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 DublinFor up to 50% of women who experience life-time depression, postnataldepression was the index episode (Stowe and Nemeroff, 1995). Oates (2007)finds that 10% of new mothers are likely to develop depression in the yearfollowing childbirth, of whom between one third and a half will suffer from asevere depressive illness. However, only 0.4% of women who experience apostnatal illness require admission to a psychiatric unit (Edwards and Timmons,2005). Beck (1998) emphasises the importance of differentiating betweenpostnatal depression and postnatal anxiety and panic disorders. Otherwise,women who have postnatal onset of anxiety or panic disorders may bemisdiagnosed and treated for depression. Although research has placed greatemphasis on depression in the postnatal period, it is estimated that 15% ofwomen will also experience depression during pregnancy. Brockington (2004)suggests that the widespread use of this term ‘postnatal depression’ inconnection with childbirth may be a means of reducing the stigma associatedwith serious mental illness. Others are of the view that the tendency is reflectiveof the biomedical focus of both maternity and mental health services, whichneglects the multiplicity of psychosocial problems experienced by women duringpregnancy and early motherhood (WHO, 2000; Austin and Priest, 2004).2.6.2.3. Postnatal psychosisPsychosis in the early postnatal period - often termed postnatal or puerperalpsychosis and much rarer than postnatal depression - affects between 1 to 2women per 1,000 births (National Institute of Clinical Excellence (NICE), 2007).Some suggest that the term puerperal psychosis should be confined topsychosis beginning within 2 weeks following delivery, to distinguish it fromother psychotic disorders naturally occurring in the general population (Coyle,2003). Postnatal psychosis is considered an emergency and requires animmediate intervention, which usually includes hospitalisation. In a long termstudy of puerperal psychoses from 1927-1961, Protheroe (1969) found that only1 of the 114 women he traced had stayed in hospital since being admitted in1941. In relation to the remainder, 49 women had at least 1 further psychoticepisode, 14 of which were related to childbirth. During the follow up period 6129
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinwomen were known to have 149 further pregnancies. All except 6 of the 104women traced following discharge were living, or lived until they died, insatisfactory relationships and in reasonably well-kept homes and thus appearedto have had a satisfactory outcome. However, the author traced the long termoutcomes of these women using case notes only, which might not have fullydocumented the psychosocial aspects of these women’s lives. The author alsoexamined the family histories of 98 of the women from which no specific geneticpredisposition to puerperal psychosis could be identified.2.6.2.4. Risk to mothers with mental health difficultiesMental health difficulties during and after pregnancy have implications for thepsychological and physical welfare of the woman, fetus/baby and the family.Until recently it was thought that pregnancy exerted a so called ‘protectiveeffect’ on women’s risk to maternal suicide. However, the Confidential Enquiryinto Maternal and Child Health (CEMACH) found that mental health difficulties(suicide, or ‘accidental’ but lethal overdose of drug of abuse) contributed to 12%of maternal deaths in the United Kingdom, with more women dying from thedirect and indirect consequences of substance abuse than from otherpsychiatric causes (Lewis, 2007). The majority of suicides in pregnant andpostnatal women occur in the 6 weeks before delivery and the 12 weeks afterdelivery. As with previous reports, the majority of women who died from suicidewere receiving some type of psychiatric care, but not specialist drug addictionservices. The report also revealed that many of the deaths took place shortlyafter a child protection conference, or a child being removed into care.2.6.2.5. Risk to the fetuses/neonates of mothers with mental healthdifficultiesAlthough all pregnancies carry risk, especially to the fetus, research suggeststhat these risks increase where the woman has a mental health difficulty.According to the National Institute of Clinical Excellence severe depression isassociated with increased rate of still birth, postnatal specialist care for the babyand low birth weight babies. Maternal psychosis and bipolar disorder appear to30
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