Tag Archives: motherhood

Maternal mental health – treatment options in NZ

Maternal mental health is a big thing (most of my data comes from that link this time). Around 15% of pregnant women and new mothers will have some form of mental illness during the perinatal period (from conception through to baby’s first birthday). Floating around 60,000 births per year, that means a lot of mental illness for New Zealand women. 9,000-odd women will have some form of mental illness in the perinatal period. I’m not talking about the ‘baby blues’, either. This means serious mental illness – depression, anxiety, bipolar episodes, schizophrenia, and so on.

To deal with this there is a primary health care plan in place. General practitioners, lead maternity carers, Plunket nurses, and the like are trained to identify maternal mental illness and in many cases treat, whether with reassurance, various forms of support referral, or medication. For many mothers that’s what they need.

What happens when they need more? Well, that’s when it gets a bit hairy. There is no national secondary maternal mental health service co-ordination. Each DHB is on its own, and some do quite well, but some are all at sea. Many leave maternal mental health care at secondary and tertiary level to their regular emergency mental health teams, which does not really cover the special needs of a mother and child.

At the extreme end, some mothers really need inpatient treatment. There are two options for this, one vastly superior to the other. On the crappy hand, you can separate mother and baby while mother receives inpatient treatment – which can last weeks or months. On the better hand, you can have dedicated mother and baby mental health beds. This option is so much better for both mother and baby, as it keeps them together during a crucial phase of attachment and bonding.

We have five mother and baby beds here. Here being the entire country. Five.

Those five beds are located in Christchurch, and they are available to Southern DHB cluster mothers – women from the South Island. Around a quarter of New Zealanders live in the South Island. Northerner? Well, tough.

Around one or two in 1,000 mothers will experience post-partum psychosis. this is an incredibly serious mental health issue, one that really requires inpatient treatment, as the woman can be a danger to herself and others around her.

How do we deal with this? Honestly, I don’t know. Do we separate mothers and babies or do we leave seriously ill women to the care of their families – or lack of care, as the case may be? I suspect the former, but the latter would be horrifying. Some hope is on the horizon, though – maybe. The Healthy Beginnings paper that I linked to, released mid-2012, advocates the establishment of between 16 and 33 mother-baby beds around the country. On the other hand, the paper recognises that there is no new funding for any of its recommendations, so moving forward with them may be rather . . . doubtful.

The number of beds proposed for the country is still problematic. It’s enough to cover the national cases of post-partum psychosis – maybe. Just about. Where does that leave the mothers suffering from schizophrenia or a severe bipolar episode? They’re acutely unwell. And what about the severely depressed? They’re not able to care for themselves. Here, the families must come in.

Let me tell you a little story. When I had my first daughter, I ended up with pretty severe depression. Like, can’t dress myself not eating can’t care for baby depression. My partner was at university full-time, and worked weekends. My family were miles away (literally in Africa). In the evenings things were ok, I managed to cook for my partner and my flatmate because I had to, and somehow I pulled it together enough for that. During the day, though, I just couldn’t do it. I remember just holding my daughter and both of us crying until we were exhausted, then sleeping in a heap on the couch until it was time to do it all again.

My grandmother travelled an hour each way once a week to take me to do my groceries. But that was the extent of the support I received. I desperately needed care of some kind, but it was left up to my family and my family just could not provide the care I needed. And mine was bad, but not as bad as many. There are women who lie in a darkened room all day, feeding baby when it cries and managing little else, every day. They need better.

How do we deal with suicidal women? The ones who have come to the conclusion that their baby and their family is better off without them? The current answer is, we leave them to family care and hope, or we split them from their child. None of this is a good solution.

We don’t have mother-and-child respite care, where mum can go for a few days and be looked after a bit by nurses or social workers, and feel supported and start getting things back on track. There are some day programmes for mothers and babies run by Plunket and others, but there aren’t enough, and they’re not accessible to women who are too unwell to leave the house unaided.

We are failing the mentally ill mothers of this country. We have the beginnings of a good programme in that primary interventions are in place and work well, more or less. But we need higher level interventions to be available, and I’m sick of hearing ‘we don’t have the money’. We find the money for flag referendums, and we waste money on by-elections that didn’t need to happen. We fund a military, perks for retired MPs, ever-escalating MP salaries. Gather together some of these hundreds of thousands, these millions. We can find better uses for them.

I Look Down On Young Women With Husbands And Kids And I’m Not Sorry . . . because I’m a horrible person.

An article crawled its way into my online life this afternoon (also, my browser doesn’t think that ‘online’ is a word. Irony?). It was a rather unpleasant article, with the primary purpose of making the author (and people like her) feel superior, and anyone who’s made different choices in life feel unworthy.

The writer makes the claim that marriage and motherhood are not things to be celebrate, because they’re ‘super-easy’. Anyone can do them, she says, so why should they be celebrated? She bewails the lack of celebrations for promotions, landing dream jobs, backpacking through Asia (ignoring completely that people have parties all the time for such achievements. Apparently if it’s not an institution going back generations it just doesn’t count) She wants to celebrate only the extraordinary, because the ordinary, the average, don’t deserve it.

She turns to denigrating housewives in particular, claiming that what they do is essentially worthless. “Men don’t care to “manage a household.” They aren’t conditioned to think stupid things like that are “important.”” . . . I do wonder who does her cooking and cleaning.

The devaluation of the ordinary in favor of the extraordinary is not right. Extraordinary things should be celebrated, because they are extraordinary. No-one in their right mind thinks that special things should not be celebrated. But apparently some think that ordinary people don’t deserve to celebrate the things that are important and life-changing to them. That’s a bit nasty and a bit rude really. Ordinary people are just as entitled to celebrate the significant things in their lives, and just because some snooty high-flyer believes that what they do has no value, it doesn’t make their big moments any less special.

Beating up on the wife and mother has one major drawback – we need them. We need women having babies to continue existing. I have no idea how she thinks that would happen in her perfect world of high-achievers. Stork theory revisited? Moving on.

Feminism is not pouring derision on other women for their life choices. When someone writes an article like that, it sets feminism back a step. It makes the ideals of equality and tolerance look frayed at the edges. Women beating other women down is cruel, and it’s counterproductive. Not everyone is going to be a CEO, or a chairman, or the head of marketing at Apple. It’s impossible. There have to be average people in order for there to be anyone above average. And putting down all the people that support a high-flyer is not nice. Horrible even.