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Perinatal Mental Health: Trauma Informed Interventions
Gloria Castro Larrazábal, Psy.D. Infant-Parent Program
Division of Infant, Child and Adolescent Psychiatry Zuckerberg San Francisco General Hospital and Trauma
Center
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Adapted from Knitzer, Jane, and Ferry, Deborah F. (2009): Poverty and Infant and Toddler Development: Facing the Complex Challenges. In C.H. Zeanah, Jr. (Ed.), Handbook of Infant Mental
Health (3rd ed., pp.133-152). New York: Guilford Press.
Child and Caregiver
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Gloria Castro, Psy.D 2015
Sense of Self
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STRESS-TRAUMA CONTINUUM
The Stresses of Early Childhood: domestic violence, substance abuse, mental health, etc.
The Normal Stress Response: levels of cortisol Changes in Behavior and Functioning after Trauma:
isolated traumatic events versuss complex trauma Failures of Protection: parents as a source of trauma.
Perceived danger versus real danger
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Child’s Trauma-Based Responses
Experience helplessness in the face of danger
Traumatic expectations about relationships and about their future wellbeing (Pynoos, 1997)
Interpret the world based on this traumatic experiences
Becomes rigidly avoidant of experiences and feelings associated with the trauma
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Major Conceptual Frameworks of Perinatal Mental Health
Psychoanalytic approach Attachment theory Stress and trauma work Developmental Psychopathology Lieberman & Van Horn, 2008
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Vulnerabilities in Infants of Depressed Mothers
Attachment Emotional and Behavioral Functioning and
Regulation Neuroendocrine and Psychophysiological
Functioning Cognitive-Intellectual Functioning
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Transition to Motherhood
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TRANSITION TO MOTHERHOOD: THE DEVELOPMENT OF MATERNAL IDENTITY
Fetus: develops and matures within his mother according to a gradually unfolding plan.
Mother: is affected by experiences of the
pregnancy within her body and by her feelings about those experiences.
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CONCEPTION Biological Conception: It is important to
explore: the timing, the partner, whether planned or unplanned, whether wanted or unwanted in order to set the stage for acceptance of the pregnancy. This is true for fathers as well as mothers.
Psychological Conception: Although there is the actual conceived baby, there is also a conceived of, imagined or fantasized baby.
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Physical Changes First Trimester: gaining some weight in her
abdomen and breasts, morning sickness, and mood changes. She becomes aware that her body is changing and that there is a baby growing inside of her.
Second Trimester: while morning sickness and mood changes usually decrease, her body begins visibly to change in shape.
Third Trimester: quickening, the sensation of fetal movement that appears in the fourth and fifth months, along with ultrasound pictures of the baby, makes the experience of the baby more real.
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Redefining Self and Other
With the birth of the baby, the mother passes into a new and unique psychic organization, the “motherhood constellation” that involves openness for a close connection with unconscious representations and processes, with feelings and experiences that at other moment in life are often ignored (Stern, 1995).
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Reprocessing Old Conflicts The Life-Growth Theme: Can I maintain the life and
growth of the baby?
The Primary Relatedness Theme: Can I emotionally engage with the baby in an authentic manner, and assure the baby’s psychic development?
The Supporting Matrix: Can I create and maintain the necessary support system to fulfill these functions?
The Identity Reorganization Theme: Am I able to transform my self-identity to permit and facilitate these functions?
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Development
© Gloria Castro, Psy.D 2015
Development and Interventions
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Labor and Delivery
Therapeutic Support during Labor and Delivery
Constructing a Coherent Narrative Postnatal Phase
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Mothers Fathers Worry about bringing
the baby successfully to term
The health of the baby Surviving the birth and
delivery Able to provide milk
and nurturance to her infant
Being a “good enough mother”
How he will be seen in the world
Whether he has fathered a healthy baby
Whether he will be able to provide for the mother and the infant
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Predictors of Postpartum Depression in Women
Prenatal depression Prenatal anxiety Life stress Lack of social support History of previous depression Low socio-economic status
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Predictors of Postpartum Depression in Men
Personal history of depression
Maternal postpartum The state of the marital relationship
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Transition to Fatherhood
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Intra-psychic, Relational, and Social aspects of Transition to Fatherhood
Re-elaboration of self-image
Development of a triadic relationship: Mother-Father-Infant
Influence of social environment
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Prenatal Period
Fathers express wanting to play an active role in pregnancy: attend medical appointments, participate in childbirth, be part of prenatal classes, etc.
They report ambivalent feelings during early
stages of pregnancy
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Paternal Experiences during the First Trimester
Reflect on the type of parent they want to be. It is a multidimensional role: from being a playmate and couch to provide emotional support
Very preoccupied with the fetus and the quality of bonding with the unborn child
Lack of support for fathers during this period
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Areas of Difficulty for Men
Feelings of unreality due to lack of tangible evidence of the existence of the unborn child
Perceived disequilibrium in the relationship with their partner due to different needs
Formation of a parental identity which requires a core identity shift from the role of a partner to the role of a parent
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Paternal Experiences during the First Trimester
Reflect on the type of parent they want to be. It is a multidimensional role: from being a playmate and couch to provide emotional support
Very preoccupied with the fetus and the quality of bonding with the unborn child
Lack of support for fathers during this period
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Ways to Support Fathers in the First Trimester
Being present in the ultrasound scans of the baby
Viewing fetal movement and encourage him to reflect on his experience
Fatherhood discussion groups
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Father’s Experience during Labor and Delivery
Feels helpless, useless, and anxious Feels out of place Overwhelmed with the experience Uncertain about how to support her partner
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Fathers
Fathers who expressed high levels of fulfillment and delight with their experience of the delivery process subsequently reported few depressive symptoms
Fathers with a vaginally born infant described
their infants with more positive attributes than fathers whose babies had been delivered by cesarean-section
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Fathers’ Experiences during the Postnatal Period
Ambivalence between their former lives and the current life situation
Not having enough time to establish an intimate contact with their babies
Deterioration of lifestyle and sexual relationship with his partner
Restricted sense of freedom: not enough time to enjoy other activities