What is a Perinatal Mood Disorder?

Recently, the media has reported several stories relating to perinatal mood disorders (more commonly considered to be post-partum depression, but are not limited to depression). Guidelines around who should get screened and when have taken center stage. Despite this attention, many don’t realize what perinatal mood disorders are or whether or not they are at risk for one.

Quite simply, a perinatal mood disorder is a mental health concern that occurs either during pregnancy or post-partum. This can include depression, anxiety, obsessive thoughts, paranoid thinking, and thoughts to harm yourself or your baby. While these concerns exist prior to pregnancy for individuals, they can be exacerbated during pregnancy and after for several environmental reasons: changes in hormones and lack of sleep are two prevalent factors. Of course, not everyone who has a baby experiences changes in mood, and certainly, some people seem to be more resilient during this transition.

Common symptoms of a perinatal mood disorder may include:
*Changes in sleep (not being able to sleep at all, even when the baby is or
oversleeping)
*Irritability
*Fears of something happening to the baby (being dropped, not
breathing, etc)
*Concerns (despite weight gain) that baby isn’t eating enough
*Uncontrollable crying
*Disinterest or lack of connection to the baby
*A feeling of not being yourself

Nearly 1 in 8 women (and 1 in 10 men) experience a perinatal mood disorder. Treatment is simple and can range from therapy, medication, or both. However, without treatment, there can be long-term consequences that are dangerous for both mother and baby, as studies of depressed mothers have shown difficulties in their children as they age. There is a simple screening that you can opt to take to see if you might be experiencing a perinatal mood disorder and it can be found here. People who are are risk for developing a perinatal mood disorder include those that have experienced depression or anxiety during pregnancy; those that have a family member who had a perinatal mood disorder; those with a history (or family history) of depression or anxiety; those that have suffered a pregnancy loss; those that conceived through infertility; those with a baby that was in the NICU; teenage mothers; those that are having financial/housing/medical concerns; and those that do not have a social support system or a limited one. Certainly, this is not an exhaustive list, but is inclusive of many “red flags”.

 

If you are concerned about you or someone you know that might be having difficultly adjusting to life postpartum, you can contact your OB-GYN/Midwife/Primary Care Physician about a mental health referral. It is important that the clinician you meet with has experience and training in treating perinatal mood disorders as it is not something that most graduate programs cover.

By Julie Bindeman,  Psy-D

http://www.greaterwashingtontherapy.com/

Best Exercises for Your Pregnancy

Congratulations on your pregnancy! Now you can sit back, relax and put your feet up for the next nine months, right? Not so fast! Attitudes and beliefs about prenatal exercise have drastically changed over the past twenty years. No longer is pregnancy viewed as a time to sit, watch TV and each chocolate. These days, moms can actually maintain and improve their fitness levels while pregnant. And exercise provides many numerous benefits such as a boost in your mood and energy levels, helps you sleep better, helps prevent excess weight gain and increases your stamina and muscle strength. You cannot lose!

Regular exercise during your pregnancy can improve not only your heart health and boost your energy, but improve your overall health. Maintaining a healthy body and healthy weight gain can help reduce common pregnancy complaints and discomforts like lower back pain, fatigue and constipation and can even help with shortening your time during labor by strengthening your endurance.

First, consult your health care provider if it is okay to exercise. If you have been participating in a regular exercise regimen and are having a healthy pregnancy, there should not be a problem continuing with your regimen in moderation. You may have to modify your exercise according to your trimester of pregnancy.

If you have not participated in an exercise regimen three times a week before getting pregnant, do not jump into a new, strenuous activity. Start out with a low-intensity activity and gradually move to a higher activity level.

The best type of exercise during pregnancy:
• Increases your heart rate steadily and improves your heart circulation
• keeps you flexible and limber
• manages your weight gain by burning calories
• prepares your muscles for labor and birth
• won’t cause you to push your body too hard

Research shows that healthy pregnant women who exercise during their pregnancy may have less risk of preterm labor and birth and a shorter labor process, are less likely to need pain relief, and recover from childbirth faster.

