Perinatal mental health
Wish there was a way design could improve the way I feel!
Who? 1 in 10 women will suffer from anxiety during their pregancy.
1 in 5 women will suffer from maternal mental health in their perintal period.
30%
of women never speak to a medical professional about their problems!
Studies have shown that 1 in 10 dads suffer from postnatal depression and anxiety.
The terms perinatal and maternal are often used interchangeably. Peri is the Latin for around, and natal is the Latin for birth. So perinatal mental illness refers to mental illness during pregnancy and one year after birth.
Maternal
mental health effects women all around the
world.
DID YOU KNOW ? In the victorian era they would call postnatal depression “milk fever” as they thought the milk would drive the mothers “mad”.
Problems. Even when adequatly trained and confident in their skills, medical professionals do not have the time to explore
mental wellbeing
71% of NHS boards have NO midwives or health visitors with accredited training in PHM (perinatal mental health).
7/10 women said thier
relationshp with their loved one was affected by their illness.
50% of mental health trusts so not have a specialist psychiatrist.
Aim.
The aim of this exploration study is to gain a better understanding of the different types of perinatal mental health issues. As more information is evaluated it is important to define my area of interest further and understand how design can improve the lives of women, both expecting and postpartum, who suffer from mental health issues.
From this
To this
Causes.
- half of woman effected thought it was caused though
isolation - 40% of women had suffered a traumatic birth - stress through working too long before materity
Those women on TV make it look so easy, I am the worst mother!
leave - are under pressure to “do things right” - lack of support - previous history of mental health issues
There is constant pressure!
- have a perfectionist personality and likes to be in control of all situations - antenatal and postnatal treatment differs from
country to coutry and this can have an effect on the mental wellbeing of morthers. - many mothers feel they are under a lot of pressure to
“If we did all the things we are capable of, we would literally astound ourselves.”-Thomas A. Edison
“do the right thing”, this is a big contributer towards PND. - overall rates of suicide, schizophrenia, depression and anxiety are all higher among general populations
Prevelant Factors.
Ohhh NO!! This cannot be happening? I dont have enough money for this baby!
22.5 % = married 56.3 % = unmarried 20 % = living together
Employment
38.8 % = employed 61.3 % = unemployed
Income Source
23.8 % = no income 35 % = single income 41.3 % = joint income
Birth Situation
88.7 % = normal birth 11.3 % = c-section
Baby Factors
52.3 % = unplanned 31.3% = planned 12.5 % = unwelcome
History of Illness
53.8 % = yes (personal) 46.2 % = no (personal)
pregnant
not pregnant
Marital Status
Outcomes. - 28% of mothers admit to having trouble bonding with their child - 34 % of mothers were concerned that if they admitted a problem their child would be taken away
“Being constantly attentive and attuned to the needs of
- 22% said they had suicidal thoughts
someone else for whom one has total responsibility at all
- maternal mental health can have an impact on babies
times is a daunting task. In addition to broken nights,
before and after birth, as their emotional and social
dream deprivation and exhaustion, a biological mother also
environment has been effected.
contends with hormonal fluctuations, recovery from labour
- Mothers experience extrme feelings of guilt and
exertions and possible birth damage, painful engorgement
failure.
or mastitis and the frightening orgasmic feelings that accompany breastfeeding. Not surprisingly, perinatal breakdown is common.� - Answer from my survey
Thoughts. Unable to enjoy anything
May find that they are unable to enjoy 9 Months6 MonthsWeek 6Week 2Week 1Day 3-4 or be interested in anything. You may not enjoy being with your baby.
Appetite changes
May lose their appetite and forget to eat. Some women eat for comfort and then feel bad
Hopeless
May feel that things will never get better. Also may think that life is not worth living. Will even wonder whether your family would be better off without you.
Anxious Thoughts
-baby is very ill -baby is not putting on enough weight -baby is crying too much and -can’t settle him/her -baby is too quiet and might have stopped breathing - might harm your baby -have a physical illness -your PND will never get better.
Negative and guilty thoughts
-haveing very negative thoughts -might think that you are not a good mother or that your baby doesn’t love you -extreme feelings of guilt -lose of confidence -might think you can’t cope with things.
Depressed
Feeling low, unhappy and tearful for much or all of the time.
Irritable
May get irritable or angry with their partner, baby or other children.
Avoid other people
Will not want to see friends and family and might find it hard to go to postnatal support groups.
Experience. 35%
Anxiety (ante)
50%
Anxiety (post)
What is it like to be unwell? - The most common feeling expressed by women is low mood experienced by 81% of
women.
