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 Dublinwomen’s lack of recognition during pregnancy of depression and other mentalhealth difficulties, such as anxiety. Consequently, pregnant women may notrecognise their distress as depression or anxiety, and postpartum mothers maysimply attribute their distress to hormonal changes, a ‘normal’ part of the postnatal period or an adjustment reaction to sleep deprivation.5.4.2. Information provision about antenatal mental health difficultiesChildbirth educators have a key opportunity to educate women and theirpartners about the range of possible postnatal reactions, from baby blues topsychosis. In addition to teaching women about managing labour, educatorscan offer information that will help normalise postnatal emotional experienceand recognise if these experiences are becoming too difficult for women to copewith by themselves, and how to seek help. However, both the lack of availabilityof classes and lack of attendance at such classes exacerbates the problem.Even if available, women report that they receive very little information onmental health issues during prenatal care and have little or no knowledge onhow to access health or community resources if needed during the postnatalphase (Buultjens and Liamputtong, 2007).5.4.3. Women’s knowledge about services and help availableLocating support services and obtaining information about services can beanother major barrier to women accessing support. Lack of knowledge on howto seek help or what service to access was identified as a barrier to receivingcare by Zittel-Palamara et al (2008). Almost 16% of the 45 women in this studyreported not knowing who to speak to, with an equivalent number seeking helpbut unable to locate any assistance. Lack of knowledge on services availableand the skill set necessary to access service are likely to be more pronouncedin some groups of women, such as recent immigrant women (Teng et al, 2007),homeless women, and women with substance abuse or other severe mentalhealth difficulties.95
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublin5.4.4. Lack of fluency in English leading to lack of knowledge ofservicesIn Ireland, a study of refugee and asylum-seeking women found that they maybe at increased risk of depression in the postnatal period due to the addedstress of their situation (Kennedy and Murphy-Lawless, 2002). Accessingservices requires a level of language proficiency, which is a major issue forsome immigrant women. Health care professionals in Teng et al’s (2007) studywere of the view that lack of fluency in English was a major barrier for immigrantwomen accessing information on mental health service provision. Languagewas also reported to be a barrier in providing care. Although translators werehelpful when women entered the service, the professionals were of the viewthat they were not ideal as, in the presence of a third person, importantdiscussions on personal issues, such as mental health difficulties, were oftenlimited in depth.5.5. Barriers preventing accommodation of women with mentalhealth difficulties: Assessment and screening practices5.5.1. Assessment practicesRoutine prenatal and postnatal visits to health professionals such as midwives,public health nurses, paediatricians, or general practitioners provide goodopportunities for these health care professionals to establish therapeutic rapportand explore with women their emotional state and experiences of emotionaldistress. Although pre and post natal mental health difficulties are prevalentthey frequently go unrecognised and untreated by health care professionals(Wiley et al, 2004; Sleath et al, 2007).Kelly and colleagues (2001) found, within a large group of pregnant women theystudied (n=186), 38% met the criteria for a mental illness or substance abusedisorder; however, only 43% of these women had symptoms recorded in theircharts, 18% had a formal diagnosis, and one third (33%) received any kind ofintervention or treatment. Similarly, Chaudron et al (2005) found that 28% (61)of the Hispanic women (n=218) in his study were of the view that they neededhelp with postpartum depression, however, over 50% (32) reported that their96
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