Sensitive Midwifery - Issue 43 - July2019

Pregnancy When is it CMD and when not? CMD Not CMD Depression Symptoms need to be present for at least two weeks and negatively affect functioning Symptoms must be present for several months; functioning also affected Presents in the first few days after birth; linked to hormonal change with sudden mood swings: crying for no apparent reason, and feeling overwhelmed, inadequate, lonely or sad; usually resolves with compassionate support Occurs in 0.02% of births; is a severe psychiatric disorder; can develop rapidly; the mother is out of touch with reality; may experience delusions and hallucinations; urgent same-day referral to specialist mental health care is needed Anxiety disorders Baby blues Postnatal psychosis Outcomes of pregnancy CMDs CMDs can put the pregnant mother at greater risk for preterm delivery and a low-birth-weight baby, substance and alcohol abuse, and suicide. She is more likely to experience domestic violence and is less able to generate income. Untreated, CMDs may negatively impact the developing baby, physically, cognitively, psychologically and socially. If a mother receives appropriate care and if there are additional caregivers who are able to provide nurturing care, these impacts may be avoided. How to recognise CMDs A pregnant woman suffering from CMDs may present as a ‘difficult’ client, be more likely to miss appointments, or not adhere to medication or treatment protocols. She could be withdrawn, aggressive or experience a range of different physical complaints such as vague aches and pains. While changes in sleep, appetite or tiredness are common symptoms during pregnancy, they may also be indications of mental distress. A woman’s body language and behaviour can often show that she is sad or worried, so take note if she cares for her appearance and if she makes eye contact. After birth, the interaction between a mother and baby can provide clues as to her mental state. A distressed mother could show hostility towards her child or describe the baby as ‘fussy’ or ‘difficult’. She may not play or communicate with the infant. Breastfeeding could be difficult, particularly if the mother has low self-esteem or is worrying excessively. Detection of CMDs Screening with a questionnaire can help identify symptoms. Further assessment from a qualified professional may be needed for a diagnosis. Screening should only be undertaken if there are referral options in place. SADAG (South African Depression and Anxiety Group) have a 24-hour helpline on 0800 12 13 14, as does Lifeline on 0861 322 322. The PMHP developed a brief mental health screen that is validated for use in the South African setting (see panel on next page for details). Continued on page 8 7