Miscarriage misconceptions boost feelings of guilt and shame, study says

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causes, guilt, isolation, loss, miscarriage, misconceptions, pregnancy, shame, stigma

Miscarriage misconceptions boost feelings of guilt and shame, study says

Feelings of guilt and shame in women who experience miscarriages are exacerbated by misconceptions over the causes, a US study suggests.

An online survey of 1,084 people, which formed the basis for research published in the Obstetrics & Gynecology journal on Monday, found that almost half of those who had a miscarriage felt guilty. Two in five said they felt like they had done something wrong, and the same number reported feeling alone.

A significant number of the respondents were under misapprehensions as to what caused the loss of the pregnancy. Three-quarters believed that a stressful event could bring about a miscarriage, 64% thought that lifting a heavy object could be a cause, and a fifth that previous use of oral contraceptives could induce pregnancy loss.

Coupled with the fact that 57% of those who had suffered a miscarriage said they were not given a cause for the loss, the researchers, from the Albert Einstein College of Medicine at Yeshiva University and Montefiore Medical Center, both in New York, believe such misapprehensions could contribute to the the negative feelings experienced.

Dr Zev Williams, the director of the programme for early and recurrent pregnancy loss, said: “The results of our survey indicate widespread misconceptions about the prevalence and causes of miscarriage. Because miscarriage is very common but rarely discussed, many women and couples feel very isolated and alone after suffering a miscarriage. We need to better educate people about miscarriage, which could help reduce the shame and stigma associated with it.”

The respondents, who were self-selecting, filled in a 33-question survey, which was open for three days in 2013, to assess perceptions of miscarriage, with 10 of the questions specifically directed at men or women reporting a history of miscarriage.

Of those who took part 15% said they or their partner had suffered a miscarriage, but the majority of respondents (55%) believed that miscarriages are uncommon (defined as less than 6% of all pregnancies). The truth is that miscarriages end one in four pregnancies and are by far the most common pregnancy complication, the paper says.

A fifth of people incorrectly believed that lifestyle choices during pregnancy, such as smoking or using drugs or alcohol, were the single most common cause of miscarriage, more common than genetic or medical causes. In reality, 60% of miscarriages are caused by a genetic problem.

The importance of hearing from others who have gone through the same experience was highlighted by a significant minority of those who had suffered a loss in pregnancy. Almost half said they felt less alone when friends disclosed their own miscarriage and 28% stated that celebrities’ disclosure of miscarriage had eased their feelings of isolation.

The authors concluded: “Patients who have experienced miscarriage may benefit from further counselling by healthcare providers, identification of the cause, and revelations from friends and celebrities. Healthcare providers have an important role in assessing and educating all pregnant patients about known prenatal risk factors, diminishing concerns about unsubstantiated but prevalent myths and, among those who experience a miscarriage, acknowledging and dissuading feelings of guilt and shame.”

The majority (55%) of respondents were women and all were aged 18-49. The sociodemographic distribution across gender, age, religion and geographic location and household income was consistent with 2010 national census statistics but race and ethnicity were not.

Explaining tokophobia, the phobia of pregnancy and childbirth

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anxiety, birth, childbirth, distress, fear, hyperarousal, labour, media, negative birth experience, panic, positive birth experience, post-birth PTSD, pregnancy, PTSD, social media, symptoms, tokophobia, trauma, treatment

Explaining tokophobia, the phobia of pregnancy and childbirth

For expectant mothers, it’s very normal to approach birth with a feeling of trepidation, particularly for the first baby. From the moment a pregnancy is announced, the average pregnant woman is inundated with horror stories of pain and long labours by supposed well-meaning friends, and it can be hard to focus on a positive birth experience when you don’t know what to expect.

But for some women, the fear of childbirth goes beyond trepidation into full-blown anxiety, panic and fear. Known as tokophobia, this phobia of childbirth affects somewhere between 3-8 per cent of pregnant women.

Symptoms include worries specifically about the pregnancy and birth, a fear of harm or death related to the birth, poor sleep, and a sense of hyper-arousal (rapid heartbeat and breathing, difficulty winding down). The fear of childbirth is a common non-medical reason for requesting a caesarean section, and women with this fear have a much higher rate of both caesarean delivery and use of epidural anaesthesia.

There is no clear path to developing fear of childbirth, but there are some risk factors that we know about. A history of anxiety or depression is one risk factor, as is a history of childhood abuse, be it sexual, physical or emotional abuse.

