Bereavement in Obstetrics – World Prematurity Day & Miscarriages

World Prematurity Day – What is it?

On the 17^th of November, it was World Prematurity Day. This is a global movement made to help raise awareness of premature birth and the effect that it has on people. Expecting parents dream of the day that they can hold their baby in their arms. When a baby is born prematurely, they have to go into neonatal care. This can mean only being able to see their baby in an incubator, connected to tubes. They don't go on straight away to settle down at home and do all of the things that they as new parents have been taught to do. It can mean weeks of visiting their baby in the hospital until the baby is stable enough to go home. Sadly, not all babies make it home. According to the charity 'Bliss', out of the 15 million babies born prematurely every year, 1 million of them will not survive. This is why I decided to include World Prematurity Day in this blog post about bereavement in obstetrics. 

What is considered a premature birth?

A birth is considered premature when it happens three weeks or more before the due date. Premature births can lead to complications and medical problems. It is possible for babies born as early as 24 weeks to survive, but they do need specialist care. As mentioned above, some of these babies still do not survive.

Miscarriage:

Bereavement in obstetrics (for example, miscarriages) are very common, but there is a taboo around conversations about it. This is probably due to it being a difficult topic for some to understand, and one that makes people very uncomfortable. Although it makes people uncomfortable, it is still important to discuss. Recently, Meghan Markle opened up about a miscarriage she experienced this year. There has been a huge response, with some of the comments being grateful and some being unhelpful. Some people have said, “Not all grief needs to be made public knowledge!” Sadly, all this sort of response does it makes those who have experienced miscarriage or given birth to a stillborn baby feel that they cannot talk about it. Another comment states, “Meghan Markle may not see the awful comments about her, but your friends who have experienced miscarriages will.”

Complications during pregnancy, miscarriages and premature births:

 It's really important that parents dealing with the above get the empathy and support that they need and deserve. This can start by sharing experiences, so that others don't feel alone.  

Post Traumatic Stress Disorder – What Causes It?

What is Post Traumatic Stress Disorder?

Post Traumatic Stress Disorder was referred to as, ‘combat fatigue’, after World War One, and, ‘shell-shock’, after World War Two. However, post-traumatic stress disorder is not something only suffered by soldiers. PTSD can happen to anyone who experiences something traumatic in their life. Most people will experience some of the symptoms of PTSD after a traumatic experience, however, usually, the symptoms will reduce after 4-6 weeks on their own. If the symptoms continue after this point, further treatment is required. PTSD is treatable.

What can be classed as trauma?

There are loads of different types of trauma. The most obvious kind would be disasters, such as hurricanes and earthquakes, railway or plane crashes. However, bullying can also be considered a traumatic event, along with the death of a parent, medical trauma, and sexual abuse. The sudden death of a loved one can cause PTSD. Trauma can change the way that the brain responds to situations in future.

Symptoms of PTSD

Posttraumatic stress disorder can cause the physical symptoms of anxiety (for example, sweating, shakiness, clamminess, palpitations), as well as irritability, mood swings, flash-backs, nightmares, difficulty sleeping, being hyper-vigilant (tense and jumpy, ready to escape). Somebody with PTSD may attempt to avoid their feelings altogether, which can lead to avoiding anything that may trigger even the slightest memory of their trauma. 

What is the treatment?

Someone with PTSD may be referred to counselling or other forms of psychotherapy. Usually, medications aren’t prescribed unless the PTSD is very severe. Eye movement desensitisation and reprocessing is also a form of treatment that seems to have a good effect on those suffering from PTSD. According to the Center for Anxiety Disorders (https://centerforanxietydisorders.com/ptsdsudden-death-loved-one/),“...a study funded by the Kaiser Permanente HMO found that 100% of single-trauma victims and 77% of multiple trauma victims were no longer diagnosed with PTSD after just six 50-minute sessions.”  

What is EMDR?

EMDR is a form of therapy. The therapist will make side to side movements (usually hand tapping, or lights). Then they will ask the patient to recall the traumatic event. Usually, there will be at least 6 sessions of this. It is thought to help the brain process the traumatic event properly. 

Conclusion

PTSD can happen to anybody, after any event that a person finds traumatic, whether it be war, abuse, a bereavement, or bullying. If you have symptoms of PTSD, then it is worth going to your GP to see if you can be referred for some kind of therapy. 

 

Teaching About Alcoholism – It’s A Tough Topic

Why is Teaching About Alcoholism Important? 

Unfortunately, alcoholism is often blamed on the alcoholic themselves. It is looked at as a simple problem with a simple solution. While on the outside, it does definitely appear this way, it is often a lot more complicated than that. There needs to be more understanding of how to support somebody who is addicted to alcohol. 

Alcoholism is dangerous:

In moderation, although still bad for us, alcohol’s effect can be managed easily and we can recover. However, alcoholism can be very dangerous. Although the liver is a very forgiving organ, too much alcohol consumption on a regular basis can push it to the limit. Alcohol also has a bad effect on other organs in the body, and overuse can affect appetite, leading to an overall lack of self-care. Being run-down puts an alcoholic at higher risk of other issues.

