Week Three

At 18 months of age, Wendy is a healthy child who seems, on the outside, to be developing along a typical pathway. Sierra went to a group for mothers with newborns, but the challenges of childcare for her older daughter were too much, and she stopped going after 3 sessions. She eventually got in to see a psychiatrist after having to wait for 4 months to get an appointment. She was prescribed Wellbutrin, and she took it for a few weeks. Not feeling any better, she stopped taking the medication. 

Sierra was overwhelmed with the demands of caring for her two children and couldn't find any time for herself - to exercise or just to be. By the time the kids were in bed at night, she was exhausted. On top of it all, she couldn't help but think that Wendy didn't like her. Sometimes Wendy gave her that "look" that Sierra thought was like she was glaring at her mother. She knew she loved her daughter, but she didn't feel that her daughter loved her.   

 
* Outline the typical developmental milestones for an 18 month old child. Be sure to include physical, cognitive, social, and emotional domains.

* Describe the manner in which typical anti-depressants like Wellbutrin work in the brain. How long does it take for them to be effective? In other words, did Sierra perhaps stop taking the medication too quickly? 

* From the standpoint of parent-child attachment, what are the risks associated with parental (in this case maternal) depression? In other words, if Sierra is clinically depressed, to what extent will she be able to respond to Wendy? Cite information from the literature on attachment. Describe the basic attachment styles.

DECISION POINT ::: What kind of attachment does Wendy develop with her mother? 

Week Two

Sierra was ready for Wendy to be born – it had been a long pregnancy, and, in the heat of the summer, it was even more difficult to be pregnant. Sierra was miserable and ready to get on with being a mom again. Her older daughter was staying with a friend when Sierra went to the hospital to deliver Wendy. All seemed relatively normal to Sierra – she did have a bit of a headache – but it turned out that Sierra had preeclampsia and had to have a Cesarean section.

Sierra had chosen to keep her health insurance policy, as bad as it was, which meant that she was going to be responsible for a hefty chunk of the hospital bill. She didn’t know how she would pay, and, while the thought barely crossed her mind as she met Wendy for the first time, she knew that the financial aspect of her life would be a huge obstacle. Add to that the fact that a complication developed with the incision the doctor had made for the Cesarean – it had developed a hematoma and was slightly infected. The doctors chose not to discharge Sierra for an additional day and a half.

Once Sierra and Wendy finally came home, Wendy continued to breastfeed. Sierra introduced her older daughter to Wendy, and the three enjoyed the company of friends and co-workers throughout the first several weeks. Sierra didn’t often have to feed herself as friends brought ready-made meals, making the challenges of raising a 2 year old and a new born that much easier.

Wendy was a delightful baby who seemed to be happy and healthy. Sierra was thrilled, but there was this growing, nagging sense that something was wrong. There was nothing wrong with Wendy, but Sierra had a creeping sense of doom and foreboding. She recognized the familiar sense of depression beginning to emerge.   

* What are the risks associated with a Cesarean section delivery? There is some debate in the birthing community regarding that surgery and vaginal delivery. Which is safer? Under what circumstances would someone choose to have a Cesarean section versus a vaginal deliver? Does a Cesarean preclude later vaginal delivery? (Hint: Look at the term VBAC) What are the costs associated with Cesarean versus vaginal delivery?

* Outline the typical developmental milestones for newborns and infants in their first year.

* What are the recommended immunizations for newborns? What immunizations are typically provided just after birth? Which ones in the first year? How frequently should the newborn visit the pediatrician in terms of what is recommended? What is the CHAT and when is it given to parents? Outline Wendy’s first year in terms of doctor visits. Provide rough information as to the fees associated with these visits.

* What is preeclampsia? What is postpartum depression? What is the prevalence of the disorder? How is it typically treated? What resources might be available to Sierra in terms of self-care? Describe the potential impact of postpartum depression on parent-child attachment.

DECISION POINT :::

What does Sierra do to help manage her depression?

Week One

Sierra Hernandez’s life didn’t quite work out the way she might have hoped. At age 38, she was pregnant with her 2^nd child, and her live-in boyfriend/fiancé had just decided that he wanted to move across the country to study art. She couldn’t believe it – the two were planning to be married, and Sierra was shocked that he could be so cavalier about their 2 year old daughter and the new baby on the way. Sierra didn’t know how she would make ends meet, but she persevered and was thankful for the apartment she had and the job that paid pretty well. Sierra was angered, however, by her company’s decision to eliminate the health care benefit that employees had had for several years; she had a policy when her first daughter was born and hence had very little to pay when for the hospital delivery. She now had her own policy which she could barely afford – and she was worried about what the cost of having her new baby might be. One thing she knew – that she would name the new baby after her good friend who helped her through her darkest days – Wendy. Sierra looked forward to being a mother again, and, though it would be hard, she welcomed the sleepless nights and growing cries of a newborn.   

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     1) What are the typical developmental milestones for the child in utero? Outline the stages of pregnancy and the threats to optimal development at each stage. When are teratogens most dangerous for the developing child?

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     2) What effect does “advanced maternal age” have on the process of pregnancy? Are there precautions generally taken by an OB/GYN? What are they? Where in Virginia might one for specialized genetic testing regarding possible birth defects? When are tests done in the course of pregnancy? Why are they done at those times?  

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     3) Given Sierra’s depression, it is possible that she might want to go on antidepressants. Are any of those medications contraindicated during pregnancy?

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     4) What does it typically cost the family/mother to deliver a baby at a hospital? What options does Sierra have with regard to health insurance? Is being pregnant considered a “pre-existing condition” that might prevent one from obtaining health insurance?

 

DECISION POINT ::: Does Sierra drop her current insurance policy and try to obtain another one?