Some studies have also identified patterns with age, suggesting younger mums are more vulnerable, as are those with less education, and mums without a strong social network.

However, a recent study found that one of the biggest influences women reported on their fear of childbirth was the media. Hospital-based reality television programs and medical dramas often feature storylines with dramatic emergency situations during childbirth and this may be all women know of giving birth prior to the event.

We also know that around 95 per cent of pregnant European women report searching for pregnancy and birth information online, and social media and blogs hold the potential for the circulation of misinformation that may heighten fears rather than allay them.

There is another group of women who may find pregnancy and childbirth frightening due to related fears. One of the most common phobias in adults is blood/injury phobia, often including a fear of injections. Pregnancy and childbirth is hence very confronting for these women, who may faint or experience extreme distress at even routine blood tests throughout their pregnancy.

Researchers have found that for first time mothers, a positive birth experience can often relieve the fear of childbirth so that it is no longer an issue for future pregnancies. However, whether or not women start with a fear of childbirth, a negative birth experience can make them up to five times more likely to develop tokophobia for future pregnancies.

A negative experience of birth may be due to complications, feeling out of control, dissatisfaction with care providers, or just not having the birth that was expected. Between 2-6 per cent of women report post-traumatic stress syndrome (PTSD) following a difficult birth experience. PTSD is the disorder once known as ‘shell shock’ for its affliction of soldiers following war, and is characterised by nightmares and re-experiencing of the birth trauma, avoidance of all reminders of the birth, and hyper-arousal. Without treatment, PTSD can limit family size and cause problems in women’s relationships with their partner and their child.

While we may not hear much about tokophobia and post-birth PTSD, their prevalence suggests we do need to look out for women who may be suffering both before and after birth. In addition to the distress at the time, stress and anxiety during pregnancy are linked to a higher rate of preterm birth and later behavioural problems in children.

The good news is that like all anxiety disorders, the fear of childbirth and PTSD can be addressed and treatments are available. One of the most vital elements of treatment is education on birth, whether through the obstetric care provider, midwives, or antenatal classes. Knowing what to expect and having an agreed plan with your care provider can assist to overcome some of the irrational fears.

Linked to this, a supportive and trusting relationship with the care providers who will manage the birth is essential. This is not always possible as some obstetric settings do not allow for repeated contact with the same provider, but a relationship of trust will be more likely to create a positive birth experience.

When problems do occur in pregnancy and birth, a post-birth debriefing can be useful and may help prevent the development of PTSD symptoms. Understanding what went wrong and why things happened the way they did can help with processing the events and accompanying trauma.

As with other anxiety disorders, relaxation, light exercise and slow breathing can help to calm the body and relieve the hyper-arousal that comes with the fear of childbirth. A psychologist can assist with other anxiety management techniques that can help to minimise fears.

For those who find the idea of pregnancy and birth overwhelming, it is important to know that help is available and such symptoms can be successfully treated. The first step is confiding your fears so that those around you can start to support you through what could be a wonderful journey.

A third of first-time mothers suffer depressive symptoms, research finds

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baby, Children, Depression, depressive symptoms, diagnosis, early years, first-time mothers, four years postpartum, GPs, health professionals, health visitors, irritable, low mood, maternal health, mental health issues, midwives, mothers, new mothers, parents, Postnatal Depression, postpartum, pregnancy, risk, signs, tearful, training, worrying

A third of first-time mothers suffer depressive symptoms, research finds

One in three first-time mothers suffers symptoms of depression linked to their baby’s birth while pregnant and/or during the first four years of the child’s life, according to research.

And more women are depressed when their child turns four than at any time before that, according to the study, which challenges the notion that mothers’ birth-related mental struggles usually happen at or after the baby’s arrival.

The findings have led to calls for all women giving birth in the UK to have their mental health monitored until their child turns five to ensure that more of those experiencing difficulties are identified.

The results are based on research in Australia, but experts believe that about the same number of women in the UK experience bouts of mental ill-health associated with becoming a mother.

In all 1,507 women from six hospitals in Melbourne, Australia, told researchers from the Murdoch children’s research institute and royal children’s hospital in Parkville, Victoria, about their experience of episodes of poor mental health at regular intervals until their child turned four.

