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 DublinShakespeare et al(2003)Dipple etal 2002Ugarriza(2002)Mowbrayet al(2001,2000)U.K.U.K.U.S.A.U.S.A.To exploreacceptability towomen of P/Nscreening byhealth visitorsTo exploremothers withserious mentalillness’sexperience ofmotheringTo explorewomen’sexperiences andconstructions ofpostpartumdepressionTo explore thelife situation ofmothers withsevere mentalillnessInterviewsCase noteanalysis andinterviewsTelephone andface to faceinterviewsStructuredinterview39 postnatal womenattending a GPclinics58 mothers whowere admitted to along-stay ward in 2mental hospitals30 women withbabies 1-12 monthsold, who selfidentified asexperiencing PPD.379 women carryingout parentingresponsibility, withsevere mentalillness, and recruitedfrom public mentalhealth service in anurban area21 found screening unacceptable andintrusive. Fear of stigmatising label andcustody loss results in women giving falseinformation on screening.68% had lost custody of a child, and hadlittle or no contact with them. In 11 casesseparation occurred at birth. 57% saidseparation was against their wishes. 50%of the separations occurred during themother’s fist episode of illness. Women stillexperienced unresolved grief.Feelings of shame at not being a ‘goodmother’. Feelings of guilt at wanting toharm the baby. Lack of knowledge aboutpostpartum depression. Attending supportgroups too difficult because of logistics offitting in with an already busy day63% were mothers before the onset ofmental illness. Motherhood was describedas a positive experience with positiveoutcomes such as giving up drugs andending bad relationships. Womenexperienced many stresses in life, such aschild behaviour problems, financialconcerns and parenting alone. Mentalhealth professionals inattentive to parentalissues and not supportive. Womenexpressed need for parental skills trainingand support.185
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY, CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinChernomas et al(2000)Joseph etal(1999)Nicholsonet al(1998 a)Nicholsonet al(1998 b)CanadaU.S.A.U.S.A.Explore womenwithschizophrenia’sperceptions oftheir illness andneedsExplore theneeds ofmothers withserious mentalillnessExplore theparentingexperience ofwomen withmental illnessand casemanagers viewson the problemswomen faceFive focusgroupinterviews28 women who selfidentified as havingschizophrenia, livingin community,recruited throughhealth professionals.15 were mothersQuestionnaires 52 womenhospitalised in astate mental hospitalwith severe mentalillnessFocused groupinterviews42 mothers whowere currentlyreceiving casemanagement wererecruited fromcommunity servicesand 55 casemanagersPregnancies were largely unplanned. 7women had lost custody of a child. Stigmaa barrier to disclosure. Women notinformed about family planning, pregnancyor parenting. Concern with takingmedication during pregnancy; receivedconflicting advice from professionals. Sideeffects of medication impact on ability toparent.61.5% had at least one child, 21% had fullcustody. 12% were the primary carer.Approx 50% described themselves asneeding help in dealing with sadnessaround loss of custody, and help in gettingchildren returned.Women with mental illness are stigmatisedas poor mothers, even before they becomepregnant. Mothers’ greatest fear was lossof custody or contact with their children.Fear heightened if needed hospitalisation.Constant pressure to prove themselvescompetent mothers. Mother’s mental illnessblamed for any problems the child mayhave. Mothers evaluate themselves againstunrealistic standards. Mothers place priorityon child’s needs and neglect own health.Family members reinforce sick role and donot consult mothers about children’s needs.186
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University of DublinTrinity College
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