Ms Clare BarnettRegistered Nurse
Registered Midwife
Waikato DHB and at Wintec
11:00 - 11:55 WS #30: Perinatal Mental Health - Changing the Face of the Future
12:05 - 13:00 WS #39: Perinatal Mental Health - Changing the Face of the Future
(Repeated)
Perinatal Mental Health
Changing the Face of the Future
Clare Barnett MCouns, BA, RM, RCompN, CTT, PGCert.Prof.Supervision
Private Practice/WDHB/Wintec/PADA Board Member
Whakapapa
Perinatal Anxiety & Depression Aotearoa (PADA)
• 2011 Perinatal Mental Health NZ Trust (PMHNZ)
• 2015 Rebranded to PADA
• National organization• Supporting PMH professionals
Education • Stronger than the stigma• www.pada.nz
• Does not receive any government funding
Perinatal Mental Health
• WHAT
• WHY
• BARRIERS
• HOW
–Welcome
–Assessment
–Resources
PMH definition
• Perinatal
Pregnancy within oneyear
• Mental Health Wellbeing of mother (baby and whānau)
WHO mental health definition:
“A state of wellbeing in which the individual realizes his or her own abilities, can cope with the normal stressors of life, can work productively and fruitfully and is able to make a contribution to his or her community”
It’s important
Statistics
Affective conditions
• ‘Baby blues’(50-80%)/ ‘Pinks’
• Puerperal psychosis (<1%)
• Postnatal depression /distress (15-20%)
• Paternal PND (10-20 %)
• Anxiety (15-20 %)
• Postpartum Post Traumatic Stress PPPTS (9+ %)
• Bipolar (1-2 %)
It’s important
Statistics
2018 PMMRC findings
PMMRC 2018• Maternal suicide (x7)
• Māori 16/28 (57%)
• National pathway access for MMH
– Culturally appropriate
– appropriatescreening
– Prev MMH hx
– communication and coordination.
It’s important
Statistics
2018 PMMRC findings
Link between childbirth and MH
Systemic gaps
Current situation? Crisis?
• Badly underfunded• Lack of local evidence based
research• Fragmented Primary Support• Women are afraid to ask for
help• If women speak out, help is
not always readily available• Practitioner concerns
Together empowering women through their
perinatal journey
Unpredictable client situation?
Low stress High stress
Low distress
VULNERABLE
RESILIENT
High performing women are invisible
Sometimes called the ‘worried well’, this group of women appears to be coping, but behind the mask they wear, they are suffering deeply.
BARRIERS?
TIME
What if?
Different role models
Where to refer?
HOW to fit it all in?
1. Welcome/ Listen
2. Brief assessment
3. Initial suggestions
& resources
• Follow-up 2-3 weeks
• Baby check = mum check
1. Welcome, Look, Listen… take the TIME
• He didn’t even look at me
• They just sat with their back to me typing
• I went wanting to be heard… and left with pills and not much else
• I wouldn’t be comfortable talking to my GP about this…
Relational Neuroscience:Receptive presence/ Engagement
• “Connection is a biological imperative” -Porges
• Showing you are “with me”
– Use of space/ touch
– Mirroring
– Paraphrasing/summarizing
– Reflecting “sounds like…”
– Congruence
– Empathy, warmth and care
2. Brief assessment
• Pain• Sleep• Attachment• Supports• Trauma?• Partner?• Risk of harm?• Routing PMH
screening?
Screening Assessment Tool?
“Inclusion of formalized screening emphasizes to the woman that she is not alone, not left to feel blame, and can be assisted in getting well.”
Breedlove, G., & Fryzelka, D. (2011). Depression screening
during pregnancy. Journal of Midwifery & Woman’s Health.
56(1), 18-25.
Mothers helpers survey
2015
• 63% perinatal distress
(preg- 6/52)
• 15% of those women were picked up during that time.
2019• 83% perinatal distress
(preg- 6/52)
• 29% of these women were picked up during that time.
EPDS- Edinburgh Postnatal Depression Scale
• Objective• Validated for- anxiety,
depression, partners, cultural diversity
• Common language• Supports client lived
experience
• WHEN? A/n & P/n• Not diagnostic, over the
last 7 days
Routine conversation?
“What we know is that 10-20% of women find it helpful to have specific mental-emotional support for their adjustment to parenting. One way I can screen for this is to use the EPDS…”
WWW.MOTHERSHELPERS.CO.NZ/EPNDA
http://perinatology.com/calculators/Edinburgh%20Depression%20Scale.htm
EPDSAnxiety questions 3-5
Depression questions 1, 2, 6-9
Suicide risk question 10
Review? 10-12
Referral ? >13, Q10
Scoring system- over the last 7 days
- 0-3 questions 1, 2, 4
- 3-0 questions 3*, 5*-10*
Suicide risk?• Stay calm! Breathe
• Don’t assume
• Know how to refer- MMH, crisis team, police
• Ensure they have family/friend support
• Supervision
• 3 M’s– Motive (mood)
– Method
– Means
Paternal postnatal depression PPND
• 1:4 partners who have postnatal depression
• Similar symptoms but can be more ANGER
• EPDS used to screen
• Include partners in discussion
https://www.google.com/search?site=imghp&tbm=isch&source=hp&biw=1440&bih=795&q=postnatal+depression&oq=postna&gs_l=img.1.0.0l10.70466.75453.1.76817.7.7.0.0.0.0.307.1017.2-3j1.4.0.msedr...0...1ac.1.60.img..13.9.2909.t9ufoZmkTvk#facrc=_&imgdii=_&imgrc=Wc0934ltE8X_uM%253A%3Bp9CPb4gecBbRtM%3Bhttp%253A%252F%252Fwww.privatehealthvisitor.com%252Fblog%252Fwp-content%252Fuploads%252F2014%252F03%252Fmale-postnatal-depression.jpg%3Bhttp%253A%252F%252Fwww.privatehealthvisitor.com%252Fblog%252Fparents-category%252Fpostnatal-depression%252F%3B270%3B270
