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Parenting a preemie can be tough and it's important to find ways of coping and looking after your own health. It can also make you feel more in control if you can learn some great strategies to help with your prem's learning and development.


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Finding a balance and a way forward

Parenting a preemie can be challenging and is a significant life transition. It is important that you find time and ways of taking care of your own health and wellbeing. Eating well, staying fit and healthy, and getting enough rest and relaxation are vital for optimal health. Maintaining and caring for relationships, especially with your partner is also important. If you need it, don't discard the option of professional assistance. Also, find advice about optimizing development and learning strategies to help with thinking & behavior difficulties.


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Parental Depression & Anxiety

Research suggests that 10% of mothers of infants with very low birth weight report severe symptoms of psychological distress in the neonatal period which is five-fold the rate of term mothers, and almost one-third of mothers have clinically meaningful levels of depression and anxiety.

preterm birth & parental depression and anxiety

Preterm Birth and Parental Depression & Anxiety

The birth of a preterm infant can cause significant psychological distress for parents and families. In particular it has been consistently reported that the birth and hospitalisation of an unwell baby is associated with high levels of distress and depressive symptoms in the mother of the infant. Most research in this area has focused on the mother of preterm infants but research groups are now trying to evaluate the emotional affect preterm birth also has on fathers.

Research suggests that 10% of mothers of infants with very low birth weight (VLBW; infants born <1500 g) report severe symptoms of psychological distress in the neonatal period which is five-fold the rate of term mothers, and almost one-third of mothers of VLBW infants have clinically meaningful levels of depression and anxiety.

Other studies have reported greater stress on families when preterm children are at school-age (e.g. less parenting competence, more difficulty in parental attachment, greater likelihood of not having additional children, financial burden, limits on family social life, high levels of adverse family outcomes (stress and dysfunction), and difficulty maintaining employment). Some have reported that married mothers of VLBW infants are more than twice as likely to become divorced/separated than married mothers without a VLBW infant in the first two years following delivery. Although reports of such outcomes vary they are somewhat dependent on the degree of prematurity and the level of infant wellness.

(Singer et al., 2007; Singer et al., 1999) (Swaminathan, Alexander, & Boulet, 2006) (Singer, Davillier, Bruening, Hawkins, & Yamashita, 1996) (Halbreich, 2005).

Depression during pregnancy and the postnatal period

This information is not intended as a substitute for professional medical advice, diagnosis or treatment.

The childbearing years, particularly the first few weeks after childbirth, are the peak period for onset of depression in women and 15–20% of women are affected. Disorders vary with respect to symptoms, timing of onset, causes, risk factors, severity and duration. They also vary in the need for professional assessment, and in the type of treatment.

Types of depression in pregnancy and the postnatal period

Distinguishing between the ‘baby blues’, antenatal and postnatal depression. Short episodes of tiredness, nausea, aches and pains, irritability, sleep disturbance, and loss of interest in sex are relatively common as part of the normal adjustment process in the perinatal period and will not require treatment.

The ‘baby blues’

The term ‘baby blues’ refers to a brief episode of mood swings, tearfulness, anxiety and difficulty in sleeping that is very common in the first week after the birth of a baby. It requires no special treatment, unless the symptoms are severe.

Antenatal depression

Antenatal depression means depression that starts during pregnancy. Between 10‐15% of pregnant women experience mood swings during pregnancy that last more than two weeks at a time and interfere with normal day‐to‐day functioning. Medical assessment is necessary in such circumstances.

Postnatal depression (PND)

PND describes the more severe or prolonged symptoms of depression (clinical depression) that last more than a week or two and interfere with the ability to function with normal routines on a daily basis, including caring for a baby. Around one in seven women experience PND and for around 40% of these women the symptoms begin in pregnancy.

Different types of PND:

Why can be helpful to know that there are different types of PND?

Not only can the symptoms vary between different types of depression, but they tend to respond best to different treatments.