Alcohol detox is a lot more difficult than it sounds:

Detoxification from alcohol can be very difficult. Some people might try detoxing at home, or some in an in-patient facility. Either way, it is a huge challenge, and some may face health risks even detoxing. If somebody is too dependant on alcohol, they may need medication to help wean themselves off of the alcohol. Completely cutting out alcohol at this stage can be dangerous, with some of the worst side effects being seizures or even death. Medical supervision is ideal for these cases. 

Relapse is a part of addiction:

Every addict faces a huge amount of judgement when they relapse. Relapses are common because addiction is just not an easy thing to defeat. Unfortunately, this is a difficult thing to change peoples’ perspectives on. Judgement is something that can bring out feelings of shame in somebody suffering from addiction, making them more secretive. They may hide a relapse out of shame and this could lead to further self-harm.

Underlying mental health problems:

A lot of addicts have underlying mental health problems that drive them to substance abuse. It is a way to numb the pain that they may be feeling. This is something not often obvious to those who judge somebody with alcoholism or any other addiction. 

Biological Factors:

Genetics and physiology can play a part in alcoholism. Some people have no trouble limiting their alcohol intake, while others really struggle to know when to stop. According to an article from Alcohol Rehab Guide, there are certain chemicals in the brain that can make someone more susceptible to alcohol abuse, and this could explain why alcoholism seems to run in families. 

Other Factors:

There are plenty of other factors that can play a part in the development of alcoholism. For example, living closer to shops or venues that sell alcohol may make you more likely to drink alcohol regularly. Culture, family and social circles can also have an impact on whether you drink a lot of alcohol or not. Pair this with a stressful new job or any kind of big life change and this can make a person more susceptible to alcoholism.

So there we have it, alcoholism is a lot more complex than just, ‘choosing to drink too much’. 

Psychopharmacology Treatment – Different Types of Antidepressant

 

Psychopharmacology Treatment

Over the years, many different anti-depressants have been created, giving a range of options for those who struggle with their mental health. Some kinds are said to have fewer side effects than others, though this can really depend on the person taking them. Some anti-depressants can cause suicidal thoughts, which is why monitoring is extremely important. In some cases, you can order a gene test which tells you which antidepressants you may respond badly to, and which ones might suit you. This is ideal, but a very expensive process. Most doctors will go through trial and error to see which one fits their patient best. Below are the different kinds of antidepressants.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are the antidepressants most likely to be prescribed. The reason for this, is that they are less likely to cause side effects. However, this does not mean that they’re side-effect free. Some people do experience severe side effects, which is why during the first 4-6 weeks of taking the medication, the patient should be monitored by their doctor. Side effects usually calm down a few weeks in, though some people may have a different experience. Examples of SSRIs are citalopram, paroxetine, sertraline and fluoxetine. SSRIs sometimes can cause sexual problems.

Serotonin-noradrenaline reuptake inhibitors (SNRIs)

Although SNRIs were created in the hope that they would be a more effective treatment than SSRIs for depression, there is no solid evidence of this. They are quite similar to SSRIs, except rather than just serotonin reuptake being inhibited, serotonin and noradrenaline reuptake are both inhibited, which is supposed to help the patient feel a bit more motivated. Everybody responds differently to these medications. Examples are duloxetine and venlafaxine.

Noradrenaline and specific serotonergic antidepressants (NASSAs)

NASSAs may be prescribed to somebody who is unable to take SSRIs for one reason or another. Side effects can be similar, but they are more likely to cause drowsiness, so it’s good to keep an eye on that. Mirtazapine would be an example of a NASSA.

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants are an older kind of antidepressant, and they aren’t usually recommended anymore. Sometimes they’re used for other things, such as nerve pain. This is because the side effects can be to numb nerve endings. They’re a lot more dangerous when it comes to an overdose and has a lot more side effects than the above medications. Examples of TCAs that may be prescribed are amitriptyline (which can also be used for nerve pain), clomipramine, imipramine and nortriptyline.

Monoamine Oxidase Inhibitors (MAOIs)

These are very rarely prescribed and are an older type of antidepressant. The side effects these cause can be very serious. Examples of these are phenelzine, tranylcypromine and isocarboxazid. It is unlikely for a patient to be prescribed these.

Psychopharmacology treatment can be quite complex in some cases. When prescribing these, a doctor will have to take into account any other medications that the patient already takes and how they may react with each other. Although there is a stigma that comes with medication for mental health problems, it’s important to recognise that many of the above medications are a lifesaver for those who struggle to function without them. A lot of the medications are used alongside talking therapies such as cognitive behavioural therapy.

Bereavement in Obstetrics is More Common Than You Might Think

Bereavement in obstetrics is a lot more common than some might think, unfortunately. There is a taboo around the topic, and a lot of people don’t like to discuss miscarriages or stillbirths as it makes others uncomfortable. The sad fact is that it can be very helpful to discuss any kind of bereavement with a friend or family member, and can help process grief.