The authors found that almost one in three first-time mothers reported “depressive symptoms on at least one occasion from early pregnancy to four years postpartum [and that] the prevalence of depressive symptoms was highest at four years postpartum”. The women’s depressive symptoms are often short-lived episodes and do not mean that the women were diagnosed with postnatal depression. Studies in both the UK and internationally have estimated that between 10% and 15% of new mothers suffer from that clinical condition.

The researchers also found that four years after the child’s birth 14.5% display depressive symptoms, of whom 40% had not previously reported feeling very low. At that time, women with only one child were much more likely (22.9%) than those with two or more offspring (11.3%) to be depressed.

Dr Jim Bolton, a member of the Royal College of Psychiatrists and a consultant psychiatrist at a London hospital, said that one in three women giving birth in the UK were likely to become depressed at some point during those first four years. “If a similar study was done here, I wouldn’t be surprised if the results were similar. Usually the sorts of mothers who are at greater risk of depression are younger mothers who feel they can’t cope and mothers living in situations of adversity or deprivation or partner violence,” he said.

“These findings are about depressive symptoms, which can be very short-lived, not a formal diagnosis of illness or postnatal depression. This study isn’t saying that one in three women gets that,” stressed Bolton, who treats mental health problems in pregnancy and after birth among new mothers in his hospital’s women’s health unit.

The authors recommend that the UK overhauls its monitoring of maternal mental health, which focuses on pregnancy and the early years after birth, because more than half the women who experience depression after becoming a parent are not identified by GPs, midwives or health visitors.

More women could have postnatal depression than the usual estimate of 10%-15% partly because women may mistake the signs of it – which include being more irritable than usual or unusually tearful, inability to enjoy being a parent or worrying unduly about the baby’s health – as being things undergone by all new mothers.

Health professionals do not always spot it or ask the right questions to identify it, though are far more aware of it than ever, Bolton added.

One leading psychiatrist said that the one in three women who had depressive symptoms was between two and five times higher than the estimated number of people in the general population who would experience serious low mood in their lifetime, but was higher than the number of women who experienced the most severe forms of depression. Between 5%-10% of people generally suffer major/serious depression during their lifetime.The study, published in BJOG: An international journal of obstetrics and gynaecology, is the first to follow a sizeable number of new mothers for as long as four years after birth. Elizabeth Duff, senior policy adviser at the parenting charity the NCT, said: “This study has included mothers for four years after birth, so suggests that perinatal mental health needs to be monitored for a longer period. Given the devastating effects of postnatal depression, health professionals should give equal consideration to the mental and physical health of parents with young children.”

A Department of Health spokeswoman said it welcomed any new research that would lead to women receiving better help with maternal depression.

“We want to do everything we can to make sure women and families get as much support as possible throughout pregnancy and beyond. That’s why, earlier this month, we announced that expert training in mental health will be rolled out for doctors and midwives to identify and help women who are at risk of depression or other mental health issues,” she said.

Numbers of midwives and health visitors have been growing under the coalition, while specialist mental health doctors and midwives will help improve earlier diagnosis of such problems, she added. However, the Royal College of Midwives said that even more midwives were needed to ensure mothers received the best possible care of their psychological welfare.

Thousands of children sexually exploited each year, inquiry says

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abortion, abuse, alcohol, child sexual exploitation, Children, control, crime, drugs, gangs, humiliation, mental health issues, miscarriage, perpetrators, power, pregnancy, punish, rape, sexual assault, smartphones, social networks, STDs, support, threaten

Thousands of children sexually exploited each year, inquiry says

Thousands of children are raped and abused each year, with many more cases going unreported by victims and unrecorded by the authorities, according to an official study presented as the most comprehensive inquiry to date of the scale and prevalence of child sexual exploitation in England.

The disturbing and at times horrific study, which describes a range of traumatic and violent sexual crimes perpetrated mainly against girls, by male teenage gang members and groups of older men, was described as a “wake-up call” for safeguarding professionals by the Office of the Children’s Commissioner for England (OCCE).

It draws an alarming picture of serious sexual crimes against children: girls groomed, then drugged and raped at seedy “parties” in private homes and warehouses organised by groups of men, for profit or pleasure; assaults in public parks, schools and alleyways by gang members influenced by violent pornography, and intent on threatening, punishing or controlling young women by means of forced oral sex, and anal and vaginal rape.