23%
Depression (ante)
69%
Depression (post)
2%
Psychosis
- Tearfulness was also extremely common (81%) and could be a good proxy by health professionals when exploring womens wellbing. - Appetite changes were reported by 57%, with over-eating being more of a problem than under-eating.
Story. Please watch my video to further explore !
Passwrod = Lucy !
url = https://vimeo.com/197394471
Steps to Help. There are many services for women to actively seek help. One of the hardest things is making sure women have access to these services and admit to how they are feeling. NHS England figures show less than 15% of areas currently provide recommended services for mothers with mental health issues, and more
than 40% provide no service at all.
Reasons why women do not seek help sooner : 1. Many women have a fear of social services, they think their baby may be taken or that they will not be taken seriously. 2. Overthinking about everything, this really effects decision making. 3. Fear they may be judged on their mothering. 4. For talking therapies women need to self refer, working up the courage to phone up is hard and women do not want to discuss problems with reception. 5. Women do not know what to expect from peer groups and therapy, this can hinder their choice to seek help.
Honesty statistics:
9%
Not asked about how they were feeling
18%
Was honest about feelings
28%
Hid illness
46%
Not honest about feelings
Reasons for lack of honesty ?
Who did they tell first ?
43%
36%
34%
45%
25%
13%
Too embarrassed
Cannot admit to themself
Scared baby might be taken
Husband
Health professional
Mum or family
23%
15%
8%
10%
Feel can’t be helped
Not friendly
Friend
Other
Treatment. This data reflects a group of women who were surveyed by Tommy’s, these were the treatments that were the most helpful
for recovery.
Just under 3 in 10 recieved cousilling, 50% thinking it was helpful.
50%
8%
Healthy Eating 13%
Exercise
13%
Counsilling
13%
Talking to Experts 17%
Reduction of Stress
17%
Peer Support 19%
Of women took anti-deprssants. Out of these 50% found them helpful.
“My personal survey revealed that 50 our of 131 women relaxed through meditation and yoga.”
Self-help 24%
Support From Family
24%
Medditation
26%
Recognition of Illness 36%
Time
Treatment.
These results are is made from results from my
survey, carried out my 140 women around the world, from the USA, to Australia, Bulgaria and the UK.
25 %
did attend
31.3%
did not attend
postnatal classes %
did attend
Main reasons they were helpful:
Main reasons they were
“They were good for deep relaxation techniques.”
“Not really very...I didn’t attend the delivery suite session as I didn’t want to know in advance. The classes as well as the midwife appointments added more
breathing &
“Good. Informative & good to meet others in the same situation to chat.” “Met other new mums, educated me about what to expect in labour.” “They taught us a lot of common sense things about childbirth that seemed obvious but we didn’t already know! Really useful stuff.”
not helpful:
stress and more running around for a working Mum.” “I ended up with emergency c-section so no.” “I attended but did not find them very helpful. There was nothing too different from what I read in books.”
75
68.8%
antenatal classes did not attend
Classes they attended:
Reasons for not
“Baby massage, music groups, swimming groups.”
“I did not attend any post natal classes. I did have trouble with breastfeeding and had a lovely American lady spend a day with me in my bedroom in Tokyo from La Leche. She was a god send and so kind and patient and helpful.”
“Mum baby yoga, baby massage, baby sensory, Book bugs at library, mum and baby group.” “Locally run classes - met group of people who I’m still in touch with (some of them)”
now
“Meeting up with mums that I had shared the antenatal class with. Something offered by our health care provider and baby’s massage classes.”
attending classes:
“was living overseas in an area that did not have any available.” “I wasn’t made aware of local classes that I could attend.” “Ill health before pregnant and had a C-Section”
Antenatal Timeline.
When a midwife is not constant this can effect feelings of anxiety, as they feel they have to explain everthing again, and if the midwife was the same throughout the pregancy they would get to know the mother and therefore spoting signs of depression or anxiety.
“40% of mothers said they saw a different midwife at every appointment.� may have a few different midwifes throughout this period
4 Weeks
10 Weeks
13 Weeks
First prentatal check up, from this point it will be monthly.
Set appointment to obtain fetal heartbeat.
Scan to support downs screening.
At this point hearing the heartbeat can be very reasuring for many mothers.
MIDWAY 20 Weeks
Midway point ultrasound.
26 Weeks
34 Weeks
36 Weeks
Time to go to antenatal classes weekly if there is one.
