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Advising women with depression & mental health illnesses about pregnancy

(10 Posts)
ladyhaja Thu 17-Jul-14 17:34:57

Hi all,

I would be really interested to see what your take is on this article. I wrote it about the need for doctors to give frank and full advice to women about depression risks around pregnancy, both antenatal and post. I'd love to hear your thoughts on whether you agree or not. I have bipolar and there are a lot of issues I feel are ignored in women with histories of depression around pregnancy.

Article is here:

whiteblossom Thu 17-Jul-14 17:59:09

I think it should be standard that MW's ask about history of depression, PNT etc. They should ask everyone-history or not as to how they feel, are they coping and complete a form which would show any decline- such as the Edinburgh test score sheet. This should show any pre natal depression too.

I had very bad PND after my first. It took 8 years to even think about having a 2nd child. I have spoke to both my gp and mw to explain I wanted them to keep an eye on me this time almost laughed and said it might never happen and Ive not seen one mw more than twice and they really don't give a hoot. I was told having had PND I will know the signs and to contact them if it does. Im shocked, surely prevention or catching it before it takes a hold is key?!

By the time my Health vistor caught up with me after the birth of my first, I'd made plan to kill myself. I'd accused my dh of setting up the meeting...I was so far gone.

It really isn't highlighted enough, I had no idea about PND with my first neither did my dh...Their should be leaflet outlining depresstion during and after pg, signs, details of where to get help etc.

whiteblossom Thu 17-Jul-14 18:00:35

there sorry typos!

Primaryteach87 Thu 17-Jul-14 18:14:18

Should doctors be able to discuss what a patient's plans are regarding children to better aid their treatment - yes! My worry however is that it will morph into manipulating women with mental health issues to do what the doctor thinks is best - maybe even not having or aborting babies. This is very wrong in my opinion as my MIL has serious MH and is a fantastic mum. Some male doctors in particular can be very intimidating and overbearing especially if you are feeling vulnerable. Overall, I would be worried about this.

CoolCat2014 Thu 17-Jul-14 18:41:19

It looks like fear mongering to me. As someone who has had past severe mental health problems I think a far better approach is to gently raise awareness as my midwife did at my booking in appointment - there is a section on the form asking about past/current mental health issues, and when I explained I was offered access to perinatal monitoring and support, which I have taken with the understanding that I don't have any issues at the moment, but should something come up I've got a team who I can phone and who will be looking out for me. I think it's a fantastic system and much better than the NHS treatment I've had in he past from some teams.

There are many women with MH issues who are fantastic mothers, and I've known some who said they were so much better during pregnancy and childbirth. Women shouldn't be scared off the joys of being a mother because of the fears of MH issues, rather they should be supported and encouraged and given the right tools to help themselves. Partners should also be given information, possible in antenatal classes as to what to look out for.

JennyBlueWren Thu 17-Jul-14 19:49:20

Don't know what it's like in England but at my first MW appointment in Scotland we do a questionnaire and along with general medical health and family history there are questions on mental health which I found really helped me to open up to the MW.

frankiebuns Thu 17-Jul-14 20:05:13

In my experience at my booking in my midwife asked about mental health problems in me and family it is in my family and I had pnd I automatically got yellow booked which made me feel un easy they have already had a chat to me re my feelings and have been concerned I'm in pain can't take any pain relief at all so I'm hacked off,

frankiebuns Thu 17-Jul-14 20:05:24

In my experience at my booking in my midwife asked about mental health problems in me and family it is in my family and I had pnd I automatically got yellow booked which made me feel un easy they have already had a chat to me re my feelings and have been concerned I'm in pain can't take any pain relief at all so I'm hacked off,

squizita Thu 17-Jul-14 20:25:43

My MW asked about it at my booking in and I was immediately offered CBT for my serious health-related anxiety.

If anything, I was relieved because the prevailing prejudice is that people with MH issues, regardless of details, "can't cope" and will go off the rails.
Sadly the flipside is if someone's had no signs of it before, no-one keeps an eye on them and they can get PND unmonitored.
Or people are terrified they'll be branded a bad mother and so cover up a genuine health need.

Much like in my line of work - people lie because it is assumed you 'cannot cope' when in fact it's relatively common as throughout society.

RedToothBrush Fri 18-Jul-14 14:01:57

I am currently pregnant and have had mental health support for anxiety. This was something I actively sort out but this has not been without concern.

So far my experience has been a positive one, but having read a lot of threads on MN about similar situations, this does not seem to be the case everywhere and support does not seem to be universally available.

I do not like the fact that this seems to be focused solely on depression. Anxiety can be strongly related to depression but is fundamentally different. It needs to be treated differently as a result, but it is very easy to suffer from both or for one to be mistaken for the other.

At my booking in appointment, I had a test to identify depression, however because I don't suffer from depression, I passed and didn't get flagged as being at potential risk of postnatal depression. However, I do know that my anxiety does put me at higher risk.

My biggest issue with the proposals is, if you bring in, this kind of discussion into general healthcare, separate from pregnancy in this way, I do think you run the risk of alienating women from HCPs rather than actively helping them. It could stop women from getting help they need as a result.

It really depends on the bedside manner of doctors and how they interpret the guidelines. Everyone knows that some are far better than others and sensitivity and tact is a skill not everyone possesses.

There is a real fear from depressed or anxious people that they will be judged for their illness and suggesting in someway that you will be 'a bad mother' needs to be handled with extreme care. Even if a woman was getting help for depression or anxiety they then could make try and avoid seeing HCPs to discuss pregnancy or if they fall pregnant.

Also there is a real fear by some that, they will be put on some sort of watch list by social services or could have their children taken away from them if they are depressed/anxious after the birth. I don't believe this is true (and indeed when I have raised this fear, I have been told that because I have sought help this is very much in my favour and suggests I am not a risk)

Put simply, I worry that in many cases this approach will only serve to feed fears and put additional unnecessary pressure on women who find themselves struggling to cope.

I think there instead needs to be promotion of mental health services in pregnancy or for those seeking to become pregnant, with the emphasis on women to seek help on their own terms rather than feeling like they are being forced down a particular route. One of the problems I personally had, was being able to access appropriate support with a midwife prior to getting pregnant as I had no previous children. My doctor was unsure what to do with me, as there was no care pathway for women in my position. The only real solution at the moment is to do a more general referral rather than one that focuses on having pregnancy/childbirth and subsequent period afterward. Something that is not always appropriate.

On top of that, I feel that pre-emptive treatment, also misses where the real need currently exists. I've seen a lot of posts on MN from women, who feel dismissed for raising their anxiety or depression by midwifes. There is a real lack of understanding within maternity services where problems come to a head. Its all very well advising women prior to pregnancy if those treating you during pregnancy are badly trained and ill equipped to deal with those problems. All to often women feel that poor treatment or attitudes may have contributed to their post-natal depression.

This also comes back to lack of services. I know that the mental health services at the hospital I am at, which I consider to be better than most places, are extremely strained and under pressure. Despite that, I know I am lucky. I also know that many areas have no peri-natal mental health support at all.

Currently the emphasis is on post-natal depression. This means the whole system is set up in a way which doesn't allow women to be in a position where they are supported earlier.

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