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 Dublinincrease the risk of infant mortality and stillbirth, and have also been associatedwith preterm delivery and low-birth weight infants (NICE, 2007). Women whoexperience eating disorders during pregnancy are more likely to havecomplications, such as miscarriage, delivery by caesarean section andpremature or small babies.2.6.2.6. Risk to the children of mothers with mental health difficultiesThere is now emerging evidence that untreated mental health difficulties inpregnancy may be associated with poorer long term outcomes for childrenbeyond the immediate postnatal period. Studies have shown that untreated orenduring mental health difficulties in the mother may impact negatively on theemotional and cognitive development of the child. A number of studies suggestthat children of postnatal depressed mothers are more likely to have difficultiesin relationships and attachments. Mothers with a diagnosis of depression areconsidered to interact less with their infants, and to be less affectively andinteractionally synchronised with their children (Cox et al, 1987; Fendrich et al,1990; Goodman and Brumley, 1990; Hammen et al, 1990; Kelly et al, 1999;Mullick et al, 2001). While not discounting Mullick et al's view (Mullick et al,2001) that a small number of severely ill women with psychotic symptoms mayexperience thoughts leading them to harm their children, the tendency withinthe research to emphasise the cost of the mother’s pathology on thedevelopment of the child has resulted in motherhood and mental illnessbecoming synonymous with negative parenting regardless of diagnosis, severityof experiences, support systems and family circumstances and social context(Cogan, 1998; Mowbray et al, 2000). In addition, it is clear that many childrenare resilient and appear to avoid significant problems, yet very little researchhas focused on identifying sources of resilience or on what makes for positiveoutcomes.31
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublin2.6.3. Motherhood and mental distress in context: social andpersonal circumstances2.6.3.1. Social circumstancesThe medical model, which has dominated women’s experiences of childbirth,has been criticised for pathologising postnatal events and ignoring the socialcontext of many women’s lives. Perinatal mental illness is a complex issue, andthe social context in which women live and parent plays an important role in itscause, as well as exacerbating existing mental health difficulties and theeveryday challenges of parenting. Separation, divorce, lone parenting,relationship difficulties, poor social support, and stressful life events duringpregnancy have all been identified as factors contributing to or exacerbatingpre- and postnatal mental health difficulties (Whiffen and Gotlib, 1993; O'Haraand Swain, 1996; Borjesson, 2005; Horwitz et al, 2007). The strongestpredictors of postpartum mental illness, especially depression, are past historyof illness (Verkerk et al, 2005; Kim et al, 2008), low social supports, stressful lifeevents during pregnancy, high levels of birth complications, traumatic births,and relationship difficulties (O'Hara and Swain, 1996). Evidence suggests thatlow family income, lower occupational status and financial strain are alsoassociated with increased risk (O'Hara and Swain, 1996; Horwitz et al, 2007).Many of these factors are present in the lives of mothers with enduring mentalhealth difficulties. These issues add to the stresses of parenting and canadversely affect and thwart women’s wishes to parent well. Research both inAustralia and the U.S.A. reveals much about the difficulties and complexities ofwomen’s lives as they cope with the dual demands of motherhood and livingwith a mental health difficulty. A great number of women enduring mental healthdifficulties have begun child bearing early, are low income parents, with highrates of unemployment (Nicholson et al, 1998c; Mowbray et al, 2000; Mowbrayet al, 2001), are parenting alone, have smaller social networks and live insuboptimal accommodation (Caton et al, 1999; Chernomas et al, 2000;Oyserman et al, 2000). Marital discord, social isolation and conflicts with32
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