The report says that victims commonly suffer serious physical and emotional harm as a result of their experiences, including severe mental illness, and drug and alcohol problems. Some victims contract sexually transmitted diseases, become pregnant, have terminations or suffer miscarriages.

“The reality is that each year thousands of children in England are raped and abused by people seeking to humiliate, violate and control them. The impact on their lives is devastating,” said the inquiry chair, deputy children’s commissioner Sue Berelowitz.

The inquiry was established in 2011 to investigate what it saw as mounting concern about child sexual exploitation. The inquiry team, comprising academics and senior safeguarding professionals from the police, NHS and charities, collected data and evidence from local authorities, police forces and primary care trusts. It took oral evidence from 68 professionals and 20 sexually exploited children across the country.

It concluded that too often police, local authorities and other safeguarding agencies have failed to spot or act on the warning signs of sexual exploitation, despite what it says is 20 years of evidence that large numbers of children are being sexually exploited in the UK. “Too many child victims are not getting the protection and support they need,” writes Berelowitz in the foreword to the report.

It criticises safeguarding professionals who labelled victims as “promiscuous” or “asking for it”. This “worrying perspective” suggested officials too often assumed that sexually exploited children, many of whom exhibited disruptive or aggressive behaviour, were “complicit in, and responsible for, their own abuse”.

Debbie Jones, president of the Association of Directors of Children’s Services, said: “It is clear that we cannot make assumptions about victims or perpetrators based on their age, ethnicity or whether they are in care. Making such assumptions will risk some children not being identified as being sexually exploited and not receiving the protection that they so desperately need.”

The inquiry’s interim report published by the OCCE says that despite media attention surrounding a number of high-profile court cases involving groups of Pakistani men and white British female victims, sexual exploitation was widespread. There was no evidence that perpetrators belonged disproportionately to a particular ethnic group.

“The vast majority of the perpetrators of this terrible crime are male. They range in age from as young as 14 to old men. They come from all ethnic groups and so do their victims – contrary to what some may wish to believe,” writes Berelowitz.

The study found the largest group of perpetrators were classed as “white” males, but because there were gaps in official data recording, and because many victims found it hard to identify their attackers, it was impossible to estimate accurately who and how many people were sexually exploiting children.

“What all perpetrators have in common – regardless of the differences in age, ethnicity, or social background (information on disability or sexual orientation was rarely available) – was their abuse of power in relation to their victims, and that the vast majority were male,” the report said.

Although it identified 2,409 children and young people as “confirmed victims” of sexual exploitation in gangs or groups over a 14-month period, and estimated that 16,500 children were at “high risk” of sexual exploitation during a 12-month period, the report said this was an undercounting of the true scale of the problem. The report did not consider cases of sexual exploitation by “lone perpetrators”.

Anne Marie Carrie, chief executive of Barnardo’s, which works with 1,000 victims of child sexual exploitation each year, agreed that the figures were undercounted: “We agree with the OCCE that it is likely that the figures of both confirmed victims and those at high risk only show us the tip of the iceberg.

All kinds of children and young people, both male and female and across a range of ethnic backgrounds, were sexually exploited, the report found. Although vulnerable youngsters in care or from dysfunctional families were most at risk, children “from loving and secure homes” were also abused by gangs and groups.

“The characteristics common to all victims are not their age, ethnicity, disability or sexual orientation, rather their powerlessness and vulnerability,” the report states.

The study found that 28% of the victims reported to the inquiry were from black and minority ethnic backgrounds. The report says: “This information is significant, given that the general perception appears to be that sexual exploitation by groups, in particular, is primarily a crime against white children.”

Technology was used widely to initiate, organise and maintain child sexual exploitation. Victims reported being harassed through text messages, and perpetrators would often film and distribute incidents of rape via smartphones and social networking. Younger perpetrators had in many cases been exposed to violent pornography, the inquiry found, and it speculated that this informed abusers’ understanding of sexual relationships.

Berelowitz writes: “We need to ask why so many males, both young and old, think it is acceptable to treat both girls and boys as objects to be used and abused. We need to know why so many adults in positions of responsibility persist in not believing these children when they try to tell someone what they have endured.”

