Mode of Delivery Doesn't Affect Later Maternal Stress

Whether a woman gives birth by vaginally or by C-section, the mode of delivery makes no difference in stress levels six months later, but state of mind during pregnancy can be a contributing factor.

NEW YORK (Reuters Health) - Whether a woman gives birth by elective C-section or vaginal delivery may not affect her anxiety or stress levels afterward, suggests a new study that questions the idea of using C-sections just for the sake of a mother's mental well-being.

Looking at more than 55,000 women in Norway who gave birth between 1998 and 2008, researchers found the strongest determinant of a woman's postpartum emotional distress was her state of mind during pregnancy. Mode of delivery made no difference in the women's stress levels six months later.

"Often in the delivery ward the remark might be that this was a tough delivery...that in itself doesn't affect the mental health afterwards," said the study's lead author Dr. Samantha Adams, of the Akershus University Hospital Health Services Research Centre in Norway.

According to Adams and her colleagues, it's becoming more common for women to choose a C-section over traditional vaginal delivery as a means of improving their psychological well-being, even if there appears to be no medical benefit.

Their study assessed the mental health of participants in the Norwegian Mother and Child Cohort Study, using a self-administered test that each woman took 30 weeks into her pregnancy and six months after her child was born.

In both tests, each mother ranked her feelings on a scale between one and four, in response to questions such as whether she was feeling fearful, nervous or scared.

In the study group, 78 percent of women had a normal vaginal delivery, nine percent had vaginal birth with the help of instruments, eight percent had an emergency C-section and five percent elected to have a C-section. Just over 44 percent were first-time mothers.

As a group, women who chose to have a C-section had a slightly higher—that is, more distressed—median score on their mental well-being tests before and after delivery than other women.

However, after adjusting the findings for emotional distress levels during pregnancy and other possible confounding factors like a mother's age and any illnesses during pregnancy, the researchers found little connection between the type of delivery a woman had and her stress or anxiety level at six months postpartum.

That finding included women who needed an emergency C-section or traditional vaginal birth with the help of instruments, both situations that suggest stressful conditions during delivery itself.

In contrast, emotional distress during pregnancy was strongly linked to distress after birth. Women with the highest pregnancy distress levels were 14 times more likely than women with the lowest levels to be distressed at six months postpartum.

Previous research has already shown that maternal distress during pregnancy is a risk factor for distress afterwards, the researchers note in BJOG: An International Journal of Obstetrics and Gynecology.

They conclude, "Concern for maternal mental health after delivery should not influence clinical decision regarding mode of delivery."

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The Logic Behind the Toddler Temper Tantrum

Witnessing a child’s temper tantrum is painful for all, but knowing why it occurs can help parents and caregivers weather the storm.

Researchers at the University of Minnesota and the University of Connecticut have revealed a method to the madness when it comes to childhood temper tantrums. The new science behind the kicking, screaming and shouting involves the pattern and rhythm of the sounds that emerge from toddlers during such tantrums. The details of the analysis were recently published in the journal Emotion.

According to the researchers, once the pattern of vocalizations that emerge and fade during temper tantrums are understood, they can assist parents as well as teachers to provide more effective responses to such outbursts.

In addition, the rhythms of the tantrums can help clinicians discern the difference between tantrums considered to be a normal part of a childhood development, and those that warn of a possible disorder.

For their study, the researchers began by collect various tantrum sounds. Study co-author James A. Green of the University of Connecticut explained, “We developed a onesie that toddlers can wear that has a high-quality wireless microphone sewn into it.”

He said that parents could put the onesie on their child and simply press a go button to record several hours of the child’s activities via a recorder fed by the microphone. This allowed any ensuing tantrums that might occur during the time the child was wearing the apparatus to be recorded.

In all, the researchers collected a high quality audio recording of more than one hundred tantrums.

When the researchers analyzed the audio they had gathered, findings revealed that strongly distinct audio signatures were present among the different tantrum sounds.

By placing these sounds on a graph, Potegal and Green discovered that the different sounds emerged and faded in a specific pattern in which sounds such as screaming and shouting typically came together.

Regarding the patterns they found, Potegal stated that “screaming and yelling and kicking often go together,” while “throwing things and pulling and pushing things tend to go together.” He said that they also noted “combinations of crying, whining, falling to the floor and seeking comfort—and these also hang together.”

However, the study showed that while it has long been believed that temper tantrums simply begin in anger and end in sadness, that both emotions were actually intertwined.

He noted, “The impression that tantrums have two stages is incorrect. In fact, the anger and the sadness are more or less simultaneous.” The findings showed that vocalizations of sadness continued to underly the bouts of screaming and shouting. Understanding the rhythm of tantrums can provide parents with a sense of control and help them know when to begin intervention.

To attain the goal of ending the tantrum as quickly as possible, one must get the child beyond the peak of anger to the downswing where only sadness is left, at which point the child will seek comfort. However, because the fastest way to achieve this is to do nothing during the display of anger, this is often difficult for parents and caregivers alike.

Potegal pointed out that there is an “anger trap” that can easily be fallen into. He said that even asking simple questions can go a long way to prolonging a temper tantrum, as tantrums tend to have a flow of quickly building to a peak of anger.

Green noted, “You know, when children are at the peak of anger and they’re screaming and they’re kicking, probably asking questions might prolong that period of anger.” He went on to explain, “It’s difficult for them to process information. And to respond to a question that the parent is asking them may be just adding more information into the system than they can really
cope with.”

