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 Dublinreport that looking after children is rewarding and central to their lives, eventhough the demands of parenting are considerable (Schwab and Clark, 1991;Mowbray et al, 1995a). Krumm and Becker (2006) point out that frequentlywomen with enduring mental health difficulties, due to educational background,have fewer occupational options in comparison to women without a diagnosis ofmental illness. They suggest that this may contribute to these women’s desire tohave a normal reproductive biography, as motherhood is seen as an expressionon ‘normality’ and a chance to be competent in a valued social role.Motherhood for some women is an opportunity to be fulfilled and creative- ameans of feeling love, delight, warmth and normality. In a study of 24 motherswith mental health difficulties, Mowbray et al (1995b) reported that, for 81% ofthe women, transition to motherhood was a positive experience and they feltvery positive about their children and parenting skills. The mothers describedparenthood as a way of promoting personal growth and development and a keyoutlet for expression of feelings of care and concern. The majority of women(n=22) in Diaz-Caneja and Johnson’s (2004) qualitative study said that havingchildren gave them a purpose in life, made them feel fulfilled as women andincreased their self-esteem. The significance of having children is alsoillustrated by women’s experiences of parenting as ‘the only time they felt likean adult’ (Schwab and Clark, 1991:pg. 97). For parents who did not havecustody of their children, but had visiting rights, seeing their children was animportant focus in their lives (Schwab and Clark, 1991; Joseph et al, 1999).Motherhood also signified responsibility, with some women expressingconcerns about the impact of the illness on their children, and worrying aboutthe children becoming ill, whether from genetic or environmental reasons(Mowbray et al, 1995a; Diaz-Canjela and Johnson, 2004). Being responsiblemeant protecting and shielding the children from the illness through pretence,downplaying, and camouflage of emotions and distress. By hiding the ‘illness’and related distress the mothers believed that they could be viewed as ‘normal’.35
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinTherefore, their parenting would not be questioned and they would be affirmedby their children and others (Montgomery et al, 2006).Babies and children also provide a social and community context for mothers,as rearing a child connects the mother with other mothers, schools, playgroupsand paediatric health professionals For some women, becoming a mothermeant moving from the position of ‘stigmatized outcast’ to a valued andhonoured member of society (Apfel and Handel, 1993). For other women thewish to bear children is enormous, even in the face of previous losses ofchildren or consequence to one’s own mental and physical health (Apfel andHandel, 1993). Having children was viewed by mothers as having manybeneficial effects on their mental health. Motherhood was seen as a motivatingfactor to sustain their participation in treatment or engage with psychiatricservices in the community in order to prevent relapse (Mowbray et al, 2001;Diaz-Canjela and Johnson, 2004). As Fox (2004:pg. 763) stated ‘the bond ofmother and child replaced my ache of having to take medication, of dealing witha deadly illness (schizophrenia)’. Other women also reported positive effects,such as giving up drugs and ending bad relationships (Mowbray et al, 2001).2.6.5. Mothers with enduring mental health difficulties’ experience ofthe mental health serviceAlthough degeneracy theory has been discounted within the scientific literature,the idea of people with mental illness marrying each other and bearing childrencontinues to be met with disapproval within society and, in particular, by healthprofessionals. Mothers with a known diagnosis of mental health difficultiesreport being subjected to high levels of suspicion and surveillance fromprofessionals who visited their homes. Despite this constant ‘surveillance,’women do not consider mental health professionals very helpful in assistingthem with their parenting role. The focus on the biomedical entity of mentalillness and symptom reduction appears to overshadow professionals’understanding of women’s experiences and needs as mothers (Oyserman et al,2000; Montgomery et al, 2006). Health care professionals are perceived as36
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