Valerie Gommon Midwife’s Blog

Archive for the ‘Baby Blues’ Category

From next year the Government has pledged that all women will be offered a choice of where to give birth including at home but so far only half of women are reporting that they were offered a home birth.

A recent survey carried out by www.netmums.com revealed that as many as one-third of all women in NHS hospitals are left alone and worried during, or shortly after childbirth and more than 30 per cent of mums polled received no NHS antenatal classes and 43 per cent did not have access to a midwife on a postnatal ward.

Women who participated in the poll were also very critical of postnatal care, including support offered for breast-feeding, this is despite the fact that the Government is now putting huge investment into improving breastfeeding rates; some women also mentioned that they felt the lack of care had led to postnatal depression.

Cathy Warwick, General Secretary of the Royal College of Midwives (RCM) said maternity services in England are at a critical point; she said that progress was being made. but went on to say that the target to give women a choice of where to give birth looked like it would be missed.  Warwick said surveys suggested full choice was only offered in about 50% of cases.  She also said services were also struggling to cope with the rising birth rate  which has jumped by 20% since 2001.

The RCM say that staffing numbers have increased, but by less than 10%, leaving the health service short of 5,000; they also highlighted that student midwives are finding it difficult to gain employment.

I am probably not going to be able to do this subject justice in a short blog posting, but the subject was being discussed this afternoon on Radio 4 – “Am I Normal?” presented by Vivienne Parry www.bbc.co.uk/radio4/science/.

The programme debated many interesting issues, for example the increase in the diagnosis of postnatal depression and the changing role of women in society.

I apologise that the information below is perhaps written in a slightly “academic” or technical style as it is taken from an essay I submitted on my degree programme, however I think the information is largely valuable – if you feel you would like to discuss anything I have written do feel free to contact me info@3shiresmidwife.co.uk or telephone 01908 511247.

I also feel very strongly that women are often given inadequate support in the postnatal period.  Indeed many women are reporting receiving only two or three postnatal visits from NHS midwives (and then it is not always a trained midwife who visits) and Health Visiting services are also very stretched.  As an Independent Midwife I am able to offer far more support postnatally and this is something that I believe all women deserve.

If you are struggling DO speak to your midwife, health visitor or GP – make a nuisance of yourself!  Self-help groups and lay groups like the National Childbirth Trust (NCT) www.nct.org.uk, La Leche League (LLL) www.laleche.org.uk Meet A Mum Association (MAMA) www.mama.co.uk and Association for Post Natal Illness (APNI) www.apni.org can all be very supportive.

Postnatal Depression

It can be predicted that the early days, months and even years after childbirth are a time of stress for the woman and her family.  Indeed there are also the major physiological changes from the pregnant state into lactation and the return to the usual non-pregnant state of monthly menstruation cycles.  These changes are normal physiological reactions to the changes undergone by the woman (Stables, 1999), often women as said to experience “baby blues” at this time.  Some women, however, go on to experience stronger reactions that may be described as “postnatal depression” or occasionally “puerperal psychosis” (Sweet, 1997).  A few women will be so traumatised by their experience that they develop “post traumatic stress disorder”.

Baby blues” is considered by many to be a normal phenomenon that happens around three or four days postpartum, and is associated with the rapid physiological and psychological changes taking place.  Many women experience a degree of transient emotional lability and changes or mood that is self-limiting and usually resolves quickly.  (Ball, 1996).

Postnatal depression (PND) is more severe.  Cox, 1986 suggests that 10% of all mothers develop clinical depression following childbirth and that a further 10% exhibit considerable emotional distress.  The onset is gradual and may last for 3-6 months (or longer).  PND is a reactive illness and can be associated with other stress factors (i.e. moving house, marital tension and low self-esteem).  Women suffering PND are usually able to sleep, but continue to feel tired and exhausted, often feeling worse as the day progresses.  PND can cause disruption to family life, and can affect mother-child relationships.  (Ball, 1996).

In recent years Health Visitors have been encouraged to use the Edinburgh Postnatal Depression Scale (developed by Cox et al, 1987) as a tool to detect postnatal depression.  Some authors have suggested that midwives should use the Edinburgh Postnatal Depression Scale (EPDS), (Sweet, 1997 and Clements, 1995) but the tool is not foolproof.   Postnatal women are asked to identify and report on their feelings and they may choose not to disclose feelings.  Feedback suggests that the scale is a useful tool, and can enable further discussion to ensue.  If indicated, the woman may then be offered “listening visits” when the Health Visitor will set aside time to talk on a one-to-one basis with the woman.  Some women may also be helped by medication and the Health Visitor will liaise with the General Practitioner and indeed the wider mental health team if it is thought appropriate.  It is thought that early treatment is most effective, midwives and health visitors should therefore be alert for early symptoms such as excessive anxiety and depression.  (Church and Scanlan, 2002, Bryant et al, 1999).

There has, however, been criticism of The Edinburgh Postnatal Depression Scale.  Robinson, 1998, suggests that it is ineffective because of indiscriminate usage, whilst Ballard et al, 1995 suggest that women often score highly on the EPDS and receive inappropriate treatment.

Puerperal psychosis is a severe form of mental illness that will affect approximately one or two mothers in 1000.  The onset is rapid and usually occurs within the first few days after delivery.  The condition presents as a depressive psychosis, manic illness and in some cases schizophrenia.  Primiparae are most often affected.  Women affected in this way need prompt admission to a psychiatric unit.  (Ball, 1996).

Women can experience Post Traumatic Stress following childbirth, this phenomenon has only been documented in the literature in recent years.  Indeed an extensive literature and internet search did not reveal any mention of post traumatic stress following childbirth until 1994 (Ralph and Alexander, 1994).

During the 1990s there were several articles discussing the merits of offering “debriefing” to postnatal women.  (Charles & Curtis, 1994, Jones, 1996, Westley, 1997, Robinson, 1998).  Interest in labour debriefing revealed that some women experience severe adverse reactions to their birth experience and it was suggested that a small number of women may experience post traumatic stress symptoms following childbirth.  The prevalence of post traumatic stress following childbirth has been estimated at between 1.5 per cent (Ayers & Pickering, 2001) and 1.7 per cent (Wijma et al, 1997), although Laing, 2001 argues that this is probably an underestimation of the problem.

I am very happy to offer a birth debrief to women within my catchment area, please see my website www.3shiresmidwife.co.uk for details.

Lastly, I should add that serious Postnatal Depression only affects a small number of women, but it is important that it is spoken about and that you seek help if you need it.


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