TRAUMA- as women perceive IT
• LOSS OF CONTROL
- Powerlessness
- Helplessness
- Hopelessness
• Extreme pain
• Fear
• Interventions
• Previous MH history/ trauma
• Uncaring unsympathetic attitudes
• PPPTSD v PND
Supports v Stressors
supportsstressors
VALUES
hopes/dreams
3. Resources- check in on?
• Back to Basics
– Moving our mood
– Connection to others
– Relaxation / Breathing/ Sleep
– SUPPORTS
– Whole foods/ CRAP/ hormones
3. Resources- what could I suggest?
• Support groups
• Apps
• Online resources
• Lactation Consultant
Positively Pregnant App
3. Resources- what could I discuss?• Psychological Therapies–Psychologist–Counsellor–MMHS–Culturally relevant &
acessable
• Psychiatrist• Medication
Australasian Marcé Society
https://www.marcesociety.com.au/
An international society for the
understanding, prevention and treatment
of mental illness related to child bearing.
Resources for me?
• 296 page handy, one stop
shop reference guide for
busy professionals
• each chapter has been
written by a different author
with knowledge and
expertise in their area
$35 + pp
PMH take home points
• Safeguarding future wellbeing
• Rule of 1/3- attend/screen/resource
• Routine Screening- EPDS best practice
• Give her the mouse
• Variety of strategies mild-mod-severe
• Know your community supports
• Baby check = Mum check
Questions?
References and useful books on the topicBarker, S. & Dowson, E. Essentially MIDIRS. December 2013. Vol 4. Number 11 Beck, C., & Driscoll, J., (2006). Postpartum mood
and anxiety disorders. Sudbury, MA: Jones and Bartlett.Beck, C., Driscoll, J., & Watson, S. (2013). Traumatic Childbirth. Abington, OX: Routledge.Beck, C. T., Gable, R. K., Sakala, C., & Declercq, E. R. (2011). Posttraumatic stress disorder in new mothers: Results from a two-
stage U.S. national survey. Birth, 38(3), 216-227.Breedlove, G., & Fryzelka, D. (2011). Depression screening during pregnancy. Journal of Midwifery & Woman’s Health. 56(1), 18-
25.Cohen, L., & Nonacs, R. (2005). Mood and anxiety disorders during pregnancy and postpartum. Washington, DC: American
Psychiatric Publishing.Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression
Scale. Br J Psychiatry. 1987 Jun;150:782-6. PMID:3651732 Durie, M. (1994). Whaiora: Māori health development. Auckland, New Zealand: Oxford University Press.Guilliland, K., & Pairman, S. (1995). The midwifery partnership. A Model for practice. Wellington, New Zealand: Victoria University
of Wellington.Huljich, P. (2014), Stress Pandemic. 9 natural steps to break the cycle of stress & thrive (2nd ed.). USA. Mwella PublishingJomeen, J., & Martin, C. (2014). Developing specialist perinatal mental health services. The practising Midwife, March. 18-21.Mellsop, G., Dutu, G., & Robinson. (2007). New Zealand psychiatrists views on global features of ICD-10 and DSM-1V. Australian
and New Zealand Journal of Psychiatry, 41. 850-853. Ministry of Health (MOH). (2012). Healthy Beginnings. Developing perinatal and infant mental health services in New Zealand,
Wellington, New Zealand: Ministry Of Health.Moeke-Maxwell, T., Wells, D. & Mellsop, G. (2008). Tangata whaiora/consumers perspectives on current psychiatric classification
systems. International Journal of Mental Health Systems, 2(7), 25-30.New Zealand Nurses’ 0rganization, 2008. How to best treat perinatal depression. downloaded from
http://www.thefreelibrary.com/How+best+to+treat+perinatal+depression%3a+nurses+and+midwives+need+to...-a0181989685
Regel, S., & Joseph, S., (2010). Post-traumatic stress. Oxford: Oxford University Press.Rouhi, M., Usefi, H., Hasan, M., & Vizheh, M. (2012). Ethnicity as a risk factor for postpartum depression. British Journal of
Midwifery.20(6). 419-426.Steen, M. & Steen, S., (2014). Striving for better maternal mental health. The practicing Midwife. March, 11-14.Weeks, S. (2013). Mothers cry too. Recognising and coping with postnatal depression. Auckland, New Zealand: Penguin.Wilson, J., & Giddings, L. (2010). Counselling women whose lives have been seriously disrupted by depression: What professional
counsellors can learn from New Zealand women’s stories of recovery. New Zealand Journal of Counselling, 30(2), pp. 23-39.Youngson, R. (2012). Time to care.How to love your patients and your job. Raglan: New Zealand. Rebelheart.
Useful websiteswww.bpac.org.nzwww.beyondblue.org.auwww.health.govt.nz/system/files/documents/.../healthy-beginnings-
jan2012.docwww.littleshadow.org.nzwww.marcesociety.com.auwww.midlandmentalhealthnetwork.co.nzwww.mind.org.ukwww.mothershelpers.co.nzwww.mummoodbooster.comwww.pada.nzwww.perinatology.comwww.positivelypregnant.org.nzwww.stephenporges.comwww.thescienceofpsychotherapy.com/receptive-presence