Getting toddlers through a temper tantrum is a trying experience to say the least. Many parents feel that they will never make it through this childhood stage due to feelings of restlessness, embarrassment and guilt.

By viewing these tantrums from a scientific perspective, maybe parents can gain some assurance, and renewed hope for getting past all the kicking, screaming, and crying. It’s worth a try to stand pat and do nothing when the next temper-related thunderstorm rolls. Being prepared can perhaps help parents and caregivers better weather the storm.

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Posted in: HEALTH

Could Acute Postpartum Blues Signal Bipolar Disorder?

Women treated for major depression shortly after giving birth are more likely to be diagnosed as bipolar later in life compared to those whose first psychiatric episode happened at any other time.

NEW YORK (Reuters Health) - Women treated for severe psychiatric conditions, including major depression, shortly after giving birth were more likely to be diagnosed as bipolar later in life compared to those whose first psychiatric episode happened at any other time, in a new study from Denmark.

Researchers said they didn't know if some postpartum depression or schizophrenia-like episodes were actually misdiagnosed bipolar disorder—or if more women with those initial diagnoses developed bipolar disorder over time.

"We're looking at severe psychiatric episodes," said study author Trine Munk-Olsen, from Aarhus University. She noted that while "postpartum blues" are relatively common, severe depression and other acute psychiatric episodes requiring inpatient or outpatient clinic care only occur in about one in 1,000 new moms.

"The severe episodes are rare, but they are serious episodes and of course they should be taken seriously. You want these women to get help, no doubt," she told Reuters Health.

Bipolar disorder is characterized by alternating swings between severe depression and "mania," when a person is overly excited, happy and energized. It can be treated with medications including mood stabilizers and talk therapy.

The condition most often manifests in early adulthood, and the National Institute of Mental Health estimates six percent of the U.S. population has the disorder at some point in life.

Munk-Olsen said that previous studies have suggested giving birth may act as a trigger for a first overt episode of bipolar disorder. But few women are actually diagnosed as bipolar in the weeks after having a baby.

The researchers theorized that a severe psychiatric episode shortly after giving birth could be a signal of underlying bipolar disorder.

So they tracked women in Denmark for 15 years after their first psychiatric episode to see whether the timing of that episode—shortly after childbirth or not—predicted who would later get a bipolar diagnosis.

Using Danish registries, they found 120,000 women treated in an inpatient hospital or outpatient clinic for their first bout of severe depression or another psychiatric condition starting around 1970. Of those, 2,900 had those episodes within a year after giving birth to their first child.

That didn't include women with an initial diagnosis of bipolar disorder, since the researchers were interested in women with other psychoses that later became bipolar.

Over the next decade and a half, close to 3,100 of all women initially given a different diagnosis were ultimately diagnosed with bipolar disorder. Of women who had their initial psychiatric episode in the first month after giving birth, 14 percent were eventually diagnosed as bipolar. That compared to between 4 and 5 percent of women who were first treated in the rest of the year after giving birth or at any other time.

"It is likely that some of the women were misdiagnosed—we cannot rule that out—but it is likely that some of the women develop bipolar over time," Munk-Olsen said.

The results translate to a four-fold increase in the probability that a severe psychiatric episode in the month after giving birth, versus one that happens at some other time, will ultimately lead to a bipolar diagnosis. Among those with such early postpartum episodes, the patients admitted for inpatient psychiatric treatment were also twice as likely as those treated as outpatients to later be diagnosed as bipolar.

"Clinically these findings make absolute sense," said Dr. Verinder Sharma, an obstetrician and gynecologist who studies bipolar disorder at the University of Western Ontario in London, Canada. "We have seen that childbirth is a potent and specific trigger of bipolar disorder."

Sharma, who wasn't involved in the new study, told Reuters Health that hormone changes that occur during this time, as well as sleep loss, might trigger some women to develop bipolar symptoms, which could be misdiagnosed as depression or an anxiety disorder.

However, he said, there are still many questions about the role that having a baby plays in a woman's chance of becoming bipolar.

"We don't know whether these women have the illness because of childbirth, and if they didn't have children they would have gone without any episode of bipolar whatsoever," he said.

The findings also can't prove that postpartum depression, or giving birth itself, causes bipolar disorder, and the researchers didn't measure whether less severe, more common postpartum blues are linked to bipolar symptoms.

Still, they wrote Monday in the Archives of General Psychiatry that severe psychiatric symptoms which first show up soon after a woman has a baby should be added to the list of features that could increase the risk of bipolar disorder.

Doctors, Munk-Olsen told Reuters Health, should "think about when women have their onset, and you might have an indication that there is an underlying bipolar disorder. We want these women to be diagnosed correctly, in order to help them in the best way."

In particular, Sharma added, doctors who are treating women with new psychiatric symptoms after childbirth should rule out bipolar disorder before they think about treating with antidepressants, which could make certain bipolar symptoms worse.

"It's really important to think about the diagnosis of not just depression but of severe depression and definitely bipolar disorder in new moms who present with a sudden onset of mood symptoms," agreed Dr. Dorothy Sit, who studies mood disorders in women, including postpartum psychoses, at the University of Pittsburgh and wasn't involved in the new report.

"What this study's confirming is in the first 14 days if we identify patients with any of these symptoms we really need to get our patients into a setting for emergency psychiatric evaluation (and) early treatment for the primary disorder that's causing the symptoms," she told Reuters Health.

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