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POSTPARTUM WOMAN
AND HER BABY
Sarah Gopman, MD
Associate Professor
Dept. of Family and Community Medicine
University of New Mexico
July 1, 2015
Learning/Practice Objectives
• Postpartum depression
• 10-20% of women affected
• Greatest risk is first 12 weeks after delivery, but
risk persists for one year
• Symptoms last more than 14 days
What are postpartum depression
symptoms?
• Tearfulness, sad or flat affect, irritability, mood instability
• Feeling inadequate, guilty, overwhelmed
• Sleep and appetite disturbance
• Intense worries or obsessive thoughts re. harm to the
baby
• Difficulty concentrating or making decisions
• Lack of interest in the baby, family or activities
• Poor bonding
• Thoughts of death or suicide
• Somatic symptoms: HA, CP, palpitations, numbness,
hyperventilation
How is postpartum psychosis
characterized?
• 1-2 in 1000 women affected
• Agitation and anger
• Anxiety/Paranoia
• Insomnia/Delirium/Confusion
• Mania (hyperactivity, elated mood)
• Suicidal or homicidal thoughts
• Auditory hallucinations (about the baby, of a religious
nature)
• Visual hallucinations (seeing or feeling “a presence” or
“darkness”)
• Delusions and commands to harm the infant (not just an
obsessive thought)
EMERGENCY: PSYCHIATRIC HOSPITALIZATION NECESSARY
What is the risk of suicide in the
postpartum period?
amamasblog.com
How do postpartum patients with perineal
laceration complications present?
5/28 09:15 18.0 2330 MCH consulted, feed freq’ly, f/u for wt
(dir=0.4)
6/1 15:45 17.8 2410 F/u 4-7d
(dir=0.4)
6/8 09:30 19.7 2330 Wt loss noted, MCH consulted w/ plan to
(dir=0.6) admit, PCP rec = no admit, supplement
w/ formula, G6PD, retic, repeat coombs.
6/9 15:15 16.2 2380 On-call resident leaves vm for mom to go
(dir=0.5) to Peds ED. Email communication b/w
mom and PCP that Peds ED not needed.
6/10 2450 Got 30cc formula after each breast feed.
Preer GL, Philipp BL. Understanding and managing breast milk jaundice. Arch Dis Child Fetal Neonatal Ed (2010). doi:10.1136/adc.2010.184416
References
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analysis. Pediatrics. 2010 May;125(5):e1048-56.
• Ballard J, Chantry, C, Howard C. Academy of Breastfeeding Medicine. Protocol #11: Guidelines for
the evaluation and management of neonatal ankyloglossia and its complications in the
breastfeeding dyad.
• Keister D, Roberts K, Werner S. Strategies for Breastfeeding Success. American Family Physician.
2008;78(2):225-232, 233-234.
• Baker L, Oswalt K. Screening for Postpartum Depression in a Rural Community. Community Mental
Health Journal. 2007.
• Sarsam S, Elliott J, Lam G. Management of Wound Complications From Cesarean Section.
Obstetrical and Gynecological Survey. 2005. Vol. 60, No. 7. 462-473.
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• Kendall-Tackett K, Hale T. The Use of Antidepressants in Pregnant and Breastfeeding Women: A
Review of Recent Studies. Journal of Human Lactation OnlineFirst. August3, 2009.
• Dennis C-L, Hodnett E. Psychosocial and psychological interventions for treating postpartum
depression. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006116.
References, continued
• Brand S, Brennan P. Impact of Antenatal and postpartum Maternal Mental Illness: How are
the Children? Clinical Obstetrics and Gynecology. 2009. Vol. 52, No. 3, 441-455.
• Beck C, Gable R. Comparative Analysis of the Performance of the Postpartum Depression
Screening Scale With Two Other Depression Instruments. Nursing Research. Vol. 50(4).
July/August. 2001. 242-250.
• ACOG Practice Bulletin. Use of Psychiatric Medications During Pregnancy and Lactation.
No. 92, April 2008.
• De Scalea T, Wisner K. Antidepressant Medication use During Breastfeeding. Clinical
Obstetrics and Gynecology. Vol. 52, No. 3, 483-497.
• Dimidjian S, Goodman S. Nonpharmacologic Intervention and Prevention Strategies for
Depression During Pregnancy and the Postpartum. Clinical Obstetrics and Gynecology. Vol.
52, No. 3, 498-515.
• Spencer J. Management of Mastitis in Breastfeeding Women. American Family Physician.
Vo. 78, No. 6. September 15, 2008.
• Chen K, Ramin S, Barss V. Postpartum endometritis. UpToDate. January 2011.
• Dresang L, Fontaine P, Leeman L, King V. Venous Thromboembolism During Pregnancy.
American Family Physician. Vol. 77, No. 12. June 15, 2008.
• Diaz M, Le H-N, Cooper B, Munoz R. Interpersonal Factors and Perinatal Depressive
Symptomatology in a Low-Income Latina Sample. Cultural Diversity and Ethnic Minority
Psychology. 2007. Vol. 13, No. 4, 328-336.
• Payne J. Antidepressant Use in the Postpartum Period: Practical Considerations. American
Journal of Psychiatry. 164:9. 1329-1332. September 2007.
References, continued
• Yonkers K, Wisner K, et al. The management of depression during pregnancy: a report from
the American Psychiatric Association and the American College of Obstetricians and
Gynecologists. General Hospital Psychiatry. 31 (2009): 403-413.
• Payne J, Meltzer-Brody S. Antidepressant use during pregnancy: current controversies and
treatment strategies. Clinical Obstetrics and Gynecology. Vol. 53, No. 3. 469-482.
• ACOG Practice Bulletin No. 92, April 2008. Use of Psychiatric Medications During
Pregnancy and Lactation.
• Gjerdingen D., Yawn B. Postpartum depression screening: importance, methods, barriers,
and recommendations for practice. Journal of the American Board of Family Medicine. May-
June 2007. Vol. 20, No. 3.
• Preer GL, Philipp BL. Understanding and managing breast milk jaundice. Arch Dis
Child Fetal Neonatal Ed (2010). doi:10.1136/adc.2010.184416