This post is crossposted By Analía Sierra
When our eyes met
At first everything was new, I did not know what to expect. I got at the end of those nine months without enough information but with all the excitement and expectation that would be the most important moment of my life.
I had many fears, and they all were reason for my hospitalization- I have always been a healthy woman and have never been in a similar situation- My concern about that was big, I have never liked the idea of going through a surgery and this was the closest I was going to be to a surgery room … In my mind I had the old phrases , which grandmothers and mothers say, “You will forget everything, … it is a special moment and such a joy when you deliver your child all pains stops” … When the moment arrived, everything went slowly. They were long 11 hour of waiting … waiting for something I wasn’t sure what or who, if the anesthetist, the obstetrician or my child deigns to leave …
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Source: When our eyes met – WMMH Day
There are clear economic and societal arguments for investing in mental health interventions for women during pregnancy and immediately after birth.
This report examines the economic case for investing in early interventions that reflect best practice in England. Best practices that can and should be transferable to a cost-benefit analysis for perinatal mental health care in Low- and Middle Income Countries.
The second in a series of blogs by Dr Robert Nettleton, Education Advisor, Institute of Health Visiting, on his travels to Cape Town, South Africa through his Florence Nightingale Foundation Travel Scholarship 2017. He met our director, Simone Honikman, and our clinical team at Mowbray Maternity Hospital:
“The connection between a ‘trauma-informed’ approach and infant and perinatal mental health was obvious from my visit to the Perinatal Mental Health Project team at Mowbray Maternity Hospital, led by Simone Honikman.
There is an ‘epidemic of mental distress among women living in adversity’. Alongside wealth, there are extensive townships or informal settlements that are a legacy of the apartheid era in which, for example, 50% of women are HIV positive and levels of domestic, gender-based and sexual violence are high, as is poverty. Providing for accessible front-line assessment of mental health distress is a priority, through providing training to a range of workers and also within the community through ‘social connectors’ (I’ll learn about this more next week).
A challenge that resonated for me was about promoting quality and consistency in a fragmented system where there is also a heavy reliance on separate NPOs (not-for-profits) as providers of services.
Two key learnings for me were:
- The importance of what Simone calls ‘self-care’ – what we might call supervision with a substantial restorative component. I met, briefly, Charlotte who provides counselling out of a cubby-hole of an office in a maternity hospital. Her heart was bigger than her office! Maintaining resilience is something that we know is important, and the ‘Sollihull Approach’, while not rolled out in Cape Town, was something that colleagues recognised as applicable.
- The dilemma of seeking to deliver a quality service within a very low-resource environment. This resonated with me as we face resource pressures in the UK. We discussed and reflected on what would be the essential elements of a service (the ‘active ingredients’ or ‘programme mechanisms’) and what could be delegated or substituted without placing effectiveness at risk. The ability to form effective empathic relationships is one of those essential elements common to both South Africa and the UK, as is support and supervision.”
Misconceptions regarding maternal depression are obstacles to the integration of mental health initiatives in Maternal and Child Health (MCH) programmes.
The myths about maternal mental health include the beliefs that: maternal depression is rare, not relevant to MCH programmes, can only be treated by specialists, and its incorporation into MCH programmes is difficult.
Fact is that: Maternal Depression is the second-leading cause of disease burden in women worldwide, following infections and parasitic diseases
In the second article of a five-part series providing a global perspective on integrating mental health, Atif Rahman and colleagues argue that integrating maternal mental health care will help advance maternal and child health.
This can be achieved by collaboration between policy makers in mental health and those in MCH for action that will advance maternal and child health status. And by linking strategies to improve maternal mental health to broader development goals, including poverty reduction and gender empowerment.
We are starting the New Year with a poignant reminder by the Medicated Mommy blogger.
“I consider myself lucky. Maybe not lucky to have gone through the debilitating experience of postpartum depression (although looking back I am grateful–more on that in my next post), but fortunate enough to have recognized something was very wrong within 48 hours of being home from the hospital with my son. Upon this realization… The help I needed came in many different forms during my struggle that first year.”
What is empathic engagement and why is it important?
Empathy is the ability to perceive the meaning and feelings of another person and to be able to communicate these to that person. Empathy is a core aspect of building relationships and positive client interaction. When care workers engage empathically with clients, clients feel empowered, service uptake is improved and clients are more likely to adhere to recommended interventions and treatment regimens. There are also benefits for the care workers who report less burnout and enhanced work satisfaction.
Studies have shown that empathic engagement does not necessarily take up more time, is not emotionally exhausting like being sympathetic, and does not overburden the care worker, as the client maintains responsibility for their own problems. In addition, this type of communication can actually save time, effort and expense as the relevant client issues are more quickly identified resulting in early and more effective management.
Building up to empathic skills: learning about maternal mental health
Stigma, related to a lack of understanding and negative stereotyping of those with mental illness, is a significant factor in communities and among care workers. We attempt to reduce this stigma through the provision of background information about maternal mental illness and related medical and social problems. We encourage participants to work in small groups, engage with, discuss and apply our training material in a way which is relevant to their unique situations and work environment.
We noted a gap between the perceived ability and actual ability of workshop participants to engage empathically. Most participants struggle to “listen” and accept the client’s perspective without judgment. Instead, they very quickly assume they understand the problem and revert to “telling” and “fixing” based on their own perspective and experience.
Read more on how to develop a meaningful training, how to support trainers and how to evaluate the training process in our Learning Brief
A number of new studies have found that stress, depression or anxiety during and after pregnancy can have long lasting effects on the development of your child.
We have translated some of those findings into an Issue Brief and added some of our recommendations for evidence based interventions for parents.
This Issue Brief outlines not only the risk factors for parents, but also encourages the building of resilience to prevent or lessen the negative impacts for children.
“Caring for mothers and fathers – is caring for the future”
“Cindy* neglected her four children to such an extent that social workers removed the youngest two, both toddlers.
But after Nadia Drotsche, a social worker dealing with Cindy, attended a course on empathic training, she realised that Cindy might be depressed rather than an uncaring and lazy parent.”
Abused in labour, depressed after giving birth – pregnancy can be a nightmare for women. But an inexpensive intervention by the Perinatal Mental Health Project (PMHP) is trying to change this by teaching caregivers to listen, empathise, and identify depression.
Read more in this article by Kerry Cullinan in the Daily Maverick
Our partner – organisation, PRIME, was recently featured on NDTV’s programme Every Life Counts in a news clip zooming in on perinatal depression in India. A full feature will be aired in September.
Perinatal depression continues to be a stigmatised and poorly addressed problem in many low- and middle-income countries. In India it’s no different and the burden of this disease increases every year. Watch the clip below and keep an eye out for the full feature in September.