Regular, moderate exercise not only gives you a healthier pregnancy, it may give your baby a healthier start. Research shows that when pregnant women exercise, their developing babies have a much lower heart rate. Babies of active moms may also have a healthier birth weight. Experts recommend that you exercise for 30 minutes a day, on most days. Most exercises are safe to perform during pregnancy, as long as you exercise with caution and do not overdo it.

Your pregnancy exercise regimen should strengthen and condition your muscles. Always begin by warming up for five minutes and stretching for five minutes. Following your choice of exercise, finish your regimen with five to ten minutes of gradually slower exercise that ends with gentle stretching.

The safest and most productive activities to perform during your pregnancy are brisk walking, swimming, indoor stationary cycling, prenatal yoga and low-impact aerobics (taught by a certified aerobics instructor). These activities carry little risk of injury, benefit your entire body, and can be continued until the birth of your baby. Other activities such as jogging can be done in moderation. You might want to choose exercises or activities that do not require great balance or coordination, especially later in your pregnancy.

Use common sense:
• Avoid exercising that involves lying on your stomach or flat on your back after the first trimester of pregnancy.
• Stay well hydrated and drink plenty of fluids before, during and after you exercise.
• Avoid overheating and humidity, especially during the first trimester when the fetus is undergoing its most important growth and development.
• Stop exercising if you feel fatigued, develop persistent pain or experience any vaginal bleeding; check with your healthcare provider if regular contractions occur more than 30 minutes after exercise (possibly a sign of pre-term labor).
• Avoid heavy weightlifting and any activities that require straining.
• Avoid exposure to extremes of air pressure, as in high altitude exercise (unless you’re accustomed to it) or scuba diving.
• Do not increase the intensity of your workout beyond pre-pregnancy intensity level
• Eat small, frequent meals throughout the day. Sedentary pregnant women need about 3,000 calories per day during the second and third trimesters; if you are physically active, your caloric needs will be higher to make up for the calories burned up during your exercise regimen.

Basic exercise guidelines:
• Wear loose-fitting, comfortable clothes, as well as a good support bra
• Choose shoes that are designed for the type of exercise you choose. Proper shoes are your best protection against injury
• Exercise on a flat, level surface to avoid injury
• Finish eating at least one hour before exercising
• Get up slowly and gradually to prevent dizziness
• Never exercise to the point of exhaustion. If you cannot talk normally while exercising, you are probably over exerting yourself, and you should slow down your activity.

Physical changes during your pregnancy will create extra demands on your body. Keeping in mind the changes listed below, remember you need to listen to your body and adjust your activities or exercise regimen as necessary.
• Your developing baby and other internal changes require more oxygen and energy.
• Hormones (relaxin) produced during pregnancy cause the ligaments that support your joints to stretch, increasing the risk of injury.
• The extra weight and the uneven distribution of your weight alters your center of gravity. The extra weight also puts stress on joints and muscles in the lower back and pelvic area, and makes it easier for you to lose your balance

If you have any medical condition, such as asthma, heart disease, hypertension or diabetes, exercise may not be advisable. Again, consult with your health care provider before beginning any exercise regimen.

Exercise may also be harmful if you have a pregnancy-related condition such as:
• vaginal Bleeding or spotting
• Low placenta (low-lying or placenta previa)
• Threatened or history of recurrent miscarriage
• Previous premature births or history of early labor
• Weak cervix

Talk with your health care provider before beginning any exercise program. Your health care provider can also suggest personal exercise guidelines, based on your medical history.

Stop exercising and consult your healthcare provider if you:
• Feel pain
• Have abdominal, chest, or pelvic pain
• Notice an absence of fetal movement
• Feel faint, dizzy, nauseous, or light-headed
• Feel cold or clammy
• Have vaginal bleeding
• Have a sudden gush of fluid from the vagina or a trickle of fluid that leaks steadily (when your bag of “water” breaks, also called rupture of the amniotic membrane)
• Notice an irregular or rapid heartbeat
• Have sudden swelling in your ankles, hands, face, or experience calf pain
• Have increased shortness of breath
• Have persistent contractions that continue after rest
• Have difficulty walking

Regular exercise will keep you and your baby healthy while staying fit, and enjoying your pregnancy!

