Emotional care of women on their journey to motherhood

1. Emotional care of women on their journey to motherhood Dr Sue Barker

2. Background to study • When starting my PhD I wanted to see if I could use it in some way to improve the care given to pregnant women and new mothers. • Literature search generated lots of studies about the aetiology of post natal depression, treatment approaches and outcomes for children. • Use of EPNDS • Higher scores antenatally (Evans et al 2001) • Serious concern (Dennis and Kavanagh 2001) • Risk factors (Beck 2001) • No individual factors (Reading and Reynolds 2001) • CBT (Prendergast and Autin 2001) • social support (Taggart et al 2000) • group therapy, (Forrester 2001) • hormones (Lawrie et al 2002) • antidepressants (Hoffbrand et al 2002) • Meta analysis of treatment (Bledsoe and Grote 2006) • cognitive restructuring, problem solving and efficacy enhancement (Ngai et al 2009) • children • distressed mothers to be insecurely attached (Murray and Cooper 1997, Logsdon et al 2003) • aggression expressed in children exposed to maternal depression (Hipwell et al 2005). • developmental and behavioural problems (McMahon et al 2001, Lemaitre-Sillere 1998, Miller et al 1993) • whole family (Tammentie et al 2004a, Tammentie et al 2004b, Burke 2003).

3. Rationale The journey to motherhood is an emotional one for the woman, her family and those caring for her (Mercer 2004, Wilkins 2006). Her emotional well being can effect her relationships with her partner, family and most significantly her baby (Miller et al. 1993, Lemaitre-Sillere, 1998 McMahon et al 2001, Burke 2003, Drift 2004, Tammentie et al 2004a, Tammentie et al 2004b).

4. Methodology Developed from the philosophical approach of Edmund Husserl by Amedeo Giorgi and labelled descriptive phenomenology (1985). Husserl’s aim for phenomenology was to achieve a rigorous and unbiased study of things as they appear, so that an essential understanding of human consciousness and experience may be gained. The goal Holloway and Todres (2003:348) stated for phenomenology was “describe, interpret and understand the meanings of experiences at both a general and unique level”. Giorgi offers a step by step approach to analysing the lifeworld experiences of a given phenomenon (Giorgi and Giorgi 2003)

5. Method • Participants • 8 community midwives • Data Collection • Presentation / Snowballing • Interviews • Data Analysis • Interviews transcribed verbatim • Phenomenological Reduced Attitude • Bracketing • Imaginative Variation • Whole and parts • Ethical Issues

6. Findings • Community midwives appear, through their ‘with women’ ideology, to provide emotional support. Offering this support increases their emotion work. • On going struggle between being ‘with women’ and ‘with institution’ as identified previously by Hunter (2004) • When midwives have decided to provide emotional care they come alongside women using their communication skills to share of themselves, their personal experiences and intuition. • This is undertaken to facilitate comfort in women and ease their passage to a new way of being. • Boundary between being professional and being one person with another. • Use personal rules or intuition.

7. Communication - listening Hetty said she needed to listen to the woman, as it was “her body, baby and world” (Hetty 41), so it was important that she listened to the woman’s perceptions. Some of this sentiment appeared to be shared by Diane who said “she didn’t have to listen to everything I was telling her, it was her baby and she knew it in a way that I never do” (Diane 40).

8. Communication - touch “at the end of that particular visit as I did for all the others I gave her cuddle which drew us close together” (Betty) “and I was holding her hand I took her hand to offer her some physical attention I said to her do what you want to do” (Gina)

9. ‘with woman’ ‘with profession’ “I suppose that is why it is emotionally draining at times, exhausting, because it is quite a thin line between giving emotional support and relating part of your own life but also keeping a distance” (Fiona).

10. Conclusions • All women need emotional care on their journey to motherhood. • Midwives are ideally placed to offer emotional care to women. • They need excellent communication skills, good role models, support and recognition to manage their emotion work. • Emotional care appears to facilitate comfort and reduce suffering.

