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Postpartum Depression: Diagnosis and Treatment
Postpartum Depression: Diagnosis and Treatment

Section 7
Anxiety in Giving Birth

CEU Question 7 | CEU Test | Table of Contents | Depression
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

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In the last section, we discussed unplanned pregnancy.  This included when partners disagree, the acceptance technique and termination.

In this section, we will discuss undiagnosed depression and when depression leads to addiction.  Do you have a client who is pregnant and using addiction to battle postpartum depression?  How do your experiences compare with those presented in this section?

♦ Undiagnosed Depression
First, let’s discuss undiagnosed depression.  Have you found, as I have, that women who are anxious, depressed, and not feeling confident about themselves also tend to lack confidence in the process of childbirth? 

Because these women are fearful and think of themselves as failures in general, they are terrified that they will also fail in the delivery of their child.  Their anxiety may actually lead to the very consequence they are afraid of.  I have found that women who are unable to relax and who do not have a positive image of how the delivery process will proceed are also those most likely to have prolonged and difficult labors.

As a public health nurse, Jocelyn had counseled hundreds of pregnant women though emotional problems and difficult deliveries.  When Jocelyn and her husband decided to have a baby and she became pregnant, Jocelyn quite naturally began to attend the clinic where she worked.  Because she knew all the obstetricians, she felt comfortable confiding in them, and she wanted to practice what she preached to her patients by being open and honest about how and what she was feeling.

Over the course of her pregnancy, however, Jocelyn found herself becoming more and more withdrawn until she stopped going to her doctor and attending prenatal classes altogether.  Luckily, because Jocelyn’s obstetrician knew her so well, he realized that something was very wrong.  Eventually, Jocelyn admitted that she’d stopped attending the classes because she knew she was experiencing symptoms of depression and was embarrassed and ashamed to be "one of them."

In other words, even to a professional such as Jocelyn, who worked every day of her life with women experiencing postnatal depression, there were "right" and "wrong" groups of patients.  Those in the "right" group experienced no postnatal problems, sailed through labor and delivery, and were, in her eyes, model patients.  Unfortunately, Jocelyn herself was not what she considered a model patient.  She experienced mood swings throughout her pregnancy and was now frightened of the delivery process.

In the end, Jocelyn had a cesarean section.  After repetitive negative thoughts such as, "What if my uterus doesn’t contract?  What if my cervix doesn’t dilate?" Jocelyn had finally convinced herself that it actually would not be safe even to attempt a vaginal delivery.

♦ When Depression Leads to Addiction
Undiagnosed depression can also lead to more serious physical complications for the baby as well as the mother, especially when women try to self-medicate with alcohol or drugs. 

When I met Nina she was twenty-nine weeks pregnant and had been referred to me by her family physician who sensed there was something wrong that he just couldn’t put his finger on.  Nina and her husband Dave belonged to a young social set among whom the recreational use of crystal methamphetamine, or crystal meth, was considered the amusement of choice for a Saturday night.

Nina was well-dressed, stylish, and elegant, but almost from the moment she sat down in my office she seemed uncomfortable and suspicious of me.  Nina asked, "Are you judging me?!" and I thought the question odd.  As it turned out, Nina had a good reason to ask it.  Her pregnancy had been unplanned, and although Dave was ecstatic, Nina herself was not. 

For one thing, she simply wasn’t happy about the changes taking place in her body.  Nina no longer looked good in her regular clothes, and she thought her maternity clothes were awful.  As Nina’s pregnancy advanced, things went from bad to worse.  She became increasingly depressed, and she thought constantly about crystal meth, which, she said, had always given her a tremendous sense of freedom.  Eventually, she began to use it to make herself feel better about her pregnancy.

One day, Dave, who had become suspicious regarding Nina’s behavior, arrived home early from work to find her in a state of almost total collapse.  Frightened and horrified, he rushed her to the doctor.  But even he couldn’t bring himself to confide the truth of what was going on and more or less left it up to their family physician to figure things out for himself.

Somewhat to my surprise, Nina continued to keep her weekly appointments with the counselor at our hospital who was helping her to overcome her addiction while I also began to help her treat her depression.  Nina and Dave realized that they had narrowly escaped a disaster and could no longer ignore her problem.  In the end, Nina gave birth to a healthy baby girl.

I have found that when depression overtakes women and their judgment is impaired, they don’t know how or where to ask for help, and so they do the only thing they know to alleviate the pain.  If they don’t know what’s wrong with them and their doctors don’t recognize it, they simply do what they can to escape the reality of depression in whatever way and for however long they can.  If the reporting of multiple physical symptoms is often an indication of underlying depression, and if depression can, in turn, lead to physical complications for mother and child, then it is also true that the symptoms of physical illness can both contribute to and complicate the treatment of depression.

Do you have a Jocelyn or a Nina?  How do you respond? 

In this section, we have discussed undiagnosed depression and when depression leads to addiction.

In the next section, we will discuss panic and depression.  This will include panic disorder; panic attacks and pregnancy; and panic vs. depression, which comes first?

Peer-Reviewed Journal Article References:
Brandão, T., Brites, R., Pires, M., Hipólito, J., & Nunes, O. (2019). Anxiety, depression, dyadic adjustment, and attachment to the fetus in pregnancy: Actor–partner interdependence mediation analysis. Journal of Family Psychology, 33(3), 294–303.

Cao, H., Zhou, N., Leerkes, E. M., & Su, J. (2021). The etiology of maternal postpartum depressive symptoms: Childhood emotional maltreatment, couple relationship satisfaction, and genes. Journal of Family Psychology, 35(1), 44–56.

Istvan, J. (1986). Stress, anxiety, and birth outcomes: A critical review of the evidence. Psychological Bulletin, 100(3), 331–348.

Tomfohr-Madsen, L., Cameron, E. E., Dunkel Schetter, C., Campbell, T., O'Beirne, M., Letourneau, N., & Giesbrecht, G. F. (2019). Pregnancy anxiety and preterm birth: The moderating role of sleep. Health Psychology, 38(11), 1025–1035. 

Whisman, M. A., Davila, J., & Goodman, S. H. (2011). Relationship adjustment, depression, and anxiety during pregnancy and the postpartum period. Journal of Family Psychology, 25(3), 375–383.

Online Continuing Education QUESTION 7
How can anxiety lead to a difficult labor experience? To select and enter your answer go to CEU Test.

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