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 Dublinextended family are also common within this group of women (Oyserman et al,2000). Congruent with this picture, is a high number of women who reporteddifficulties paying off debts as well as paying for basic necessities such as foodand clothing, which further exacerbated their poor self-esteem and feelings thatthey were bad mothers (Mowbray et al, 2000).2.6.3.2. Personal circumstancesResearch also suggests that women with mental health difficulties experience asignificant number of unplanned pregnancies, as a result of failed contraceptionor lack of use of contraception (Miller and Finnerty, 1996; Barkla et al, 2000). InBarkla et al’s (2000) Australian study, 52% (134) of the women with enduringmental health difficulties experienced ‘unplanned ’pregnancies, with 25% ofthese ending in termination. Although these figures may reflect the trend ofunplanned and terminated pregnancy in the general population, and the degreeof ‘wantedness’ can change over time, women who have terminations in difficultpsychosocial contexts are at high risk of depression. Women with an enduringmental illness are also at a greater risk of being deprived of their parenting rolethrough miscarriage, stillbirth and custody loss (Dipple et al, 2002). Studieshave reported that 20-30% of women with prenatal loss of a child (stillbirth orneonatal death) have appreciable depressive symptoms up to 30 months afterthe loss, with rates of clinical depression in women after a miscarriage rangingfrom 40-50% (Bernazzani and Bifulco, 2003).Many mothers with mental illness have experienced adversity and trauma inchildhood, such as physical and sexual violence. Experiences such aschildhood sexual abuse are associated with depression in adulthood. Inaddition, the obstruction of attachment in childhood impacts on the ability toform stable relationships in adulthood, and can result in the development of apersonality disorder (Miller and Finnerty, 1996; Brunette and Dean, 2002;Bosanac et al, 2003; Dickerson et al, 2004). It is important, therefore, thatmental health professionals identify which women clients are parents, so thatappropriate, focused parenting services and supports are offered.33
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinWhile mental health services are now addressing needs for housing, work andeducation among people with enduring mental health difficulties (Government ofIreland, 2006), they are far behind in responding to the needs of women asmothers (Mowbray et al, 1998; O'Shea et al, 2004). It is evident from theliterature that many women routinely seen by the mental health services are notidentified as parents and the parent role function is ignored in care andtreatment planning (Zemencuk et al, 1995). Nicholson et al (1993) found thatfew American Mental Health Services routinely collected data on whetherwomen attending services had children and most neglected to ask about familyroles and responsibilities. Dipple et al’s (2002) study in the United Kingdom alsohighlighted the inadequacy of women’s case notes, regarding their role asmother. This included records with no mention of children, the incorrect numberof children, inadequate information to enable mother or staff to contact childreneasily, and incidents where a major event such as the death of a child was notrecorded. This is indicative of the tendency of services to neglect the communityand family context of women’s lives and the specific psychosocial needs ofmothers. It is also indicative of the biomedical paradigm and its focus on thewoman as ‘patient’ as opposed to mother with, consequently, the identity of thewoman as ‘mentally ill’ becoming primary, supplanting all other identities(Oyserman et al, 2000; Montgomery et al, 2006).2.6.4. Positive aspects of mothering for women with mental healthdifficultiesThe literature on motherhood and mental illness is largely dominated by aprofessional discourse that portrays mothers with enduring mental healthdifficulties as ‘risky,’ incompetent mothers. However, there is a small emergingbody of literature that gives voice to these women and recognises that they arecapable of effective parenting with support from innovative services andresources. Mothers with severe mental health problems say that motherhoodhelps provide them with an identity, other than that of being ‘mentally ill’(Chernomas et al, 2000; Oyserman et al, 2004; Montgomery et al, 2006), and34
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