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Surviving Postnatal Depression

An insight into the care available for mothers with postnatal depression

Date : 06/11/2014

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Becky

Uploaded by : Becky
Uploaded on : 06/11/2014
Subject : Psychology

Surviving Postnatal Depression

I lost my baby due to a combination of reasons; all which had a massive impact on her life as well as my own. When I say lost my child I do in fact mean that she was cared for by her father. I didn't give her up for adoption. I was simply unable to look after her. I didn't abandon her either. I suffered from terrible postnatal depression that wasn't diagnosed by a health professional. This postnatal depression lasted for many years and was aggravated by other psychological conditions. I can recall one morning when I was feeding my baby milk and she was gazing up at me with clear blue eyes, I actually felt like thrusting the bottle into her and the feelings of guilt and horror were immediate. Another time she was crying in her cot and I could tell by her muffled sounds that the blanket must have risen and covered her face. My legs felt like lead as I tried to climb the stairs, each step taking longer and longer. I couldn't run and I only just got to her in time. Again the feelings of terror were immense. When she rolled down the stairs when I took my eyes of her for a second, I felt as if it was my fault and when she was ill and I couldn't care for her because of my own intense feelings of anxiety, again I felt I was to blame. I lost two stone in one week and no one seemed to notice. Not long after that I suffered a nervous breakdown due to my increased symptoms of anxiety and inability to cope. This was my own diagnosis as I did not receive assistance from a health professional at the time. In fact. I was never formally diagnosed with postnatal depression. My consequent research, degree in psychology and acquired knowledge allowed me to self diagnose many years after the birth of my child. I discovered that I had been displaying some of the most common symptoms of postnatal depression; guilt, feeling overwhelmed and unable to cope, panic attacks and a low mood for a long period of time (Wisner et al, 2002). It should have been the happiest days of my life with my baby and it was the worst. I never had another child because of my experience. Fortunately though the bond between my daughter and myself is steadfast despite everything but it highlighted the lack of recognition of the condition and support available. This occurred between the years of 1996 to 1998 but the effects were longer lasting and even today, 15 years later, I wonder if my condition has entirely gone. Therefore this article intends to ask: What's changed? Has detection of postnatal depression and its management of it improved? Howard (2004) suggests that postnatal depression can be broadly defined as non-psychotic depression occurring during the first 6 months postpartum. Muir (2007) proposes that over half of new mothers will experience baby blues. She states that baby blues can occur in up to 80% of new mothers and the tears are of emotion rather than depression. I experienced baby blues also whereby in the first few days after the birth I found myself in floods of tears for no reason. A new mother can feel 'down' 2 to 3 days after the birth and this can last a day or two. It is the result of exhaustion and hormonal surges. Postnatal depression, however, is longer lasting and stronger in its effects. Importantly, it can effect at least one in ten of new mothers. Symptoms can vary according to each unique individual and be different for each person in terms of how long a specific symptom may last and any changes that may take place along the course of the illness. Sharma et al (2004) explains that puerperal psychosis differs in that contact with reality is lost after birth; delusions and hallucinations can be experienced. It is much rarer than postnatal depression but seeing a doctor immediately is imperative. Beck (1998) categorises symptoms of postnatal depression to indicate areas such as anxiety, panic attacks, worrying thoughts, tension, irritability, aches and pains, sadness, sleeping difficulties, helplessness, appetite problems, guilt, shame, strange thoughts and loss of sex drive. The list is extensive and I had not realised that I was depressed postnatally; I simply thought I was unable to cope with anxiety and the demands of my new baby. However, though such an illness needs urgent treatment, primary care teams, despite easy and reliable detection procedures that have been created such as the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Depression Screening Test (PDSS), often still fail to diagnose it (Dennis et al, 2006). It is somewhat absurd that despite the well researched risk factors and detrimental health consequences for a postnatally depressed mother and her baby, such an illness still fails to be detected. Heneghan et al (2000) discovered in a cross-sectional study of 214 women who brought their children to a general paediatric clinic, that 86 reported depressive symptoms on the psychiatric symptom index (PSI) but unfortunately, of these women, only 29% were identified as depressed by the paediatric heath care providers. The study concluded that such health care professionals; made up of paediatricians, paediatric trainees and nurse practitioners, needed to ask the mothers more direct questions about maternal functioning and could also have benefited from using a structured screening tool designed to identify mothers most at risk for developing depressive symptoms. However, Heneghan et al (2000) additionally found mothers to be reluctant to discuss parenting stress and depressive symptoms with their child's paediatrician because of fear of judgement and lack of trust; a difficulty faced by many new mothers when considering confiding in any health care professional including midwives and health visitors. A health visitor visited me in my home and diagnosed postnatal depression but she didn't follow it up and I was too ashamed and anxious to seek support for myself. With this evidence of Heneghan's in mind Morrell et al (2010) developed the PoNDER trial (the POstNatal Depression Economical evaluation and Randomised trial) which involves training health visitors in cognitive behavioural techniques with a person-centered approach to assist mothers suffering from postnatal depression. Morrell et al (2010) agree that health professionals are not equipped to deal with mothers who are depressed and regularly miss important signs. The cluster randomised controlled trial revealed that training in identifying depressive symptoms and providing a psychologically informed intervention can positively benefit postnatally depressed women. This was the largest trial with regards to postnatal depression and health expert intervention. Understanding of this package of postnatal care is relevant to health visitors, nurses, counsellors and psychologists alike. Much of my symptoms were anxiety related more than depression and I considered this to mean that I wasn't suffering postnatal depression. Though a suitable questionnaire would have suggested such a diagnosis, provided an experienced clinician was able to assess for postpartum anxiety also (Tuohy and McVey, 2010) it is a reminder that women should be supported whatever their symptoms maybe after childbirth. If there was more of an awareness of the uniqueness of postnatal depression, perhaps more women would