Women with Disabilities: Barriers and Facilitators to Accessing ...

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WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinChapter Five: Women with mental health difficulties:barriers and facilitators to accessing services andprofessional help during pregnancy, childbirth andearly motherhood5.1. IntroductionSeeking help from professionals has many layers of difficulty attached. A reviewof the literature suggests that the experiences of mothers with mental healthdifficulties accessing services, during pregnancy, childbirth and earlymotherhood have received little attention in the research and in servicedevelopment, so there is little basis for confidence that their needs, and those oftheir children, are being met. Individual narratives and research on women’sexperiences of mental health difficulties during pregnancy and motherhoodsuggest that there are a number of significant socio-cultural, professional andservice issues that coalesce together, making accessing help and support alarge task for a mother experiencing mental health difficulties.Initial sections of this chapter will present the barriers to accessing services, asidentified from 23 published research papers (Appendix 5, Table 6). In additionto factors under the headings of accessibility, accommodation and acceptability,this group of women were unique in having specific problems with the lack ofavailability and affordability of services also. Finally, facilitators to improveaccess are presented, although it is notable that only 9 of the published papersdiscussed facilitators to access, in addition to highlighting numerous barriers(Appendix 5, Table 7).89
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublin5.2. Barriers to availability of services for women with mentalhealth difficulties5.2.1. Links between maternity and mental health servicesFor women who experience perinatal mental health difficulties, rapid access toappropriate specialist services and treatment is recommended to lessenwomen’s maternal distress and the possible negative impact on the baby (RoyalCollege of Psychiatrists, 2002). Perinatal mental health services should beseamless; embracing a number of specialist areas, and with interdisciplinaryworking between midwifery, obstetrics, mental health professionals and GP.However, services to women who experience perinatal mental health difficultiesare often nonexistent, disconnected, fragmented, difficult to access orinadequate in meeting the specialist needs of mothers (Miller and Finnerty,1996), and links between maternity and mental health services are weak(Currid, 2004). Consequently, women experience suboptimal perinatal care,with their mental health issues being considered separately from theirpregnancy (Miller and Finnerty, 1996). Currid (2004) is of the view thatmaternity staff focus on biological aspects of pre and post natal care, viewpregnancy and childbirth as their domain, and fail to see that maternity careembraces a number of specialist areas.In a recent study of 152 trusts providing obstetric or midwifery-led maternityservices in England, 56% of trusts stated that they held certain antenatal clinicsjointly with specialists in substance misuse, and 63% employed specialistmidwives to support women who misused substances during pregnancy. Jointclinics were also held by approximately one third of trusts with mental healthteams for women with a history of previous postnatal psychosis and psychiatricdisorders, 19% employed specialist midwives to care for women with previouspuerperal psychosis and 21% had specialist midwives to support women with apsychiatric disorder (Commission for Healthcare Audit and Inspection, 2008).However, 42% of trusts had no access to any specialist perinatal mental health90
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