Background: PTSD as the Primary Factor Causing Infant Death and Factors Enhancing It: Statistics
The issue of infant death has been on the agenda for quite a while. Despite numerous efforts at reducing the rates thereof, infant mortality has been affecting the American community in a very direct and harsh manner extensively. Although the rates of infant mortality have dropped over the past few years, the subject matter still remains an issue and needs to be addressed: “The infant mortality rate of 5.96 deaths per 1,000 live births in 2013 was a historically low value, but it was not significantly different from the 2012 rate” (Xu et al., 2013, p. 1).
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At present, infant mortality rates peak at 535 per 100,000 (Infant, child and teen mortality, 2016), and the above number is going to grow, according to rather pessimistic prognoses of the American OBs (Jarosinski & Fox, 2016). Apart from being a tragic phenomenon on its own, infant mortality also harms the mother significantly, causing the further aggravation of the PTSD syndrome and inevitably leading to severe depression. Therefore, there is a consistent need to reduce the degree, to which the phenomenon manifests itself in the contemporary society, if not eradicating it from the current health agenda completely.
One must admit, though, that PTSD is only one of the numerous factors that create premises for infant death rates to rise. Among other essential factors that enhance the frequency of the above unfortunate phenomenon, premature, or preterm birth (PTB) needs to be mentioned. However, the two factors are often related to each other very closely. According to the existing studies on the subject matter, receiving traumas or suffering from the aftereffects thereof raises the possibility for an occurrence of PTB in a pregnant woman to a considerable extent: “Despite the higher incidence of both PTB and psychosocial distress in many LMI countries, empirical work on psychosocial predictors of PTB has been predominantly conducted in high-income countries” (Premji et al., 2015).
Expectant Mothers: Subgroups. Identifying the Existing Taxonomies
The lack of studies on the issue of expecting mothers and their subgroups needs to be mentioned among the primary issues that hamper the process of addressing the problem concerning high infant death rates (Hehir et al., 2015). More importantly, even though a range of studies focus on the issue of PTB, there are very few researches that actually consider the taxonomy of expecting mothers.
The study carried out by Alkareem and Ali (2014) suggests that the expecting mothers should be split into categories based on the number of children that they are expecting (e.g., singleton mothers, who are going to have only one child, and the women that are going to give birth to twins, triplets, etc.). The above approach can be deemed as sensible as it helps identify the primary threats that the mother and the children are going to face.
PTSD in Expecting Mothers: Locating the Specific Circumstances
A recent study on the issue of PTSD rates and their effect on the PTB rates among mothers shows that there is an evident correlation between the factors above. Particularly, the research carried out by Yonkers (2012) makes it obvious that the PTSD-related factors create premises for PTB immediately, therefore, jeopardizing the chances for the baby to remain alive: “The rate of PTB was 13.9% in women with as compared to 10.3% in women without elevated depressive symptoms. The adjusted OR for PTB was 1.3 (95% CI 1.09 to 1.35)” (Yonketrs, 2012, p. 1). At this point, the fact that the rates were excruciatingly high once solely the singleton pregnancies were taken into account needs to be brought up.
Determining the Prenatal Stress Mechanism and the Chemistry Behind It
The phenomenon of the prenatal stress is, in fact, very complicated. The fact that the medicine taken by pregnant women to reduce the stress rates affects the pregnancy duration should also be brought up as an essential factor that may cause PTB and, therefore, contribute to the death of the infant. A recent research on the issue of PTSD and depression among pregnant mothers points to the fact that active use of the medicine will inevitably lead to a change in the patient’s health status. Particularly, consistent use of selective serotonin reuptake inhibitors (SSRI) that prevent the absorption of serotonin by the presynaptic nerves that it was released from need to be considered (Fluoxetine, Paroxetine, Sertraline, etc.) (Bismuth-Evenzal et al., 2012).
In addition, one must pay attention to the fact that the PTSD issue rarely occurs on its own, especially at the time of pregnancy, Because of the factors that can contribute to the aggravation of the expecting mother’s health status –and, which, in fact, do so actively – PTSD goes hand in hand with a range of other psychological issues, depression being the most negative one of them. The increased depression rates, in their turn, affect the development of the fetus very negatively; particularly, the
The threat of depression as a possible outcome of an instance of severe PTSD is in fact, quite possible. According to a recent research, when unattended, PTSD may develop into a much greater problem and cause the overall aggravation of the patient’s health rates: “PTSD symptoms severity was associated with concurrent stressors and family history of anxiety and depression” (Aftyka, Rybojad, Rozalska-Walaszek, Rzoñca, & Humeniuk, 2014, p. 348). Given the fact that expected mothers have to face a range of health complications during pregnancy, they may feel unable to cope with the PTSD on their own; therefore, the disorder may progress, causing pregnant women to feel depressed. As a result, the threat of a PTS becomes increasingly possible.