Written by: Angel J. Miller, MSN, CNM, certified nurse-midwife, Midwifery Service Director, Washington, D.C. Area and co-author: Nine Months In ~ Nine Months Out.
References
Miller, Angel, Kelly, Stacia, Kirkbride, Shelia, Matthews, Corry. Nine Months In ~ Nine Months Out. Sterling, Va. Ironcutter Media, 2011.
http://www.webmd.com/baby/exercise-during-pregnancy
http://kidshealth.org/parent/index.jsp?tracking=P_Home
http://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/in-depth/pregnancy-and-exercise/art-20046896

Preconception Counselling

Becoming a parent is a major commitment in life. It can be met with challenges, rewards and informed choices. Before you conceive, be sure to incorporate a healthy life-style to ensure optimal health for mom and baby. Receiving preconceptional counseling and care can lay the ground work for a healthy lifestyle and healthy pregnancy. Good health before pregnancy can help you cope with the stress of pregnancy, labor and birth. Obtaining good health care before you conceive will help you throughout your pregnancy. It also provides you with the opportunity to find out your risks, treat any medical problems that may affect the outcome of your pregnancy and adopt or continue a healthy lifestyle.

If you are planning to conceive, schedule a preconceptional visit with your healthcare provider. Included in your visit is a comprehensive history of your health including: Family history and risk factors, your medical history, surgical history, medications that you are presently taking including vitamins, supplements, OTC (over-the-counter) meds; your diet and lifetstyle and any past pregnancies.

Your preconception visit is a time for you to ask questions. Do not hesitate to seek advice, discuss your concerns and your options. Your healthcare provider is there to provide information and guidance to help you make informed choices in your healthcare to help you obtain and maintain a healthy pregnancy.

Women who are planning to conceive should stop their form of birth control several months in advance. Even though methods vary in use, it may affect when your menses resumes and becomes regular. During this time you may also want to start taking a prenatal vitamin daily to ensure you are getting added vitamins and increased folic acid.

Your lifestyle includes diet, exercise, weight, substance use, living/working environment and infection history. Current immunizations are important to prevent any infections during your pregnancy that can harm you and your baby, even if you were vaccinated as a child (measles, mumps, rubella, polio, tetanus), you may not be immune now. If you are vaccinated prior to conceiving, you will be protected. The vaccine for mumps, measles and especially rubella should be given at least 3 months prior to conceiving. During this period of time, you should use a reliable method birth control.

Optimal health at any time during your lifetime involves a healthy diet and the proper amount of exercise. Ideally, you should be in good physical shape and follow a regular exercise regimen before your conceive. If you are not used to being active, you should start an exercise program gradually.

Tobacco, alcohol and recreational (illegal) drug use is addictive and can harm you and your baby that can last a lifetime or even result in death. They can have detrimental affects on the organ formation, causing damage. The misuse of prescription medication can also harm the fetus. For the sake of your own health and that of your baby, now is a good time to cut back on smoking and alcohol and quit all recreational drugs. It takes time and patience to quit a habit, especially if you have had that particular habit for a long time. Ask your healthcare provider to suggest ways to get through the withdrawal state or quitting and to refer you to support groups. Your decision to quit may be one of the hardest things you have ever done, but it will be one of the most worthwhile.

Does your work environment impose any hazards? If you are trying to conceive, it is a good idea to look closely at your work place and surroundings. Are you exposed to toxic substances, chemicals, or radiation? Discuss your level of exposure to specific substances with your employee health division, personnel office or union representative.

Exposure to lead or certain solvents, pesticides or other chemicals can reduce your partner’s fertility by killing or damaging sperm. Unlike women, who are born with a complete supply of eggs for their entire lifespan, men make new sperm on a daily basis for most of their lives. Unless the damage to a man’s reproductive system is very serious, he will probably be able to make healthy sperm against a short time span after his exposure to the harmful material stops.

Healthy lifestyle choices during pregnancy are essential. Your health care provider will likely discuss the importance of a healthy diet, regular physical activity and keeping stress under control. If you’re underweight or overweight, your health care provider may recommend addressing your weight before you conceive.

