At any rate, I have a world class statistician waiting to run the numbers as soon as I am ready with them. He knows it is on hold for reasons of 'study integrity.' This is no joke.
Mood Experience Pre, Intra and Post Natal Experience for Families
INTRODUCTION
With the death of five innocent children, the conclusion of the Andrea Yates trial and now the district attorney wanting to prosecute Russell Yates some real questions arise to the competency of the system that touches all our lives. The medical and legal communities have deficits to the adequacy of knowledge and support the American Landscape offers young and experienced, as well as inexperienced couples in planning for, experiencing and coping with pregnancy and the family beyond (Dimitrious).
The purpose of this study is to provide the groundwork for continued examination, at an interval to be decided later, allowing a quantitative measure of mood experience to the North Carolina family (Murray) pre-, intra- and post-natal.
An examination of the literature available, which although insightful is still not vast in volume, revealed interesting and rather solid evidence of a dynamics that plays through the development of family through pregnancy. The focus, of course, is primarily on the woman carrying the pregnancy to term without complications, which in this day and age can be a unique experience. The family experience through pregnancy in the United States of America can be laced with issues such as infertility, past abortion, surrogate parenthood, embryo donation, sperm bank donation, the very controversial cloning as well as the “norm” of the two parent fertile couple.
In focusing on the female experience within the family through pregnancy process there are definitive physiological processes that impact on the psychological stability. (The literature bears this out and will be cited at a later time.) To speak to pregnancy, there is an increase of 25% to 30% estrogen levels to support the uterus, placenta and baby to term.
Estrogen, like all other hormones, especially sex hormones including testosterone, is a steroid. The reason for the increase in estrogen levels seems obvious to me, in that the female’s body not reject the pregnancy. In many instances the baby and placenta are seen as separate organs and organisms. The fetus may have different blood types and Rh factors and yet through the entire pregnancy the placenta (where the mother and fetal blood mix) and fetus are supported by the uterus through these wonderful steroids known as hormones.
The astonishing cruelty of childbirth to the female primipara or multipara is the immediate drop in estrogen levels to hopefully normal levels. The result of this an inevitable fall into depression for estimates ranging from every woman to 60% to 80% of women. This fall from grace takes on three recognized forms of mood disorder, “The Baby Blues”, postpartum or postnatal depression and postpartum psychosis.
The symptoms are well documented and definitive. (citations and facts to be included.) The problem in obtaining active support for women and men during this period falls with the American Psychiatric Association itself. In the second edition of their diagnostic manual, DSM-II in 1968, postpartum psychosis is limited to an organic condition induced by childbirth. They further diminished its importance and impact in the DSM-III in 1980and it’s revision in 1987, where the psychosis is mentioned as an atypical psychosis.
The final blow to adequate and sustained treatment for postpartum psychosis came in 1995 in the DSM-IV when the association mentions “postpartum” as only an onset specifier. By limiting “postpartum” as an ONSET specifier it ranks this particular psychosis in with all other psychosis and exposes females to a western medicine regime completely disregarding the reason for onset, which includes drastic falls in estrogen. This is of grave concern as it depersonalizes the special needs of women, provides inadequate care, impacts on their ability to parent, their ability to return to spousal enjoyment, commitment and role function, serves as a threat to family stability and ultimately dysfunction in career and/or education.
In other studies primarily outside the USA; but in countries with value systems similar, such as Great Britain and Australia; some remarkable observations have been made. For example, in one study 10 out of 11 women treated for postpartum psychosis showed remarkable results by simply administering estrogen until normal levels were reached. In yet other studies, women were hospitalized for postpartum disorders including psychosis with the infant. This proved to be invaluable in resolving feelings of inadequacy in a controlled clinical setting while instilling good quality parenting skills. An occasional study showed postpartum depression and psychosis in men following the birth of children and yet another study incorporated the male’s feelings as well. In an extended study of children with mothers that suffered post partum psychosis revealed developmental problems in the children as they grew up.
In addition to the physiological component there are the individuals themselves, their personalities, life experiences, emotional status, preparedness for adulthood and its responsibilities. This is an aspect mostly overlooked in studies and yet a vital component of quality of life. It is the hope of this study to bridge that gap as well and make it a focus to the quality of care expectant families receive pre-, inter- and post-natal.
METHOD
Subjects and Design
This study will include the obstetrical clinics of major teaching hospitals in North Carolina, Baptist Medical Center in Winston-Salem, Duke Medical Center in Durham, University of North Carolina Medical Center in Chapel Hill and Pitt Memorial Hospital in Greenville. The study will handle all correspondence with these medical centers with complete confidentiality to ensure quality and quantity of participation by same.
The hospitals will be requested to provide a mailing list, obtained from current computer files of clients to their clinics for the past six months. This will provide a broad base of participants from a variety of socioeconomic and ethnic backgrounds, which will also act as an interpreting qualifier of the study. There will be a large enough number of participants to allow the sample to have significant impact without dispute. I dare say, a near complete sample of the North Carolina birth experience with few exceptions of smaller hospital systems in a six month window. This study will begin and conclude in an interesting point of time as well, post September 11th as well as post Yates Prosecution. This will add an element of societal stress that will tend to exacerbate the negative feelings accompany family planning, pregnancy and post-natal experience. This study is a quality of life study.
MEASURE
A survey will be mailed to all prospective participants on the mailing lists provided by the medical centers. The survey will consist of a minimum of twenty identified moods of which ten are considered positive and ten negative. The female participants will be asked to exclusively fill out this survey expressing their experience pre-, intra-, and post-natal on a scale of 1 through 5 with the option of not at all with the responding number 1. To use the number zero would effect the statistics to drastically.
The statistical measures will be standard mean, median, t test and critical value with explanation of outliers. Graphs to be derived through EXCEL. This can be accommodated differently, including the purchase and use prescribed computer program for use by participating statistician. Also under consideration an expanded research of the global literature through the use of PROCITE already in possession of author(s).
DATA
To Follow.
DISCUSSION
Anticipated an interactive discussion at length and though between contributing authors to achieve the best perspective for analysis and impact at the conclusion of raw data and post statistical analysis.