Have a tour of the maternaty ward.
Start to watch for contractions and get ready.
Antenatal classes may not be available to everyone, lack of class can cause anxiety and feelings of isolation.
Postnatal Timeline. midwife
“41% of mothers said their health visitor or midwife never asked about depression.� changes to health visitor if there are no problems
3-4 Days
1 Week
Can leave the hospital at this point if all is well.
Midwife checks babies weight and cord falls off.
2 Weeks
Husband or partner goes back to work.
This can cause new fathers to experience deprssion and anxiety as they are beginning to bond with a new child and then have to support a family, and feelings of guilt for leaving their wives at home.
Going back to work can cause feelings of guilt for leaving your child in care. Causing further anxiety.
healh visitor every month
6 Weeks
6 Months
9 Months
Check in with GP for your 6 week check if everything is okay.
Start to wean baby off breast onto food.
This can be the point where some women go back to work.
This can be a positive milestone, as now other people can help with feeding and the mother does not feel like it is her sole responsibility. This can relieve some pressure and anxiety.
Child Development.
5
The early years play a large role in determining mental health through childhood and beyond. A child’s wellbeing is the result of healthy development within a nurturing environment. In the early years, infants make emotional attachments and form relationships that lay the foundation
for future mental health.
4 3
- Children of depressed mothers are more distractible, less playful and less social up to the age of 5 years.
2
C A
development of speech, language, communication and social abilities and contribute to behavioural problems.
- Infants of chronically depressed mothers do not perform as well in thinking and intelligence tests at 18 months, with speech development in baby boys being affected most strongly.
B
Anything that diminishes the ability of parents to communicate with and bond with babies and young children may affect their
1
Normal mother and infant bonding and understanding.
Mother with anxiety needing extra help to understand infant communication.
Mother with depression
have a mental block and needs help to maintain a level of communication and bond with baby.
Stories. Interview with Angela: Friday 25th November Agnela suffered from PND and mild psycosis. She knew early that something was wrong, having worked in the mental health service industry. She went to the GP and immediatly got offered antidepressents, which was not what she wanted and was taken aback as she wanted other options which were not discussed. In her area of gateshead there was a real lack of support available.
For further information please look for the attached skript!
Some of the chalenges she faced were: - For counsilling and talking therapy you have to self refer yourself which is challenging and puts people off.
Therapy
My Baby and Me
What to expect Motherhood
- You can be waiting up to 12 weeks for therapy and at this point it is hard to find childcare, which results in you taking the baby with you or not going at all.
- Talking therapys have the best outcomes
as women are reluctant to take any from of medication due to breastfeeding and pregnancy. Although many women are not keen on self perscribing to this and back out for many reasons, such as they are unwilling
to discuss with reception,don’t know how to or don’t have the courage.
For over 2 years now Angela has been involved with an organisation called
PANDAS Foundation
who aim to make sure that no individual,
family or carer feels as if they are alone.
“A safe space to talk, to let out my anxieties and find some hope that it would get easier, suggestions for talking to my GP, ideas for things to try, and a really nice group of people that I can be honest with, I wish I’d heard about you guys sooner!”
- Panda mother
“Coming to the group and saying “I’m not OK with how I’m feeling” was terrifying, but the group is really supportive and helped me to see that I wasn’t a bad Mam or a terrible person, I was tired, burned out and struggling. I needed somewhere away from home to let all those worries and feelings out, and now I feel better I want to support others so I’m still in touch with the group, thinking about baby number two and I now know others who have taken that step are there to support me”- Panda Mother
Raj’s story (Berkshire)
Chris’s story (Huddersfield)
My wife developed stress-induced psychosis when she was nearly 30 weeks pregnant. At the time, she saw me as an antagonist, and due to her condition I was subjected to mental and verbal abuse as my wife’s perception of reality was affected. Following a traumatic birth, where she received little support from the hospital midwives, my wife suffered postnatal depression and 10 days later she attempted suicide. She jumped from a window and broke three bones in her back.My wife later returned to the MBU, but her injuries meant I had to take a great deal of time off work to care for her and our baby. This had a massive impact on my career, and I also went
Joe (wife) was determined to be the perfect mother, but when she struggled to breastfeed, it led to feelings of severe anxiety and extreme failure. She begged to be hospitalised, but home treatment was considered the best option. It wasn’t, because a few weeks later she took her own life. The warning signs had been documented in her medical notes, but at no point was Joe referred to a perinatal psychiatric service specialist. I had also been given no nformation about how I should care for her.
on to suffer from depression.
