PSYCHOTHERAPY IN OBSTETRICS

Pregnancy is often regarded with excitement, but no matter how eagerly a child's birth is anticipated, stress
and other forms of emotional distress are still likely to occur during the challenging period of pregnancy.
Pregnancy issues may be mild or serious, but they can affect the health of the mother or child, put strain on a
romantic partnership, and lead to life changes, both predicted and unpredictable. When concerns that arise
during pregnancy or after birth cause distress or otherwise affect one's mental health, the support of a therapist
or other mental health professional may be helpful.

Challenges associated with pregnancy and birth

Though pregnancy can be challenging for both parents, in many cases the pregnant woman
experiences the greatest amount of strain. A single mother may experience even higher levels of emotional
distress, as single mothers may often lack help and support. These worries may be mild or severe, but the
stress they can cause may lead some women to experience increased physical or mental strain, depression or
poor physical health, all of which may lead to increased risk in childbirth.

Pregnancy can put strain on a partnership, especially when

• A pregnancy was unplanned and partners have different goals

• One partner desires children and the other does not

• Both partners wish to have a child, being unprepared for the child's arrival

Financially or in other ways may still be a cause for concern

• A couple has unaddressed or unsolved relationship issues, their partnership

May be further tested by the varied challenges of childrearing

• One or both partners is ambivalent to the idea of parenthood having a baby

May have a negative impact on the relationship,

• Other strains or stressors are present.

The physical challenges that often accompany pregnancy can also be difficult for many women to cope with.
Morning sickness aches and pains, fatigue, insomnia, and indigestion are just a few of the concerns that a
pregnant woman may face. Women who contract illnesses while pregnant can be more severely affected by
symptoms and may have a greater risk of complications, the most severe of which are birth defects or fetal
death. In order to prevent certain birth defects and food borne illnesses, a physician will typically recommend
certain dietary restrictions to women who are pregnant, such as the avoidance of alcohol and raw or
unpasteurized foods. Beyond these restrictions, some women may find it difficult to eat a variety of foods,
due to morning sickness or other pregnancy-related stomach concerns.

Pregnancy and mental health concerns

While pregnancy often elicits many positive emotions, it can also cause a woman to experience negative
thoughts and feelings. During pregnancy, past family issues, insecurities, relationship difficulties, and
financial issues can become real and immediate concerns. A woman who is expecting may find herself
experiencing mood swings, fear, anxiety, forgetfulness, or body image issues. Women who experienced
depression or anxiety before becoming pregnant may be more likely to experience mental health concerns
during pregnancy. When mental health conditions occur during pregnancy or postpartum, a woman's doctor
will generally be able to provide referrals to mental health professionals as well as immediate health care and
support.

Because some psychotropic medications can have harmful effects on developing fetuses, women who
are taking these medications and discover they are pregnant or intend to become pregnant are advised to
contact their doctor and mental health care provider. In some cases, another medication is prescribed, and in
others, a woman may receive an alternative form of treatment for the duration of the pregnancy, such as
therapy only.

Societal expectations of pregnant women and new mothers may lead many women to experience
anxiety or stress. Well-meaning individuals—family, friends, or even strangers—may criticize the practices,
diet, and weight gain (or lack thereof) of pregnant women and May often offer unsolicited opinions or advice.
Some women may experience irritation, anger, or frustration as a result, but others may come to doubt their
own ability to be good mothers. Soon-to-be parents may turn to parenting books or other sources of advice
and become overwhelmed by conflicting opinions on the best or safest options for delivery.

Symptoms of mental health concerns are the most common complication of childbirth. According to research:

• Between 15 and 20% of women experience clinically significant anxiety or depression after childbirth.

• Two thirds of mothers diagnosed with severe postpartum depression began experiencing changes in mood
during pregnancy.

• Sixty percent of mothers with moderate postpartum depression had pregnancy complications such as
gestational diabetes.

• Stress experienced during pregnancy, especially posttraumatic stress disorder has been linked to premature
birth, low birth weight, and risky behaviour (such as drinking or smoking) during pregnancy.

• Many women experience “baby blues” or a period of low mood and tearfulness, for a week or two following
childbirth. These feelings generally resolve with the support of one's partner or family. When they do not
resolve or include hopelessness, negative thoughts about oneself or one's baby, or a loss of appetite, a more
serious condition may be indicated.

• Postpartum psychosis is rare but serious: The condition is characterized by delusions, rapid mood swings,
and paranoia and carries a 5% rate of suicide and a 4% rate of infanticide. Symptoms generally appear
suddenly, within two weeks after giving birth.

Impact of birth on emotional health

1. Emotionally and physically fatigued

2. Lowered immune system

3. Increased irritability

4. And stress

5. Difficult to cope with pain and fatigue

Therapy for pregnancy and birthing concerns

Psychotherapy refers to a range of treatments that can help with mental health problems, emotional challenges,
and some psychiatric disorders. Psychotherapy is a collaborative treatment based on the relationship between
an individual and a psychologist. Grounded in dialogue, it provides a supportive environment that allows you
to talk openly with someone who’s objective neutral and nonjudgmental. In psychotherapy, psychologists
apply scientifically validated procedures to help people develop healthier, more effective habits. There are
several approaches to psychotherapy —including cognitive- behavioural, interpersonal and other kinds of talk
therapy — that help individuals work through their problems.