Bereavement in Obstetrics & Media

We see bereavement in obstetrics in films and television. Why can’t we talk about it? Film and television are very good for portraying the subject and the pain that comes with it, and can help people to understand. There are lots of different films and television series that explore the issue. One example would be Boardwalk Empire. The first that we see of miscarriage is a woman being admitted to hospital bleeding. It is shocking to the characters who are touring the hospital and the woman is ushered away as if it is shameful. Later on, the main character called Margaret Thompson works hard to set up educational women’s health classes, much to the disappointment of the nuns that run the hospital. This is a great portrayal of the stigma around baby-loss at the time. Although it is not quite as bad now, some of the stigmas still linger.

What can we do about the stigma?

The best thing that anybody could do to help the stigma and increase support around bereavement in obstetrics is to talk about their experiences. It will, over time, highlight that this can happen to anybody at any point in their life, and it never gets easier. The support for miscarriage and still-birth needs to be at the same level as any other bereavement, as people do still go through stages of grief.

Stress And Depression In The Workplace - COVID19 And Working From Home

 

Stress and depression in the workplace is a common issue, especially during the pandemic. The employees that can have moved to work from home, while others may feel anxious going out to work, but not have many choices in the matter.

COVID-19 has forced many to work in a completely different way. Having an office job may mean you can work from home, but there is no ‘water cooler’ conversation, and routinely falls apart over time when you no longer need to commute. Suddenly, you’re working in your pyjamas, sitting on your sofa with a coffee and a blanket. While this is cosy, over time it can ruin your idea of what relaxation is. Working on the sofa, a place where you might usually relax, suddenly makes it seem like a less relaxing place to be. It is the same if you have a desktop computer to work from your bedroom.

Employers may send their employees to work from home with computers, desks and desk chairs from the office. This is great for making sure that your employees have a decent work set-up so that they can prevent RSI. However, not everybody has enough space to set up a desk and desktop computer. This can lead to not so good set-ups and increase the risk of repetitive strain injury and back problems. Courses can be sent out so that everybody knows how they are supposed to sit, but really there is no way to make sure that your employees have the correct set up all of the time.

Back, shoulder and other repetitive strain pain can cause stress in the workplace. Not being able to relax in spare time can also cause stress. When the workplace is suddenly your home, you might struggle to know when to stop work. It might be hard to feel motivated to start work as well. Being overly productive or counterproductive can have an effect on emotional well-being.

It’s important for employers to regularly check on their employees during this time and show kindness and understanding to those who are struggling with any changes that may have been made. It might be good to set up regular group meetings (online) in order to keep the team spirit alive. Encourage them to speak up if they’re struggling, and see what changes you could make to improve their situation.

Bereavement in Obstetrics – Stigma Around Miscarriage

Miscarriage is when an unborn child dies between the first and twentieth week of pregnancy. It can take anything from a few days to months to recover physically from a miscarriage, and it’s likely to take even longer to recover from the emotional damage. They’re most likely to happen in the first trimester, but some happen later on in between weeks 13 to 19.

At least 10% of pregnancies end in miscarriage. This is a huge number – so why don’t people talk about it more? Miscarriages are a bereavement, so those who have experienced them should be given care and emotional support. Having said this, a miscarriage is often a private experience. It is a different kind of bereavement. Sometimes people might not feel they can talk to others about a miscarriage.

Unfortunately, some people who have experienced miscarriage have been met with comments like, “Oh, you’ll just have to try again”, and, “Well, that’s life, we have to deal with it”. These comments aren’t particularly helpful to somebody who is grieving. It can be a lot more helpful to acknowledge the unborn child as a life. Parents have a huge amount of emotional attachment to their unborn child, which others might struggle to empathise with.

In the past, women were expected to do housework, bear children and keep their husband happy. Even now, there is an unspoken expectation that you will have children at some point if you’re a woman. Sometimes there is a bigger reason behind a miscarriage – it can lead to discoveries of underlying conditions such as endometriosis, which can cause infertility. This can make a miscarriage even more devastating.

Women find themselves bombarded with questions as they get older, for example, “You should probably think about having children soon, you won’t have eggs forever!” Personally, I think it’s inappropriate to question people on this private topic. You never know what is going on in somebody’s life. I know a few people with long-term conditions that affect their fertility. It is very upsetting to answer questions about when they intend to have children. They often feel like a failure because, according to their doctor,  it’s unlikely they’ll be able to have any children. Some of these women have experienced multiple miscarriages as a result of their conditions, and the grieving does not become easier.

Bereavement in obstetrics can do a lot of damage to mental health. There needs to be more awareness of miscarriage, causes, and support for those who experience them. Also, partners are often overlooked when it comes to bereavement in obstetrics, and the focus ends up being on the person who carried the child. It is just as devastating to partners.