Two main types are outlined below: Depression during pregnancy and the postnatal period

Melancholic depression

Melancholic depression is relatively uncommon and affects only 1‐ 2% of adults. This is usually a more severe type of depression than the other type (non‐melancholic depression) and has a more distinct genetic and biological basis.

Someone who is pre‐disposed to melancholic depression might have an episode of depression triggered by a stressful life‐event (e.g. a death in the family) but this is not usually the primary cause of their depression.

Non‐melancholic depression

Non‐melancholic depression is the most common form of PND and is linked more to psychosocial risk factors (e.g. coping styles, relationships, and life events) than to genetic and biological causes.

Symptoms of PND:

There can be differences in the nature, severity and duration of the symptoms of depression seen in women who are pregnant or have recently given birth.

Professional help is generally required to diagnose the type of depression and decide the best approach to treatment.

Common symptoms of PND include:

  • Loss of enjoyment in usual pursuits
  • Loss of self‐esteem and confidence
  • Loss of appetite and weight, or weight gain
  • Difficulty with sleep (irrespective of the baby’s routine)
  • A sense of hopelessness and of being a failure
  • A wish not to be alive
  • Frank suicidal thoughts or ideas
  • Panic attacks
  • Loss of libido
  • Fears for the baby’s or partners’ safety or wellbeing.

Note: It is very important that any talk of suicide is taken seriously and treatment from a mental health professional or other appropriate person be sought immediately.

Postnatal (puerperal) psychosis

This is an uncommon disorder that occurs in 1–2 individuals per 1,000 women. It has a sudden onset with severe symptoms – usually within two to three weeks of childbirth. Symptoms can also begin during pregnancy, especially where there has been a prior episode of psychosis or bipolar disorder. This illness requires urgent medical assessment and treatment.

The symptoms of postnatal psychosis can be severe and include the following features in an individual:

  • confused thinking
  • they may start to imagine things
  • restlessness, sometimes agitated behaviour, or strange movements
  • fearful and worrying (often about the baby)
  • mood swings, sometimes with inappropriate emotions
  • elevated mood and heightened energy levels to an extreme degree, leading to manic patterns of behaviour
  • inability to sleep
  • their behaviour may appear out of touch with reality (‘psychotic’), suspicious, or inappropriate.

Note: Medical assessment is necessary if any of these symptoms are present.

Causes of depression during pregnancy and the postnatal period

There are a variety of causes or ‘triggers’ that can lead to the onset of clinical depression. Melancholic depression, puerperal psychosis and bipolar disorder are all known to be linked to biological (genetic or biochemical) causes.

Non‐melancholic depression is usually associated with psychosocial stress – psychological (linked with behaviour patterns, thought processes, personality and coping styles), social (linked with key relationships), and/or environmental (living conditions and life events).

Risk factors

Certain risk factors and ‘triggers’ have been identified, including:

  • a previous history of depression, bipolar disorder, or psychosis
  • psychosocial influences: e.g. stressful life events
  • insufficient family or social supports
  • a history of physical, sexual or emotional abuse
  • pregnancy loss
  • childbirth‐related distress
  • a baby that is difficult to settle, restless or unwell
  • personality types – certain personality styles may increase the possibility of depression, for example the ‘anxious worrier’, ‘socially avoidant’, ‘perfectionistic’ or ‘self‐critical’ styles. 

Finding help

Various health professionals are qualified to assist you to get help including:

  • Your doctor (GP, obstetrician, psychiatrist)
  • Midwife
  • Child and family health nurse
  • Psychologist
  • Social worker
  • Counsellor

Treatments

The symptoms of depression or anxiety that occur amongst childbearing women are similar to those that occur at other times of life, however the choices for treatment may differ during pregnancy or when a woman is breastfeeding. Treatment options include counselling, psychological therapies and medications.

It is important to treat depression and anxiety as early as possible because these conditions not only cause distress for the mother but also influence her ability to cope with the infant, and their developing relationship. Partners and young children can also become stressed when a parent is anxious or depressed.

