Tag Archive for: perinatal

Perinatal Anxiety 101: An Introduction

Authors: Brynn Stagg, MSc Student, University of British Columbia; Claudia Cargnelli, MSc Student, University of British Columbia; Nichole Fairbrother, Ph.D., RPsych, Clinical Associate Professor & MSFHR Health Professional-Investigator, University of British Columbia | Editors: Romina Garcia de leon, Shayda Swann (Blog Coordinators) 

Published: February 24th, 2023

Are you pregnant, recently given birth, or know someone who has? If so, chances are you or someone you know has experienced anxiety during or after their pregnancy.

Anxiety is a normal human experience.

We all feel anxious, worried, or afraid some of the time. Often, anxiety serves a useful purpose. For example, when heights make us anxious, this feeling serves as a warning to be careful in this potentially dangerous situation. Because of this fear, we take precautions to protect ourselves.

When does anxiety become a problem? 

Sometimes, however, we become fearful of something that is not dangerous, or more fearful than we need to be. If anxiety becomes severe enough to cause significant distress or interference in a person’s life, it may have developed into an anxiety or anxiety-related disorder (AD). 

There are several different ADs, including panic disorder, generalized anxiety disorder, social anxiety disorder, and anxiety-related disorders like obsessive-compulsive disorder and posttraumatic stress disorder. Given the diversity of ADs, it is no surprise that these are important to diagnose – especially when you add in the everyday stress that comes with parenting! 

What about anxiety during pregnancy and the postpartum? 

Anxiety is especially common (and normal) among pregnant and postpartum people. Often, the anxiety experienced during this time is related to one’s pregnancy (will my baby be healthy?), the childbirth (will childbirth be painful?), and one’s newborn (what if something happens to my baby?). 

Although anxiety during the perinatal period is common, and in many cases, a normal and healthy part of becoming a parent, sometimes perinatal anxiety becomes a problem. If you are experiencing substantial anxiety and fear, and these feelings are making you upset or affecting your ability to parent and live your life, you may be experiencing symptoms that meet criteria for an AD. 

Most importantly, we want you to know that you are not alone! There are things you can do (like talking to your healthcare providers, for starters).

Why does perinatal anxiety matter?

Over one in five (21%) pregnant and postpartum people suffer from at least one AD during the perinatal period. Believe it or not, this number is more than postpartum depression – which, at most, 10-16% of birthing people experience. 

ADs, when they occur during pregnancy, have been associated with adverse obstetrical and neonatal outcomes, such as increased risks for pre-eclampsia, preterm birth, and low birth weight. These can have consequences for the infant and developing child.

What can be done?

It’s important to ask for help. You are not alone. Some treatments really work, including self-help materials, group or individualized therapy, and/or medication. 

Cognitive Behavioural Therapy (CBT) is the recommended first-line treatment for most ADs. It is the talk therapy for anxiety with the most scientific support. It’s safe, effective, and is often the treatment of choice for pregnant or postpartum parents as it works as well or better than medication does. 

CBT works to reframe thinking patterns and behaviour. In other words, CBT focuses on how you are thinking (cognitive), what you do about those thoughts (behavioural), and then works on changing these to help your feelings. Lots of research has been done on the effectiveness of CBT in general populations, and we hope to see even more studies focused on perinatal people in the future!

If talk therapy is not helping, individuals may benefit from medication instead of, or in combination with, talk therapy. Selective serotonin and selective norepinephrine reuptake inhibitors (SSRIs and SNRIs), also known as antidepressants, are used to treat anxiety. While many are hesitant and fearful of using medications while pregnant or breastfeeding, not treating more severe perinatal anxiety greatly overshadows the risks associated with using medication, so it’s important to weigh the pros and cons

If you think your anxiety has become a problem, you may want to speak to your primary healthcare provider. You can also seek the services of a psychologist. 

What’s next for this area?

The team at the Perinatal Anxiety Research Lab hopes that by spreading knowledge of anxiety during pregnancy and the postpartum, we can work to make sure that perinatal anxiety becomes easily recognized so everyone can get the support they need during such a stressful time. 

Coming up, we will teach you about some important steps that are crucial in making sure parents are getting the support and resources they need. Stay tuned for our next feature on Screening for Perinatal Anxiety Disorders. 

Reflecting & Resources

If you are pregnant or have been pregnant, what has your experience been like? Did you know anxiety is this common during the perinatal period? Is there someone that could benefit from this knowledge? 

Let us know your thoughts, questions, or ideas for future posts in our Perinatal Anxiety 101 feature at womenshealth.blog@ubc.ca.

Click here for resources and additional support!

 

Behind the Science: Moving the Microscopic Lens to Marginalized Populations

Interviewee: Emmanuela Ojukwu (RN, PhD), Assistant Professor of Nursing, University of British Columbia. Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: November 18th, 2022

Could you briefly explain your career trajectory from a Registered Nurse to now an Assistant Professor?

