспитания детей. Круг замыкается: репродуктивная сфера человека имеет свой онтогенез и свою реализацию как преемственность «от рождения до рождения»: от своего рождения до рождения своих детей. В соответствии с комплексностью психологической проблематики в практике используется интегративный подход.