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

More documents

Recommendations

Info

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
Page 1 and 2:
University of DublinTrinity College
Page 3 and 4:
WOMEN WITH DISABILITIES: BARRIERS A
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66: WOMEN WITH DISABILITIES: BARRIERS A
Page 115: WOMEN WITH DISABILITIES: BARRIERS A
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
show all

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

Create successful ePaper yourself

Delete template?

Save as template?