Towards the end of obtaining my Bachelor of Science Degree in Nursing, I knew that I wanted to pursue a career in women’s health. As my journey progressed, I would eventually get accepted to a PhD program where I had the opportunity to work with a professor who was internationally recognized, with a track record of success in improving minority women’s health with a focus on social determinants of health. The decision to focus on HIV came during my RN experiences at a Perinatal HIV clinic for vulnerable populations, wherein I observed birthing parents living with HIV, to be lost to follow-up to their own care but continually engaged in their infant’s care, postpartum. Possibly due to maternal instincts, but the focus on their infants and not themselves was very apparent. This spurred the idea for what would eventually become my dissertation. So, I wanted to see what factors deterred them from engaging in their own care or factors that motivated them to go in (for those that did). Also, as a natural empath – sometimes to a fault – I would find myself really vested in their care, particularly, for the marginalized women, e.g, new immigrants/refugees, racialized populations, homeless. Most of the patients who were lost were within these categories, so it was important to note the possible intersections in their marginalized identities, which were causing their suboptimal engagement in treatment and possible impediments to their overall wellbeing. When I applied to UBC, I definitely wanted to continue with HIV research, although, I realize that HIV rates here compared to the US are relatively less, but it’s still present. And, as there is currently no treatment that completely eliminates the virus, the likelihood of transmission and/or increasing morbidity and mortality,is significantly reduced with effective treatment/management. I remain vested in this topic as a researcher, and would describe my work as focusing on health equity and social determinants of health for vulnerable populations, marginalized by race, sex, gender, disabilities such as HIV, and other psychosocial vulnerabilities.

Why did you choose to study marginalized populations and sexual health?

Asides from being such an empath, I think that I’ve had my own lived experiences of discrimination within the healthcare setting, both as a patient and a healthcare provider. I, sometimes, find that there are “sexual and reproductive health stereotypes” that follow “black women” and these often go before them upon their arrival to any hospital/clinical setting. As a patient, I can count times this has been the case for me; and not until I divulge my profession in healthcare do I get treated any differently. As a provider, the discrimination can stem from patients or colleagues with preconceived, underrated expectations of racialized peoples’ performances, and hence a lack of trust in their abilities as providers, and also unequal (or mostly, subdued) access to and opportunities for growth and development within their various units. All of these experiences, and their impacts on wellbeing demonstrate a critical need for research with and for persons on both sides of the table. By doing this work with and for patients who may fit within these identity brackets, especially for topics that could be stigmatizing such as sexually transmitted infections and HIV, I hope to amplify their voices and create an awareness of their situations. I hope that in creating such an awareness of the existing disparities and inequities; and with the development of interventions, put in place by healthcare providers, public health officers, and even the government; that there might be opportunities to rebuild some of the trust which may have seemed lost in the system, by these communities.

How does Women’s Health specifically intersect with your work at the moment?

Women’s health is at the center of everything I do in my research. A lot of my work focuses on the sexual and reproductive health of women. I currently have two ongoing studies; one, examining the impacts of COVID-19 on quality of life for African, Caribbean, and Black women living with HIV in BC; and another exploring the impacts of racism, sexism, and psychosocial vulnerabilities on access to care services for African, Caribbean, and Black women living with HIV. While I have a special interest for racialized women, I do not shy away from work focusing on the psychosocial and sociostructural factors influencing equitable care for all women. Merely existing in a patriarchal world as a woman can interfere with several aspects of wellbeing. The impacts of other layers of marginalization can have very lasting, detrimental effects on the lives of persons who fit within these identity brackets. Examining the impacts of these intersecting, underprivileged identities and unpacking the various layers and layers of vulnerabilities that surface, is at the core of my research. So in essence, the makeup of a woman’s sexual and reproductive health, and how that interferes with and/or allows them to exist inclusively in a very patriarchal system is of importance to me.

What impact do you hope to see with your work years from now?

I’m hoping that knowledge generated from my work can have lasting positive impacts in the way that care is modified/adjusted for the affected populations. Not surprisingly, there isn’t a lot of data on marginalized populations when it comes to women’s reproductive health, whether it’s rates of maternal mortality or anything else, in Canada. I’m hoping that my research can contribute to bridging those gaps and generating these data, so that researchers, community leaders, healthcare providers, the government, and others in positions of power may be alerted to these situations and help to effect change. We know that these issues exist but the paucity of data and research in this area limits the opportunities for interventions that are culturally-sensitive and -safe. I hope that my research in the short run, can be a “call to action” and in the long run can lead to sustainable “actions for change” for enhancing women’s equitable health.

Where can people find your work?

My email, usually, is the best way to contact me, at emmanuela.ojukwu@ubc.ca.