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 Dublinprimary doctor or health professional did not speak to them about their feelings.Five of the 6 women in Edwards and Timmons’s (2005) study (83%) reporteddelays in receiving help, as health care professionals (midwives, GP, healthvisitor) were slow in recognising their distress as postnatal depression ordiscounted it as a ‘normal’ part of post birth experience.5.5.2. Lack of knowledge, time and awareness in maternity careprofessionalsLack of education and awareness amongst maternal healthcare professionals ofthe significance of known risk factors for mental illness is considered asignificant factor in the under-assessment (Lewis, 2007). Others suggest thatthe problem resides with the biomedical model of communication, which affordsprofessionals little opportunity for psychosocial or emotional discussion (Roteret al, 1999). Under-diagnosis has also been attributed to a failure andreluctance on behalf of professionals to ask women about feelings ofdepression or hopelessness (Marcus et al, 2003; Sleath et al, 2007). Althoughobstetricians and midwives (n=20) in Mancini et al’s (2007) study in NewMexico (Mancini et al, 2007:pg. 433), were positive about using the PostpartumDepression Screening Scale, they reported feeling uncomfortable discussingdepression and expressed concern about ‘opening up a can of worms’, withwhich they felt inadequate to deal. Of the 389 paediatricians who returned thesurvey questionnaire, in Wiley et al’s (2004) study in the United States, only31% expressed confidence in their ability to recognise postpartum depression,with only 7% reporting that they were familiar with screening assessment tools.Not surprisingly, 51% underestimated the incidence of postnatal depression,with 49% reporting receiving little or no education on the topic. Lack of time(69%), lack of office space (57%), lack of referral recourses (43%), and lack ofeffective treatments (5%) were considered as barriers to screening in practice.The tendency, internationally, to focus on maternal depression, with the termpostnatal depression being used as an all-embracing category for perinatalmental health difficulties (Austin and Priest, 2004), also results in other mental97
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinhealth difficulties such as prenatal depression, anxiety, panic disorder,psychosis, and women with severe mental health difficulties and substancemisuse being overlooked (WHO, 2000; Austin and Priest, 2004).5.5.3. Screening practicesAs an outcome of the Inquiry into Maternal Deaths and other reports, theNational Institute for Health and Clinical Excellence made a number ofrecommendations to the National Health Service (NHS) on pre and postnatalcare for women including the key priorities of ‘prediction and detection’ ofpostnatal mental illness (NICE, 2007:pg. 4). In addition, the Council Report ofthe Royal College of Psychiatrists into perinatal mental health services statedthat perinatal mental health care should incorporate risk assessment and earlyidentification of illness (Royal College of Psychiatrists, 2002). However, insituations where health care professionals screen women, it is clear that theylack the skills to explore with women their emotional needs in a sensitivemanner (Shakespeare et al, 2003). There has been much criticism about theway in which the NICE guidelines are being implemented, following complaintsfrom mothers. The Association for Improvements in Maternity Services (AIMS)reported that women were already complaining about the way that healthcarestaff questioned them about their psychiatric histories (Robinson, 2007).Despite recommendations for sensitivity in official guidelines from NICE, womenreport feeling hassled, labelled and stigmatised. As a result their trust inmaternity care is being damaged. AIMS asks whether the drive to record allpast periods of mental illness will have a positive impact on risk and improvecare, or whether the process will increase negative outcomes for women. Theevidence from AIMS suggests that this has the potential to increase stigma andincrease the risk that women’s complaints about poor quality care will berejected. Those who confide their distress to health visitors frequently regretdoing so, and warn their friends to be careful about telling the truth (Robinson,2007).Shakespeare et al (2003) interviewed 39 postnatal women, attending 22community GP practices in Oxford, to explore the acceptability of postnatal98
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