11. Implications • As mental health nurses we have a unique knowledge base and specialist skills that can be used to support the care given to women on their journey to motherhood. • To support and encourage the ‘with woman’ philosophy. • To work alongside midwives sharing our knowledge and skills • Explore the boundaries between ‘with woman’ and ‘with profession’ • Consider our use of intuition and self in our emotional care

12. References • Beck, C.T., 2001. Predictors of Postpartum Depression, an update. Nursing Research vol 50 no. 5. • Bledsoe, S.E., Grote, N.K., 2006. Treating Depression During Pregnancy and the Postpartum: A Preliminary Meta-Analysis. Research on Social Work Practice. Vol 16 No 2 109-120 • Burke, L., 2003. The impact of maternal depression on familial relationships. International Review of Psychiatry, 15, 243-255. • Dennis, C.L., Kavanagh, J., 2001. Psychosocial Interventions for Preventing Post Partum Depression. The Cochrane Collaboration: Wiley Publishers. www.thecochranelibrary.com • Drife, J., 2004. Why Mothers die: the sixth report of the confidential enquiries into maternal deaths in the United Kingdom. London: RCOG Press. • Evans, J., Heron, J., Francomb, H., Oke, S., Golding, J., 2001. Cohort study of depressed mood during pregnancy after child birth. British Medical Journal, 323 (4th August), 257-260. • Forrester, M., 2001. Managing depression in the community. Mental Health Nursing. Vol 21 no 5 23-25 • Giorgi, A., Giorgi, B., 2003a. Phenomenology In: Smith J. A. ed. Qualitative Psychology, a practical guide to research methods. London: Sage Publications, 25-51. • Hipwell, A. E., Murray, L., Ducournau, P., Stein, A. 2005. The effects of maternal depression and parental conflict on children’s peer play. Child: Care, Health & Development 31 (1), 11-23. • Hoffbrand, S., Howard, L., Crawley, H., 2001. Antidepressant treatment for post-natal depression. The Cochrane Collaboration: Wiley Publishers. www.thecochranelibrary.com

13. References continued • Holloway, I., Todres, L., 2003. The status of method: flexibility, consistency and coherence. Qualitative Research, 3 (3), 345-357. • Hunter, B., 2004. Conflicting ideologies as a source of emotion work in midwifery. Midwifery, 20, 261-272. • Lawrie, T. A., Herxheimer, A., Dalton, K., 2002. Oestrogens and progestogens for preventing and treating postnatal depression. Issue 4. The Cochrane Collaboration: Wiley Publishers. www.thecochranelibrary.com • Lemaitre-Sillere, V., 1998. The infant with a depressed mother: destruction and creation. Journal of Analytic Psychology, 43, 509-521. • Logsdon, M.C., Wisner K., Hanusa, B.H., Phillips, A., 2003. Role functioning and symptoms remission in women with postpartum depression after antidepressant treatment. Archives of Psychiatric Nursing. 17 276-283. • McMahon, C., Barnett, B., Kowalenko, N., Tennant, C., Don, N., 2001. Postnatal depression, anxiety and unsettled infant behaviour. Australian and New Zealand Journal of Psychiatry, 35, 581-588. • Mercer, R.T., 2004. Becoming a mother versus maternal role attainment. Journal of Nursing Scholarship, 36, 226-232. • Miller, A.R., Barr, R.G., Eaton, W.O., 1993. Crying and motor behaviour of six week old infants and post partum maternal mood. Paediatrics, 92 (4), 551-558. • Murray, L., Cooper, P.J. 1997. Effects of postnatal depression on infant development. Archives of Disease in Children, 77, 99-101.

14. References continued • Ngai, F-W., Chan S.W-C., Ip, W-Y., 2009. The effects of a childbirth psychoeducation program on learned resourcefulness, maternal role competence and perinatal depression: A quasi-experiment. International Journal of Nursing Studies. 46, 1298-1306 • Prenderast, J., Austin, M.P., 2001. Early Childhood nurse-delivered cognitive behavioural counselling for postnatal depression. Australian Psychiatry. Vol 9 no 3 255-259 • Reading, R., Reynold, S., 2001. Debt, Social disadvantage and maternal depression. Social Science and Medicine. Vol 53 no 4 441-454. • Taggart, A.V., Short, S.D., Barclay, L., 2000. ‘She made me feel human again’: an evaluation of a volunteer home based visiting project for mothers. Health and Social Care in the Community. Vol 8 no 1 1-8 • Tammentie, T., Tarkka, M., Kurki, A., Paavilainen, E., Laippala, P., 2004a. Journal of Psychiatric and Mental Health Nursing, 11, 141-149. • Tammentie, T., Paavilainnen, E., Astedt-Kurki, P., Tarkka, M., 2004b. Family dynamics of postnatally depressed mothers – discrepancy between expectations and reality. Journal of Clinical Nursing, 13, 65-74. • Wilkins, C., 2006. A Qualitative study exploring the support needs of first-time mothers on their journey towards intuitive parenting. Midwifery, 22, 169-180.