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Suffering in Silence

Health Secretary Andrew Lansley said that no woman should have to cope with postnatal depression without help. As part of the recently announced pledges announced by the government to provide joined up care and focus on the emotional well-being of new parents is a promised £400 million investment in psychological and talking therapies to support women who suffer as a result of postnatal depression.

An estimated one in four of us may suffer from some form of mental illness during our lives and , 1 in 10 – over 70,000 women in England and Wales will suffer from postnatal depression (PND) following the birth of a child. It is not known if this figure includes women who report an inability to cope or general unhappiness after birth.

Over the last year, 4Children, the family outreach charity, launched its Give me Strength campaign, which looked at three causes of family instability and vulnerability, which they believe if addressed, can lead to improved family stability and a good start for children. One area targeted by the campaign was postnatal depression. 4Children carried out a survey via the Bounty parenting club into postnatal depression. The shocking results paint a picture of women and their families suffering in silence, a lack of awareness of the symptoms of PND and fear of being stigmatised as ‘being crazy’.

This survey, like others before, again suggests that women are very unhappy about revealing their concerns to health professionals when having to respond to formalised questioning on the subject. This can prevent many mothers who may benefit from early therapy coming forward – it was also reported that 49% of women did not seek help and of those women in the survey who sought help 30% said that they had to wait for nearly six months for that help. A supportive relationship with a midwife she knows could solicit this information in a sensitive way.

Similarly, a YouGov survey on behalf of the NSPCC of 516 women with children under one, reported that almost three quarters of all new mothers would have liked more professional advice before their baby was born. They wanted more information on how to deal with sleep deprivation and coping with their baby’s crying as well as anxiety, fear and depression. The survey also showed that at some point during the first eight weeks following birth, over half (57%) of mothers felt isolated with no-one to turn to. A significant number of new mothers, more than 1:3 (39%) admitted ‘getting angry’ with their baby, and 1:5 (20%) of mothers in that survey said that they were frequently “very upset” by their baby’s crying.

We should not underestimate the devastating impact of perinatal mental health on the child and should be aware that the woman’s partner could suffer as well. It is acknowledged that some partners can suffer from depression due to the sheer impact of trying to cope with a partner’s illness and or a new baby.

It is important to contextualise the degrees of mental health problems from pregnancy right through to birth and post birth. This would enable us develop an understanding and awareness that mental health problems in the perinatal period can range from unhappiness during the pregnancy or after birth to full-blown mental health disorder. That way, we we could develop more effective care with appropriate strategies in response to women’s specific symptoms – these may include a variety of supportive measures, talking therapies or other more significant therapies such as psychological or medications if appropriate. There are criticisms that some women who come forward to report symptoms for PND are too easily prescribed anti depressants instead of undertaking a broader holistic assessment to identify any underlying problems.

Two key recommendations from the Report are that GPs commit to offering psychological therapies and ‘social prescribing’ – befriending schemes and support groups if a diagnosis of PND is made. The second really relates mainly to midwives although the report implies that increasing the number of health visitors and reintroducing a new ante-natal role for health visitors would identify and support more women.

My view is that the health visitor has a role; however, midwives spend more time with the women during the perinatal period and have the unique opportunity to educate the woman about emotional well-being during pregnancy, post birth and being a parent. Midwives can, and should, discuss and enable the woman to understand that at times she may feel unable to cope, be unfamiliar and not confident with her new role as a parent or not liking the baby very much and feel vulnerable. We midwives should be able to spend a little more time with women in the perinatal period and ask them on every occasion how they are feeling and coping and offer specific help – which we ourselves do not necessarily have to provide, but can signpost or refer women on to.

As a society, we probably do not understand the extent to which perinatal mental health problems can impact adversely on families and in particular children. There is a paradox of society’s expectation of the happy mother, perfect parents with a much loved baby. This is in contrast compared to the hidden realities of becoming and being parents, and at times the emotional anguish of women and their partners behind closed doors, trying to fit into this neat societal construct.