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Item type Poster

Title Perinatal PTSD: A Concept Analysis

Authors Vignato, Julie A.

Downloaded 1-Jun-2018 15:54:10

Link to item http://hdl.handle.net/10755/620312

Concept Definition

Concept Analysis Approach

Concept Uses / Implications for Nursing Practice

Integrated Perinatal Health Framework

(Adapted with Permission)

References

Acknowledgements

It is estimated that 9% of the US perinatalpopulation has Perinatal Posttraumatic StressDisorder (PPTSD) with 18% being at risk forthe condition. Most will be undiagnosed dueto social stigmas, multifaceted healthdisparities, and healthcare systeminsufficiencies.

The purpose of this concept analysis is toclarify meanings in the present but not wellresearched concept of PPTSD by synthesizingthe perinatal mental health and PTSDliterature.

A disorder where a subjective view of atraumatic experience by a motheroccurring any time before conception to6 months postpartum leads to specificPTSD negative symptoms (intrusion,avoidance, negative alterations incognitions and mood, and alterations inarousal and reactivity as cited DSM V).

Lasting longer than one month.

Diagnosed in the perinatal period -during pregnancy and postpartum.

Contributes to poor maternal and infantoutcomes (impaired attachment /bonding and low infant birth weight.)

The approach utilized Walker and Avant’s (2011) method ofConcept Analysis. The Integrated Perinatal Health Framework(Misra, 2003) and Mental Health Framework (Leight, 2010)assists in explaining the PPTSD concept definition in regards todefining attributes and consequences. Three antecedentsidentified: trauma (perinatal complications and abuse,)postpartum depression, and previous psychiatric history.

A Model Case involves a women with prior sexual traumaexperiencing insomnia, poor concentration, relivedexperiences of the sexual assault throughout the thirdtrimester of pregnancy. She soon avoids prenatal care andbecomes easily overwhelmed or panicked if anything changesunexpectedly. During delivery, the vital sign equipment andfrequent vaginal exams contribute to the patient feeling tieddown, powerless, and violated. During the 6-weekpostpartum visit, the mother is observed not responding tothe infant’s cues for feeding and comfort.

A Borderline Case may be a woman who has a “normal”planned pregnancy. During the intrapartum period, anemergent Cesarean section occurred due to a low fetal heartrate. At the 6 week postpartum visit, she informs her providerof reliving the delivery experience, insomnia, and poorconcentration. The infant’s birth weight is low and the motherdoes not respond to the infant’s cues for feeding and comfort.

In a Related Case, a women with a healthy pregnancyexperiences preecampsia, fatigue, and a long labor. During thepostpartum period, the neonate is difficult to feed and thewoman frequently requests to sleep instead of bonding. At the6 week postpartum visit, the women continues to reportfatigue but does respond to the infant’s cues for feeding andcomfort. The infant continues to have a low weight.

A Contrary Case involves a healthy mother and newbornwithout complications and an uneventful delivery.

Antecedents may be the Distal and Proximal Determinants andProcess during pregnancy and delivery. Consequences are shortand long-term outcomes that influence maternal infant health andwell-being.

Identify risk factors and adverse maternal child outcomes to

improve nursing knowledge and practice.

Decrease social stigmas, multifaceted health disparities,

healthcare system insufficiencies, and excessive costs.

Influence health policy to increase preventative screening and

treatment of perinatal PTSD throughout pregnancy and

postpartum.

I would like to thank Dr. Cynthia D. Connelly for her patience,

support, and expertise in this endeavor.

Available on handout

Perinatal PTSD: A Concept AnalysisJulie Vignato, PhD, RNC-LRN, CNE

Distal DeterminantsBiological Societal

Proximal Determinants

Processes

Outcomes

Genetic Factors(twins)

Physical Environment

(crowding, lack of transportation)

Social Environment(domestic violence, low SES and social

support)

Biomedical Responses

(Infection, prior mental illness or birth complications,

nutrition, stress)

Behavioral Responses (stress, nutrition, locus of

control, drug use)

Preconceptional / Interconceptional State

(seeking care)

Pregnancy = Intraconceptual State (traumatic birth)

Short-term maternal and infant disease (birth complications,

hemorrhage, low birth weight)

Long-term maternal and infant complications (poor parenting

and bonding)

Maternal and infant health

functioning (ADLs, Infant growth & development)

Maternal and infant well-being

(attachment, child school achievement)

Health Care (proper treatment)

Purpose & Aims

Introduction