Types of treatment will vary with the nature and severity of the symptoms and the type of depression experienced. Wherever possible, doctors try to avoid the use of medication that might affect the developing foetus or the breastfeeding infant. However, in certain cases, the severity of symptoms sometimes makes it necessary for medication to be used as part of the treatment. A consultation with your GP or psychiatrist will assist you to get help about management of symptoms.

Psychological or counselling treatments

Stressful life events, relationship difficulties or personality patterns can contribute to the difficulties of coping with a newborn baby. Psychological therapies and counselling are particularly helpful for managing non‐melancholic depression. In many cases, the simplest treatments are those that are supportive and educational and which aim to give the woman and her partner some understanding and acceptance of the causes for the depression or anxiety disorder and information about ways of coping. Your doctor will be able to advise where you can access a psychologist or counsellor.

Medication

Always discuss medication issues with your doctor before taking any medication whilst pregnant or breastfeeding. There are potential risks associated with exposure of the foetus or breastfed infant to medications so the decision to use medication needs to be weighed carefully in terms of benefits versus risks. If you are taking prescribed medication and plan to become pregnant, discuss your plans with your doctor before discontinuing your medication to ensure that you do not experience adverse withdrawal effects or a relapse of the condition being treated.

Antidepressants

Current research shows that some medications appear to be relatively safe when used in pregnancy and do not appear to cause congenital abnormalities. These are the SSRIs (selective serotonin re‐uptake inhibitors) and Tricyclic antidepressants. A recent drug company alert on Aropax (an SSRI) suggests that it may be associated with heart defects and thus should not be taken in pregnancy. Your doctor will know which the safest medications for use at this time are.

In breastfeeding

In breastfeeding, less than 5% and as little as 1% of the drug passes into the breast milk, which means that exposure of the baby to the drugs is minimal. Some babies show withdrawal effects from SSRIs and may need medical supervision for a short time.

Key points to remember

  • The childbearing years, particularly the first few weeks after childbirth, are the peak period for onset of depression in women
  • Depression can begin during pregnancy
  • Excessive fatigue can contribute to low mood, adequate rest can help
  • Around 13% of women will suffer postnatal depression
  • Anxiety and depression often go hand‐in‐hand
  • Symptoms of anxiety and depression should be treated as early as possible
  • Treatment options include counselling or medication
  • Doctors, child and family health nurses, midwives, psychologists, counsellors, social workers and others can advise you about getting help

Additional Information

Information from:

Black Dog Institute
Hospital Road, Prince of Wales Hospital, Randwick NSW 2031
www.blackdoginstitute.org.au

Related articles

 


Technical Reference List

Black Dog Institute

Halbreich, U. (2005). The association between pregnancy processes, preterm delivery, low birth weight, and postpartum depressions--the need for interdisciplinary integration. Am J Obstet Gynecol, 193(4), 1312-1322.
Singer, L. T., Fulton, S., Kirchner, H. L., Eisengart, S., Lewis, B., Short, E., et al. (2007). Parenting very low birth weight children at school age: maternal stress and coping. J Pediatr, 151(5), 463-469.
Singer, L. T., Salvator, A., Guo, S., Collin, M., Lilien, L., & Baley, J. (1999). Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. Jama, 281(9), 799-805.
Swaminathan, S., Alexander, G. R., & Boulet, S. (2006). Delivering a very low birth weight infant and the subsequent risk of divorce or separation. Maternal and Child Health Journal, 10(6), 473-479.

 

 



AlbertEinstein_iconOne of the greatest minds in history, Albert Einstein was born preterm.

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Preemie, Premmie, or Prem?

Most babies spend between 38 and 42 weeks in their mother’s uterus. So, technically a preterm birth, preemie, premmie, or prem, is an infant who is born less than 37 completed gestational weeks. 


Read More: Defining Preterm birth


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