come forward for help. When addressing the type of intervention required to help the depressed mother, there are several strategies for the management of postnatal illness that can support the patient. This is essential, for if the illness is left alone; it may be more prolonged with a detrimental effect on the relationship between mother and baby as well as on the child's subsequent cognitive and emotional development. Sadly my illness was left untreated and only many years later did I receive therapy for anxiety which was considered as unrelated to the birth of my child. Hoffbrand et al (2001) endeavoured to evaluate the effectiveness of different anti-depressant drugs on the postnatally depressed mother as well as to compare their effectiveness with other forms of treatment. The data was found to be inconclusive, needing more trials with larger sample sizes as well as longer follow-up periods in which to be able to compare the effects of different anti-depressants with psychosocial interventions. However, Appleby et al (1997) used a randomised controlled treatment trial, double blind in relation to drug treatment with 4 treatment cells involving fluoxetine or placebo as well as 1 or 6 sessions of counselling with postnatally depressed women 6 to 8 weeks after childbirth. The results indicated an improvement in subjects receiving the antidepressant, which was significantly greater than those receiving the placebo. There was also improvement after 6 sessions of counselling significantly greater than a single session of counselling. However, there was no interaction found between medication and counselling. I received no medication after I had my child due to the lack of support that I received stemming from the lack of diagnosis. Do mothers understand the importance of medication to treat their symptoms? Chabrol et al (2004) researched mother's opinions of antidepressants and 405 women admitted in obstetrical clinics were questioned using a repeated measures design after delivery during their stay. Before mothers received information about the present knowledge on antidepressant treatment, the acceptability of antidepressants was significantly lower than psychotherapy and after information was given to the mothers, significantly more so again which highlights the uncertainty surrounding medication used for postnatal depression, not only with health professionals but mothers too. Plews et al (2005) insist that health visitors are in the ideal position to be able to help mothers with postnatal depression. Counselling, which is a systematic process that offers individuals a chance to explore and discover ways of living with a greater sense of well-being, has been evaluated in studies. Cooper et al (1997) suggests that systematic intervention that is non-directive in nature (based on supportive listening without giving advice) of around 6 to 8 sessions, delivered by primary health care workers such as health visitors, is effective in reducing mother's postnatal depression after having a baby compared with routine care. It has also been found, according to Lavender and Walkinshaw (1998) that midwives giving counselling and support as well as explanations about childbirth prior to labour, provide a better mental health of the mothers. Further positive results have been discovered by Seeley et al (1996). They compared two groups of women with postpartum depression consisting of 40 in each group; one group was the control group. They analysed the results from using the EPDS as well as the mother's experience of infant care including their perception of infant behaviour and their relationship with their infant as a questionnaire. They found the group that received health visitor intervention to have their difficulties to be reduced by half, while for the control group; the high rate of problems with their child did not reduce from six weeks to four months postpartum. Seeley et al (1996) concluded that health visitors can be trained in the detection and management of postnatal depression as well as difficulties with the mother-child relationship and as a result can provide an intervention that benefits depressed mothers. However, the study did have methodological flaws in that the groups were unmatched and the researchers employed a non-standardised questionnaire with regards to the perception of infant behaviour and relationship. It appears therefore, based on research, that health professionals such as midwives and health visitors are in the best position to offer mothers the emotional support and care that is needed and that their role is very significant. A mother may feel more able to confide in a health professional as she is more likely to have a trusting relationship with such an expert, particularly if she has known her midwife or health visitor throughout her pregnancy. I wish I'd had a health professional to talk to but was left isolated with only my family to attempt to support me. MacArthur et al (2003) looked at redesigned postnatal care compared to the current care on women's physical and psychological health after having a baby. Using a cluster randomised controlled trial with general practice as the unit of randomisation, 36 randomly selected general practice clusters were picked in the West Midlands Health Region. Midwives recruited 1087 women in the intervention and 977 in the control practice clusters. The results showed that the redesigned community postnatal care led by midwives which involved screening tests and symptom checklists used at various times in the postnatal period, individual care and visit plans based on needs as well as care delivered over a longer period, to be very beneficial for the postnatal mothers. There was an improvement in women's emotional health in comparison to current care at 4 months postpartum, which persisted at 12 months. This illustrates the positive outcome for midwifery-led care that is focused on individual women's physical and psychological health needs. De Craene (2002) adds that a midwife can help combat postnatal depression by not only merely visiting women according to their need but if they are also given the necessary tools and training to facilitate such a recovery.

In conclusion, this research indicates that change with regards to detecting postnatal depression and treating it effectively is somewhat slow in discovery. Perhaps not much has altered since I had my daughter but as Dennis et al (2006) states using a qualitative systematic review, there is a combination of problems occurring. Women feel unable to disclose how they feel and this is not helped by family and health professionals being reluctant to respond to her emotional needs. Stigma and myths do still exist, preventing a depressed mother from recognising her own symptoms and thus allowing her condition to deteriorate further and detrimentally affect her life. However, this 'ignorance' is reducing with celebrities now coming forward to say what they have suffered after having their children. I advocate further awareness and knowledge of this topic, to allow it to emerge from the shadows to decrease feelings of shame and worthlessness that such mothers commonly experience. Education and training for health professionals is urgently required and once this is more firmly in place, perhaps women who suffer from postnatal depression will become more proactive in seeking help. Hopefully then many new mothers will be saved from this enduring illness and truly enjoy the experience of motherhood.

References

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