Effects of Stress on Different Gestational Stages: Comparison
In addition, the fact that stress has a different effect on both the mother and the child at different stages of the fetus development must be brought up as one of the issues that shape the further development of the fetus. While, at the gestational stage, PTSD is hardly going to have any effect on the fetus, with every additional month, the women will be under an increasingly high threat of a miscarriage.
Suffering from PTSD during the ninth month is especially fraught with dire consequences for the mother and the fetus alike, as the possible miscarriage is likely to lead to a major loss of blood in the mother, therefore, threatening her wellbeing and possibly causing death (Norman & Aviisah, 2015). Similarly, PTSD and the related disorders, especially depression that it may cause, are highly likely to become the primary factor for a miscarriage.
Means of Addressing the Negative Factors: Reducing Infant Mortality Rates
As the overview of the problem carried out above has shown, there are certain tools that way help reduce the threat of postnatal complications or, in the worst-case scenario, the death of the child. Particularly, the identification of the external and internal factors that may cause a distress in the patient will have to be identified. For these reasons, their history will have to be analyzed carefully so that the tiniest chances for the woman to develop the disorder should be driven to nil.
It should be borne in mind, though, that, due to the number of factors that may cause the patient’s distress, including the changes in her body, the techniques that will help her fight the issue as opposed to the ones that can only be viewed as preventive should be identified. Particularly, researches suggest that expectant mothers should consider the use of selective serotonin reuptake inhibitors, or SSRI (Bismuth-Evenzal et al., 2012).
Seeing that the increase in the number of stress factors triggers an immediate drop in the development of serotonin and, therefore, creates premises from the development of a PTSD or, worse yet, depression, it is crucial to help a pregnant woman maintain the current serotonin levels high. SSRIs, in their turn, can be viewed as one of the ways to avoid the issue. Additionally, the use of therapies as the primary method of developing the necessary coping strategies should be viewed as an opportunity.
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Conclusion: What Can Be Done to Reduce Harmful Effects of PTSD
The problem concerning infant death and the pregnancy complications that cause it, particularly, the PTSD issue and the depression that it inevitable triggers, call for a reconsideration of the therapy approaches used to address the needs of expecting mothers. It is suggested that the process of inhibiting serotonin production, which occurs in expectant mothers due to the increasing stress rates, should be managed with the help of SSRIs.
Furthermore, a comprehensive intervention strategy aimed at raising awareness among mothers-to-be and providing them with an opportunity to retain their optimism should be provided As long as the target patients realize that they have a strong support of their family members and/or the healthcare experts that cater to their needs, it is expected that the issue concerning infant death can be addressed successfully.
It is, therefore, strongly recommended that a very strong emphasis must be put on the tools that will allow creating the environment, in which mothers will be able to focus on the needs of their children to be born and should not be disturbed by any outside factors. Moreover, for the pregnant women that have suffered a specific trauma, the corresponding intervention and the subsequent treatment must be provided so that they could be able to retain their serotonin level high.
Thus, the threat of the instance of a PTB will be reduced significantly. As a result, the possibility of an infant death will drop as well. Addressing the issue of PTSD in mothers, one should pay special attention to the factors such as age, ethnicity, social and cultural background, family relationships, etc. Thus, the background of the patient can be identified and the factors that affect the mother negatively can be isolated. More importantly, the support of family members, which a PTSD pregnant woman requires greatly, can be provided.
Aftyka, A., Rybojad, B., Rozalska-Walaszek, I., Rzoñca, P., & Humeniuk, E. (2014). Post-traumatic stress disorder in parents of children hospitalized in the neonatal intensive care unit (NICU): Medical and demographic risk factors. Psychiatria Danubina, 26(4), 347-352.
Alkareem, L. A. K., & Ali, L. K. (2014). Maternal risk factors and neonatal complications of twins. International Journal of Advanced Research, 2(11), 135-143.
Bismuth-Evenzal, Y., Gonopolsky, Y., Gurwitz, D., Iancu, I., Weizman, A., Rehav, M. (2012). Decreased serotonin content and reduced agonist-induced aggregation in platelets of patients chronically medicated with SSRI drugs. Journal of Affective Disorders, 136(1-2), 99-103.
Hehir, M. P., Mctiernan, A., Martin, A., Carroll, S., Gleeson, R., Malone, F. D. (2015). Improved perinatal mortality in twins – changing practice and technologies. American Journal of Perinatology, 33(1), 84-89.
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