Iraq records huge rise in birth defects

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ammunition, Basra, battle, birth defects, bombardment, brain dysfunctions, Children, Fallujah, health crisis, heart defects, Iraq, lead, malformed limbs, mercury, metals, miscarriage, neuro-toxic metal contamination, pregnancy, stress, toxicology, war, white phosphorus shells, WHO

Iraq records huge rise in birth defects

It played unwilling host to one of the bloodiest battles of the Iraq war. Fallujah’s homes and businesses were left shattered; hundreds of Iraqi civilians were killed. Its residents changed the name of their “City of Mosques” to “the polluted city” after the United States launched two massive military campaigns eight years ago. Now, one month before the World Health Organisation reveals its view on the legacy of the two battles for the town, a new study reports a “staggering rise” in birth defects among Iraqi children conceived in the aftermath of the war.

High rates of miscarriage, toxic levels of lead and mercury contamination and spiralling numbers of birth defects ranging from congenital heart defects to brain dysfunctions and malformed limbs have been recorded. Even more disturbingly, they appear to be occurring at an increasing rate in children born in Fallujah, about 40 miles west of Baghdad.

There is “compelling evidence” to link the increased numbers of defects and miscarriages to military assaults, says Mozhgan Savabieasfahani, one of the lead authors of the report and an environmental toxicologist at the University of Michigan’s School of Public Health. Similar defects have been found among children born in Basra after British troops invaded, according to the new research.

US marines first bombarded Fallujah in April 2004 after four employees from the American security company Blackwater were killed, their bodies burned and dragged through the street, with two of the corpses left hanging from a bridge. Seven months later, the marines stormed the city for a second time, using some of the heaviest US air strikes deployed in Iraq. American forces later admitted that they had used white phosphorus shells, although they never admitted to using depleted uranium, which has been linked to high rates of cancer and birth defects.

The new findings, published in the Environmental Contamination and Toxicology bulletin, will bolster claims that US and Nato munitions used in the conflict led to a widespread health crisis in Iraq. They are the latest in a series of studies that have suggested a link between bombardment and a rise in birth defects. Their preliminary findings, in 2010, prompted a World Health Organisation inquiry into the prevalence of birth defects in the area. The WHO’s report, out next month, is widely expected to show an increase in birth defects after the conflict. It has looked at nine “high-risk” areas in Iraq, including Fallujah and Basra. Where high prevalence is found, the WHO is expected to call for additional studies to pinpoint precise causes.

The latest study found that in Fallujah, more than half of all babies surveyed were born with a birth defect between 2007 and 2010. Before the siege, this figure was more like one in 10. Prior to the turn of the millennium, fewer than 2 per cent of babies were born with a defect. More than 45 per cent of all pregnancies surveyed ended in miscarriage in the two years after 2004, up from only 10 per cent before the bombing. Between 2007 and 2010, one in six of all pregnancies ended in miscarriage.

The new research, which looked at the health histories of 56 families in Fallujah, also examined births in Basra, in southern Iraq, attacked by British forces in 2003. Researchers found more than 20 babies out of 1,000 were born with defects in Al Basrah Maternity Hospital in 2003, a number that is 17 times higher than recorded a decade previously. In the past seven years, the number of malformed babies born increased by more than 60 per cent; 37 out of every 1,000 are now born with defects.

The report’s authors link the rising number of babies born with birth defects in the two cities to increased exposure to metals released by bombs and bullets used over the past two decades. Scientists who studied hair samples of the population in Fallujah found that levels of lead were five times higher in the hair of children with birth defects than in other children; mercury levels were six times higher. Children with defects in Basra had three times more lead in their teeth than children living in non-impacted areas.

Dr Savabieasfahani said that for the first time, there is a “footprint of metal in the population” and that there is “compelling evidence linking the staggering increases in Iraqi birth defects to neuro-toxic metal contamination following the repeated bombardments of Iraqi cities”. She called the “epidemic” a “public health crisis”.

“In utero exposure to pollutants can drastically change the outcome of an otherwise normal pregnancy. The metal levels we see in the Fallujah children with birth defects clearly indicates that metals were involved in manifestation of birth defects in these children,” she said. “The massive and repeated bombardment of these cities is clearly implicated here. I have no knowledge of any alternative source of metal contamination in these areas.” She added that the data was likely to be an “underestimate”, as many parents who give birth to children with defects hide them from public view.