Psychotherapy -- also called talk therapy, therapy, or counselling -- is a process focused on helping you heal
and learn more constructive ways to deal with the problems or issues within life.

Signs that need therapy it include

1. A person’s problems don't seem to get better despite your efforts and help from family and friends.

2. A person finds it difficult to concentrate on work assignments or to carry out other everyday activities.

3. A person worries excessively, expect the worst or are constantly on edge.

4. A person’s actions, such as drinking too much alcohol, using drugs or being aggressive, are harming you
or others

Types of psychotherapy

• Behaviour therapy

• Cognitive therapy

• Dialectical behaviour therapy

• Interpersonal therapy

• Psychodynamic therapy

• Cognitive-behavioural therapy

• Family therapy

• Group therapy

• Supportive

• Deep

• Directive

• Non directive

Approaches to psychotherapy

• Individual therapy

• Group therapy

• Marital/couple therapy
• Family therapy

• Long term

• Short term

• Therapy for children and adolescents

APPLICATION OF THE PSYCHOTHERAPY IN CLINICAL SETUP

INTRODUCTION

Pregnancy is generally thought to be a time of happiness and emotional well-being for a

woman. However, for many women, pregnancy and motherhood increase their vulnerability to psychiatric
conditions such as depression, anxiety disorders, eating disorders, and psychoses.

PATIENT PROFILE

NAME Mrs.Viji

AGE 24 years

SEX female

AREA saidapet

OCCUPATION home maker

INFORMANT mother

HISTORY OF PRESENT ILLNESS

MRS.VIJI, 24 years old got admitted in emergency obstetrical and gynaecological care,
saidapet and delivers a female baby on 6/2/2020. After the 4-5 days of delivery, the mother experience
sleeplessness, irritation, poor breast feeding which indicates presence of PUERPERAL BLUES.

SIGNS AND SYMPTOMS IDENTIFIED

➢ Sleeplessness
➢ Irritation
➢ Lack of breastfeeding
➢ Poor self-care
➢ Depression
➢ Feeling helpless
 THERAPY GIVEN

The therapy given for the client MRS.VIJI is RELAXATION THERAPY

RELAXATION THERAPY

INTRODUCTION

Relaxation techniques are a great way to help with stress management. Relaxation isn't
only about peace of mind or enjoying a hobby. Relaxation is a process that decreases the effects of stress on
your mind and body. Relaxation techniques can help you cope with everyday stress and with stress related to
various health problems, such as heart disease and pain.

Types of relaxation techniques

Health professionals such as complementary health practitioners, doctors and psychotherapists can teach
various relaxation techniques. But if you prefer, you can also learn some relaxation techniques on your own.
In general, relaxation techniques involve refocusing your attention on something calming and increasing
awareness of your body. It doesn't matter which relaxation technique you choose. What matters is that you
try to practice relaxation regularly to reap its benefits.
Types of relaxation techniques include:
• Autogenic relaxation. Autogenic means something that comes from within you. In this relaxation
technique, you use both visual imagery and body awareness to reduce stress.
You repeat words or suggestions in your mind that may help you relax and reduce muscle tension. For
example, you may imagine a peaceful setting and then focus on controlled, relaxing breathing, slowing
your heart rate, or feeling different physical sensations, such as relaxing each arm or leg one by one.
• Progressive muscle relaxation. In this relaxation technique, you focus on slowly tensing and then
relaxing each muscle group.
This can help you focus on the difference between muscle tension and relaxation. You can become more
aware of physical sensations.
In one method of progressive muscle relaxation, you start by tensing and relaxing the muscles in your
toes and progressively working your way up to your neck and head. You can also start with your head
and neck and work down to your toes. Tense your muscles for about five seconds and then relax for 30
seconds, and repeat.
• Visualization. In this relaxation technique, you may form mental images to take a visual journey to a
peaceful, calming place or situation.
To relax using visualization, try to incorporate as many senses as you can, including smell, sight, sound
and touch. If you imagine relaxing at the ocean, for instance, think about the smell of salt water, the
sound of crashing waves and the warmth of the sun on your body.
You may want to close your eyes, sit in a quiet spot, loosen any tight clothing, and concentrate on your
breathing. Aim to focus on the present and think positive thoughts.
Other relaxation techniques may include:

• Deep breathing
• Massage
• Meditation
• Tai chi
• Yoga
• Biofeedback
• Music and art therapy
• Aromatherapy
• Hydrotherapy

REFLECTION OF THE THERAPY

Mrs.viji felt relaxed and cooperated well with the treatment and follow up after the relaxation therapy.
She felt happy and take care of her child well by giving breast feed at regular intervals

CONCLUSION

So far, i understand how psychotherapy helps in the management of puerperal blues with the help of
relaxation techniques.

REFERENCE
R.SREEVANI, “A GUIDE TO MENTAL HEALTH AND PSYCHIATRIC NURSING” 4th EDITION,
JAYPEE PUBLICATIONS LTD.,
NET REFERENCE:
https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/relaxation-
technique/art-20045368