With better mental health training and understanding I feel our GP could have diagnosed her condition sooner. There needs to be improved education for community midwives as well, because the ones we dealt with struggled to cope with my wife’s deteriorating state. In the future, I would also like to see more information and support available for fathers. By raising awareness, and with greater investment, we can make sure everyone has access to superior local mental health services.
Since Joe’s death, I’ve set up a charity and campaigned for better services that would have saved her life. We need to focus on educating people about postnatal depression and make sure that everyone who needs it has access to the appropriate treatment. There is so much already out there to equip people to manage their
emotions but not enough of us know about it.
If you had any anxiety during your pregnancy and/or postnatally what helped you over come this? - Survey Question
x8 women said
husbands!”
Talking about it with friends and other young moms.
“their Support network,
support of other mums. The midwives were amazing. My anxiety was mainly something going wrong and they always had the answers to put my mind at rest.
Within our area we get invited along to a first steps programme, where you meet mums and baby’s of the same age.
Going to anti natal classes reading about pregnancy and after. Making friends
with other pregnant ladies and carrying on with weekly meeting with our babies to support each other.
Exercise, eating healthy, sleep,
making time for myself.
Breathing, listening to music, reading books, speaking with my Mum and OB/GYN and friends.
I couldn’t breast feed because of being on thyroxine and didn’t realise until 6 weeks after the birth when my baby wasn’t thriving. I chatted to my Mum and other friends.
Nothing sadly.I
suffered everyday
I suffered from PND for 1 and a half years after the birth of my 3rd child. A group called mums in mind saved me. That and medication and family support and cosleeping helped.
I had PND, I lived for the weekly play group to talk to other mum’s and get out of the house.
Hypothesis.
Through this stage of my rsearch I hypothesise...... 1. By admitting how they feel each day this will help
women to self reflect on how and why they may be feeling this way.
2. If women are encouraged to take care of their own
mental well-being they will take the time to, as during the perinatal period they put their needs aside for their baby.
3. Small words of encouragement will help women when they are doing their daily activities, small reminders that they are doing a good job will lift spirits and relieve feelings of guilt and failure.
4. There are many idealised images and stories of
motherhood, if women hear/see true stories of experiences from other mothers this will relieve the feeling of failure.
These hypothese will help me to focus my exploration reserach further.
Summary. In the recent period there has been further progress such as new investments in the health visiting workforce with 500 new posts being created for 2017-18. On top of this it is required that all women pregnant of post partum are asked about their mental health, and all around the UK there has been a rise of mother and baby classses. Although this is all promising, there are still many gaps in the current system available for mothers and their mental wellbeing. Currently if a women is open to seeking mental wellbeing it is only available if she actively seeks it. Currenly women are being overlooked and more foucs is on ther new babies deleopment, although there are now studies that tell us that the vital comonent for a baby to develop is their mothers mental state. Mothers need to look afterthemselves.
If women openly share their experiences, it will help to normalise mental health problems and help those who are suffering in silence. There is a lot of pressure on mothers, women should be encouraged to manage realistic expectations of what they can manage when pregnant or with a young baby. Parntners and close family and friends have an important role to play when identifying a potential illness and supporting women, there is not much information out there for those who should be spotting signs of mental health problems and how to best support.
Parntners and close family and friends have an important role to play when identifying a potential illness and supporting women, there is not much information out there for those who should be spotting signs of mental health problems and how to best support. Many women suffer in silence, advice and information on maintaining mental wellbeing should be provided to all women as a routine when pregnant and post birth.
Insights. Through this area of study there are a few key insights that have stood out and are important for generating my final brief. My key area of focus is anxiety. Women who take time for themselves reduce their chances of anxiety and depression by 1/3. Areas of high importance are relaxation for the mother, and time with friends/ other mothers. Strong feelings of guilt and failure are evident in many mothers and this can cause further feelings of depression and anxiety. Advice on mental wellbeing is only available for those whoe acvitely seek it. Stories from other mothers are very benifitial and can help relieve guilt. 43% of women do not seek help due to embarrassment.
Focus. At this stage of my exploration I have chosen to focus my research further. Despite other worthy focus areas such as anxiety prevention, peer groups, health service improvements or combating loneliness. I have chosen to focus my exploration on the area of mental wellbeing and explore my hypothesis further though looking into relaxations, mindfulness and self reflection. This will be done though : - Survey carried out by mothers around the world - Interviews with experts and mothers - Activities to understand emotions
End of introduction