Professor Alastair Hay, a professor of environmental toxicology at Leeds University, said the figures presented in the study were “absolutely extraordinary”. He added: “People here would be worried if there was a five or 10 per cent increase [in birth defects]. If there’s a fivefold increase in Fallujah, no one could possibly ignore that; it’s crying out for an explanation as to what’s the cause. A rapid increase in exposure to lead and mercury seems reasonable if lots of ammunition is going off. I would have also thought a major factor would be the extreme stress people are under in that period; we know this can cause major physiological changes.”

A US Defense Department spokesperson said: “We are not aware of any official reports indicating an increase in birth defects in Al Basrah or Fallujah that may be related to exposure to the metals contained in munitions used by the US or coalition partners. We always take very seriously public health concerns about any population now living in a combat theatre. Unexploded ordnance, including improvised explosive devises, are a recognised hazard.”

A UK government spokesperson said there was no “reliable scientific or medical evidence to confirm a link between conventional ammunition and birth defects in Basra”, adding: “All ammunition used by UK armed forces falls within international humanitarian law and is consistent with the Geneva Convention.”

Dr Savabieasfahani said she plans to analyse the children’s samples for the presence of depleted uranium once funds have been raised. She added: “We need extensive environmental sampling, of food, water and air to find out where this is coming from. Then we can clean it up. Now we are seeing 50 per cent of children being born with malformations; in a few years it could be everyone.”

Metal hazards

Lead

Throughout pregnancy, lead can pass from a woman’s bones to her child; the levels of lead in maternal and foetal blood are almost identical. Children and particularly the unborn are more susceptible to lead than adults. At high levels of exposure, lead attacks the brain and central nervous system, causing comas, convulsions and even death, according to the WHO. Children who survive acute lead poisoning are typically left with mental defects and behavioural problems.

Mercury

Exposure to metallic, inorganic or organic mercury can permanently damage the brain, kidneys and developing foetus. Mercury can enter the air, water and soil. Its harmful effects can be passed from mother to the unborn child, leading to brain damage, mental defects, blindness, seizures, muteness and lack of co-ordination.

Depleted uranium

A toxic heavy metal, depleted uranium is what is left over after natural uranium has been enriched, either for use in weapons or for reactor fuel. While the US and UK acknowledge that the dust can be dangerous if inhaled, the jury is still out when it comes to long-term damage to people and their children. Scientists have suggested that its molecules can travel to the sperm and eggs, increasing the probability of cancer and damage to genes.

Indiana prosecuting Chinese woman for suicide attempt that killed her foetus

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Bereavement, miscarriage, pregnancy, suicide

Indiana prosecuting Chinese woman for suicide attempt that killed her foetus

When her baby Angel died in her arms at 1.30am on 3 January 2011, Bei Bei Shuai was so distraught she was instantly transferred to the mental health wing of the Methodist hospital in Indianapolis. Grief stricken and under heavy sedation, she was unaware that within half an hour of her baby’s death a detective from the city’s homicide branch had arrived at the maternity ward and had begun asking questions.

While Shuai was embarking on a journey into bereavement that continues to this day, the Indianapolis authorities were also setting out, albeit along a very different path. On 14 March last year Shuai was arrested and taken into custody in the high-security Marion County prison, where she was held for the next 435 days, charged with murdering her foetus and attempted feticide. If convicted of the murder count she faces a sentence of 45 years to life.

Bei Bei Shuai is at the sharp end of the creeping criminalisation of pregnancy across America. Women who lose their unborn babies – whether in cases of maternal drug addiction or in Shuai’s case a failed suicide attempt – are increasingly finding themselves accused of murder.

Speaking publicly for the first time, Shuai told the Guardian she is determined to defend herself as she prepares for a murder trial scheduled for December. “I have a strong desire to stay in America,” she said, three days after she had been released from jail on $50,000 bail. “I want to stay and fight this case. I have the best legal team, and I’m not afraid anymore to face the charges.”

On 23 December 2010 Shuai became so depressed after she had been abandoned by her boyfriend – a married Chinese man who broke his promise to set up a family with her – that she decided to end her life. She consumed rat poison, and after confessing to friends was rushed to the Methodist hospital.

Doctors took steps to save her, but on 31 December there were signs that the baby, then at 33 weeks gestation, was in distress and a Caesarian was performed. On the second day of Angel’s life the baby was found to have a massive brain haemorrhage and on 2 January was taken off life support.

Shuai held Angel for five hours as the baby gradually faded and died. “Why do they want to take my baby away?” she kept asking, in between bouts of fainting. Shuai begged for her own life to be taken so that her child’s might be spared.

