THE PRACTISING MIDWIFE June 2012

Comment
Elaine Hanzak

Do parents have to suffer in silence?

ccording to a recent survey entitled Suffering in silence by the charity 4Children (2011), there is an enduring ignorance of the symptoms of postnatal depression, the cause of as many as 35,000 women a year suffering in silence from a condition which has devastating effects on their families and can lead to suicide. A Patients Association (PA) report last year alerted us to fact that only 45 per cent of Primary Care Trusts (PCTs) provide information to parents and just 36 per cent have a strategy for commissioning perinatal mental health services (PA 2011). Yet a study in Birmingham suggested that women who received enhanced care from a midwife were 40 per cent less likely to report feelings of depression (MacArthur et al 2003). As a midwife, are you helping women and their families to prepare for the possibility that they may experience postnatal depression? And who am I to ask?

you need something relevant. Could you attend or run events on postnatal issues and develop support groups? Are you aware of the signs, symptoms and risk factors for postnatal depression? Remember that aspects of pregnancy, birth and infant care are a new experience for many families, so they dont know what is normal and need information and reassurance!

Communication
Many midwives are frustrated by heavy workloads and lack of time with mothers, so do make the most of the time you have. If your attitude, manner and body language are positive then the experience is improved. Pregnancy and birth can leave women feeling very vulnerable, shocked and confused and, if left suffering in silence, this can lead to postnatal depression. Listening well and small touches, such as using the mothers name and not the generic label babys mummy, remind her that she hasnt lost her own identity.

My story
I suffered from an extreme form of postnatal illness, puerperal psychosis, after my son Dominic was born. I had never had any mental health problems before, yet within months of giving birth I had spiralled into a psychotic, selfharming mess, unable to cope with daily living, let alone motherhood, and had to be hospitalised. Once recovered, I shared my story in Eyes without sparkle - a journey through postnatal illness (Hanzak 2005), because I wanted to show how my descent into the illness happened and how recovery can be aided. Since then I have been a speaker and writer on the subject and am now a trustee for the Joanne Bingley Memorial Foundation (JMBF), set up after Joe, a nurse for over 20 years, took her own life in April 2010, 10 weeks after giving birth to her daughter. Policies, funding and so on need to be changed and hopefully the newly formed Maternal Mental Health Alliance will develop this, but in the interim I wish to share with you some of the main things you can do to make a difference.

Caring
Respect, dignity, kindness and maintaining the individuality of each woman and her family are key to promoting positive feelings. Remember the importance of small gestures of kindness. Look after yourself so that you can look after others. We all need to work together to spread awareness, reduce the stigma, improve facilities and reduce the number of sufferers from postnatal depression. TPM
Elaine Hanzak is a speaker and writer on postnatal illness

Further resources
JMBF can be found at www.joebingleymemorialfoundation.org.uk

References
4Children (2011). Suffering in silence, London: 4Children. Hanzak E (2005). Eyes without sparkle - a journey through postnatal illness, London: Radcliffe. MacArthur C, Winter HR, Bick DE et al (2003). Redesigning postnatal care: a randomised controlled trial of protocol-based midwifery-led care focused on individual womens physical and psychological health needs. Health technology Assessment, 7(37). PA (2011). Postnatal depression services: an investigation into NHS service provision, Middlesex: PA.

Choices
What information and knowledge do you currently give to parents so that they can be empowered to make informed choices on both physical and mental health around pregnancy? What strategies can you develop with them to deal with postnatal depression? Please contact the JBMF if