Questions to Consider…
• Do I or a member of my family have a disorder that could be inherited?
• Do I need to gain or lose weight to prepare for pregnancy?
• Should I make any changes in my lifestyle?
• Could any medications I am taking cause problems during my pregnancy?
• Can I continue my present exercise program?
• Does my work expose me to things that could be harmful during pregnancy?
• Do I need to be vaccinated for any infectious diseases before I try to conceive?

What about your partner’s lifestyle?
If possible, have your partner attend the preconception visit with you. Your partner’s health and lifestyle — including family medical history and risk factors for infections or birth defects — are important because they can affect you and your baby.

Delaying Umbilical Cord Clamping

Clamping and cutting of the umbilical cord should be delayed for three minutes after birth, particularly for pre-term infants, suggests a senior doctor, Dr. Andrew Weeks, in the British Medical Journal. 28/08/2007.
Early clamping and cutting of the umbilical cord is widely practiced as part of the management of labor, but recent studies suggest that it may be harmful to the baby. Dr Andrew Weeks, a senior lecturer in obstetrics at the University of Liverpool, looked at the evidence behind cord clamping. For the mother, trials show that early cord clamping has no ill effects, he writes. But what about the baby?

At birth, he says, the umbilical cord sends oxygen-rich blood to the lungs until breathing establishes. When a baby is born it must transfer from receiving oxygen from the placenta to receiving oxygen from its lungs. For this to happen, the baby’s lungs must first expand, and the burst of blood from the umbilical cord helps to get the newborn’s lungs to expand properly. So as long as the cord is unclamped, the average transfusion to the newborn is equivalent to 21 percent of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth. For babies born at term, the main effect of this large autotransfusion is to increase their iron status.

This may be lifesaving in areas where anemia is endemic. In the developed world, however, there have been concerns that it could increase the risk of abnormally high levels of red blood cells and bile pigments in the bloodstream often leading to jaundice. But trials has shown this is not the case.

Umbilical cord blood is a baby’s life blood until its birth. It contains stem cells, red blood cells, and more recently scientists have discovered that umbilical cord blood contains cancer-fighting T-cells.
For pre-term babies the beneficial effects of delayed clamping is greater, he says. Delayed clamping is consistently associated with reductions in anemia, bleeding in the brain, and the need for transfusion.
He proposes that in normal births, delaying cord clamping for three minutes with the baby on the mother’s abdomen should not be too difficult. The situation is a little more complex for babies born by caesarean section or for those who need support soon after birth. Nevertheless, it is these babies who may benefit most from a delay in cord clamping. For them, a policy of ‘wait a minute’ would be pragmatic, he says.

The World Health Organization’s (WHO) policy supports delayed cord clamping, stating:

“The optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless (approximately 3 minutes or more after birth).” 

They continue:
“Clamping the umbilical cord immediately (within the first 10 to 15 seconds after delivery) prevents the newborn from receiving adequate blood volume and consequently sufficient iron stores.
Immediate cord clamping has been shown to increase the incidence of iron deficiency and anemia during the first half of infancy, with lower birth weight. Waiting to clamp the umbilical cord allows a physiological transfer of placental blood to the infant which provides sufficient iron reserves for the first 6 to 8 months of life, preventing or delaying the development of iron deficiency …

For premature and low birth weight infants, immediate cord clamping can also increase the risk of intraventricular hemorrhage and late-onset sepsis.13 In addition, immediate cord clamping in these infants increases the need for blood transfusions for anemia and low blood pressure infants and infants born to iron-deficient mothers being at particular risk …

Numerous research studies and experts are also confirming that waiting to clamp the cord offers significant benefits. Among them:
• In the Journal of Cellular and Molecular Medicine, researchers say delayed cord clamping is “mankind’s first stem cell transfer and propose that it should be encouraged in normal births.”
• In a BMJ editorial, James Neilson, professor of obstetrics and gynecology, states that delayed clamping should be practiced.

Resources, Support:
“Early versus delayed umbilical cord clamping in preterm infants”. Rabe H, Reynolds GJ, Diaz-Rosello JL http://tinyurl.com/4w63wv8 (Cochrane Review)

ACOG Recommends Delayed Umbilical Cord Clamping for All Healthy Infants http://tinyurl.com/lopdtn8