‘No one wins from the criminalisation of pregnant women’

“There is no doubt that Shuai was suffering from a severe mental illness,” her defence lawyer Linda Pence said. She first met the defendant when she was in the mental wing, a few days after Angel died. “I personally observed a very depressed woman, a grief-stricken individual.”

That is not how the prosecutor saw it. For the first time in Indiana‘s 196-year history, the state has applied felony charges against a woman that hold Shuai criminally liable for the outcome of her pregnancy. Earlier this month the Indiana supreme court declined to hear the case, rendering a 3 December murder trial almost inevitable.

Lawyers and women’s advocates in Indiana were astonished by the prosecution’s hard line. To attempt to take one’s own life is not a crime in Indiana, so the decision to charge a pregnant woman appeared to be creating a double standard.

The feticide law, introduced in Indiana in 1979, was designed with violent third parties in mind: abusive boyfriends or husbands who attacked their pregnant partners, causing them to lose their unborn babies. It was enhanced to carry a maximum sentence of 20 years in 2007 after a bank robbery in which a pregnant woman was shot in the stomach, killing her fetus but leaving her alive.

“From a legal standpoint, this case is absolutely frightening,” said Pence, who has set up a website and fighting fund to support Shuai’s defence.

Pence fears that Shuai’s prosecution could set a precedent that will catch others in its trap. In the future, could women who smoke or drink during pregnancy and suffer a miscarriage be prosecuted for murder, or women with HIV who pass it on to their child in the womb? “No one wins from the criminalisation of pregnant women – all this will do is persuade women to flee the state, avoid treatment or have an abortion,” Pence said.

‘I knew America as the best country in the world’

Shuai sees the threat now facing her from a different perspective – as the obliteration of her American dream. She was raised as a single child in Shanghai by parents she described as loving and caring. She graduated from Shanghai university as an accountant, worked for a year in a Chinese government department and then came to the US about 10 years ago as a legal immigrant with her then-husband, who was offered a job in Indianapolis as a mechanical engineer.

Shuai said she was delighted to come to the US. “I knew America as the best country in the world, with the best education system. People get more freedom. I really wanted to see what it was like.”

She found the initial arrival in her Indiana town – a tiny one compared to Shanghai – a bit of a culture shock, but over time she said she came to appreciate it more and more: “Seeing all the natural trees and flowers, the fresh air.”

She was full of dreams – the dream of continuing her studies, the dream of forming her own family, of owning a house and car. “Everybody tells me that they have their American dream, trying to make their life better. People tell me that all the time, and I am the same, I am one of them,” she said.

The dreams didn’t work out so easily. She couldn’t afford to go back to college, so instead studied under her own steam using the local library. Her marriage collapsed, and then when she did finally become pregnant it was with a married man.

When he abandoned her, he left Shuai on her hands and knees in a parking lot as he drove away.

Shuai is not allowed to discuss the events that led up to her suicide attempt, as that might prejudice her trial. But she can talk about the deep sense of shame she felt when she was arrested for killing her foetus.

“I remember the day I had to turn myself in. I felt hopeless and ashamed, for myself and my parents. I had never worn handcuffs before – when they put the cuffs on me it chilled me to my bones.”

Now released, her hands are free. But she is forced to wear a GPS ankle bracelet that is causing her feet to swell.

Shuai’s lawyers wonder whether it is coincidental that such an aggressive application of a law originally designed to protect pregnant women against violent men should first be applied against a woman who is Chinese. The question is all the more pertinent given the current spat between the US and Chinese governments over the treatment of the blind dissident Chen Guangcheng.

Lynn Paltrow, head of National Advocates for Pregnant Women that is co-counsel in Shuai’s defence, said: “It’s an irony that the US has paid such close attention to violations of human rights in China while at the same time Indiana has absolutely deprived a woman who is a legal immigrant from China of her constitutional human rights.”

Prosecution is determined to push on

The only hope for Shuai to avoid a murder trial is if the prosecutor, Terry Curry, decides to drop the charges. There is little chance of that, given his firm belief that he is following the correct path.

“It’s my job to enforce the criminal code as enacted by our legislature and that’s what our legislature has determined,” he said. Curry pointed to a suicide note that Shuai left the former boyfriend in which she wrote that she was “taking this baby with me”.

“What we allege is that her actions were directed specifically at the unborn child. It’s not that she was trying to take her own life, it was that she was trying to take the life of her foetus,” Curry said.

Curry’s determination to press ahead to trial is matched by Shuai’s determination to fight on. During her year in prison, she has improved her English language skills and now speaks fluently without a translator. Though there were dark times inside, including anxiety attacks and moments of despair, she said she has emerged stronger for it.

“It was a really bad experience. I thought nobody would care about me anymore, that I was a worthless person with no future,” she said. “But I learned a great deal. I learned that my life wasn’t the worst as I thought it was. Everything that has happened has made me think that I am so blessed. I have a second family here, and that gives me hope.”

Shuai kept the truth about her suicide attempt and prosecution for murder from her mother back in Shanghai for almost a year. But a couple of months ago, with the help of her lawyer, she finally confessed.

“My mother was so wonderful and supportive. She told me you don’t need to care about other people’s judgment, as she knew that was what hurt me most. There’s a Chinese saying: ‘A people’s mouth can be sharper than a knife.'”

Despite her ordeal, Shuai insists she remains dogged in her intention to make a life for herself in America, a country that she still regards as the greatest on Earth. But in the last analysis her decision to stay and protest her innocence is made on behalf of only one person.

“I want to prove to my daughter that her mother is not a murderer, and that she has been loved.”

Suffering in Silence

Tags

Children, Depression, isolation, mental health issues, Postnatal Depression, pregnancy

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.

Mothers to get ‘named midwife’ under plan to combat postnatal depression

Tags

miscarriage, Postnatal Depression, pregnancy, stillbirth

Mothers to get ‘named midwife’ under plan to combat postnatal depression

Mothers will receive one-to-one care from a named midwife during labour and birth as part of government plans to combat postnatal depression.

Women who have a miscarriage or stillbirth and parents who are forced to cope with the death of a baby will also be offered increased support from theNHS.

Under the plans, health workers will be given enhanced training so they can spot the early signs of postnatal depression.

The move was welcomed by the Royal College of Midwives (RCM) and parenting forums. Cathy Warwick, chief executive of the RCM, said the pledges were “very good news” for women and midwives.

“These are positive plans from the government targeting areas of maternity care that are under-prioritised and under-resourced,” she said.

“The impact of a miscarriage or a stillbirth can be devastating for the woman and her family and postnatal depression can be a crippling and sometimes fatal illness. Early detection and treatment is crucial.

“It is also excellent to see an intention to ensure that long-standing NHS commitments, such as one-to-one care in labour and choice about where and how women give birth, become a reality for all women.”

According to the RCM, 5,000 more midwives would be needed to deliver the care proposed.

Justine Roberts, co-founder of Mumsnet, welcomed the renewed support but said a sustained effort was needed to ensure mothers benefited from the changes.

“Sadly there are many experiences shared on Mumsnet of women not getting the best care when they need it,” she said.

“The announcement that services provided during miscarriage are to be monitored is a real advance towards identifying best and worst practice and therefore towards improving the care received.”

Sally Russell, co-founder of Netmums, also welcomed plans to address postnatal depression – a common condition that is often kept hidden.

“Most mums and dads find it difficult to admit they are suffering and yet it can be a blight on their lives,” she said. “Having better support from local services could make a big difference and we’re delighted that the government has identified this as a priority.”

Alongside beefed-up training for health visitors – who provide services for expectant and new parents after birth – the government has pledged to improve maternity care by ensuring women have one named midwife to oversee their care during pregnancy and after they have their baby, making sure every women has one-to-one midwife care and giving parents-to-be the choice over where and how they give birth.

The NHS will also be judged on how well it looks after parents who have miscarried, suffered a stillbirth or cot death, with patients asked to rate their care.

According to the Royal College of Psychiatrists, 10-15% of women who have a baby suffer from postnatal depression.

Several celebrities, including actor Gwyneth Paltrow, have spoken of their experience of the condition, which usually starts within a few months of birth. Around one in three women experience symptoms in pregnancy, which then continue. Treatment options depend on the severity of the depression, but include medication and counselling.

The health secretary, Andrew Lansley, said: “We have listened to the concerns of women about their experiences of maternity care, which is why we are putting in place a ‘named midwife’ policy to ensure consistency of care.

“Not least, we will focus on the quality of care given to mothers-to-be and measure women’s experience of their maternity care for the first time.”