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Maternal Mental Health Awareness

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Thoughts & musings on midwifery related topics for the May Education Newsletter. 

Virginia Skinner, MEAC Chair & Ruth King, Midwifery Advisor, Education Unit


Maternal Mental Health Awareness 

This year, Maternal Mental Health Awareness Day is on the 4th May (just before International Day of the Midwife).  In the UK they also have a  Mental Health Awareness Week (https://www.awarenessdays.com/awareness-days-calendar/mental-health-awareness-week-2018/) which commences on the second week in May from the 14 to the 20th May, although here in Australia our awareness dates focus on mental health in October. Looking at the UK initiative, this year’s focus is “stress” which is particularly pertinent to the maternity setting and women. 

Every year, one adult in four and one child in ten will experience a mental health issue. One in five Australian pregnant women experience anxiety, and certainly anxiety can be an underlying trait of stress. As midwives, we need to be cognisant of women’s anxiety and stress levels during pregnancy so that we can refer to the most appropriate health professional, following our psychosocial assessment of women, to prevent future development of other mental health issues and concerns. This can be a very difficult role for the midwife, as women may mask their anxiety and stress during their pregnancy, and hence the importance of continuity of care during pregnancy as women are more likely to divulge sensitive information to a midwife they know. 

As midwives we also need to nurture and care for ourselves and each other to ensure we are not stressed, or if we are experiencing stress that we have a mechanisms and strategies in place to help us manage.  This self-care will allow us to be truly present for what is probably the most intimate experience of a woman’s life.  Having a support group of your peers, debriefing after a critical incident or a big day, or even celebrating after a brilliant day are all valuable ways to reduce stress.  

Stress, if unrecognised and untreated, can lead to burnout that results in exhaustion, an inability to care for others, reduced personal accomplishment and can manifest in a whole range of other conditions.

Stress can be beneficial for human beings to a certain degree. Good stress is what makes most of us arise out of bed each morning and can motivate us to achieve deadlines and achievements in our daily lives. Most of us would be familiar with the common symptoms of stress such as, sweaty hands, dry mouth, blushed face, increased heart rate, nausea and increased urination.  All of these symptoms are sympathetic responses from our nervous systems that result in the production of adrenaline. For midwives it might be presenting or public speaking, being late for a meeting, interviews and examinations that produce these symptoms of stress.  For women during pregnancy, childbirth and the postnatal period there are countless opportunities for stress to occur that will be unique to the woman.  It may be something as simple as learning they are pregnant, attending their first antenatal appointment, or it may relate to going into labour, breastfeeding or coping with a baby that does not settle postnatally.  In labour midwives may often see a woman’s stress manifest in the fear-tension-pain cycle.  Being able to identify the signs of stress and have strategies for both the women and midwives is key to reducing stress and the resulting emotional and physical outcomes.  This is particularly important for when stress exceeds our normal coping mechanisms and distress occurs.  

The long term sequelae of chronic stress can present in a wide variety of symptoms, health conditions and anxiety disorders that may impact a midwife's (or woman's) everyday life with insomnia, fatigue, lowered immunity, disruption of an individuals ability to learn and retain information, weight gain or loss depending on the person and may even lead to higher cholesterol and heart disease.  For women during pregnancy, chronic stress means higher cortisol levels which can lead to increased rates of premature birth and lower birth weight babies. Further, with all of the work being undertaken around the microbiome and the impact of the mothers microbiome on the baby there is a growing body of knowledge to identify that chronic stress leads to poorer health outcomes for future generations.  You can learn more about this by watching the Microbirth webinar “Understanding the Infant Microbiome” (there is a FREE link for ACM) and whilst you are there you may want to check out the online course (ACM have negotiated 50% off for midwives so its a perfect time to take a look).

So rather than letting stress get to us, why not look for ways to stimulate our nervous system to provoke a parasympathetic response that evokes the production of oxytocin and positive endorphins that enable us to feel “warm and fuzzy”. For women we work with this thought process and positive action and change may result in a greater “natural “ progression of labour and more positive maternal experiences as they overcome the fear-tension-pain cycle. Check out the February Education Unit Blog for a piece on orgasmic births (the total opposite of a fearful birth) and also for some links to related webinars that you can access.

So how do we reduce stress?  

Each person knows how to alleviate stress in their own lives and sharing ideas and experiences can be a great way to learn more.  Some of the commonly talked about stress busters include meditation, yoga, listening to music, exercise, laughing, singing and mindfulness.  They may also include breathing techniques, watching movies or eating with friends and family.  Linking back to the UK Mental Health awareness week that occurs this month, the UK Mental Health Foundation has organised a “Curry and Chaat” initiative to encourage dialogue about mental health between families, friends and work colleagues (as well as raising money for good causes and getting to enjoy something yummy!).  As we head into our cooler months (well for those of us in the southern part of Australia that is) this might be a great initiative to think about re-creating locally.  But if curry is not your thing, really any opportunity for people to debrief and talk about what is upsetting or stressing them is a great place to start.  As midwives a huge chunk of our work is about listening, not just hearing the words, but really listening to what women say to us with their words but also their body language and then finding ways to support them so that they become strong and confident mothers.

From now until World Mental Health Day on the 10th October as midwives we can be raising awareness of mental health in our communities and with the women we work with.  Raising awareness will help to reduce stigma for those experiencing mental health issues (women and midwives) and create avenues for people to reach out for support so that they do not need to struggle through their day thinking that they are alone. For women in our care, if we (as midwives) can help to reduce current mental health issues, then we are setting the groundwork for a brighter and happier future.  Let’s help this year by providing a safe and caring avenue for women and others in our community to address stress and talk about their mental health. Remember, individuals experiencing stress and anxiety may feel isolated and ill-informed about where to find help.  So we need to provide facts and information in a way that will facilitate a better understanding of support, and as required treatment, options available. 

So where to from here….

STEP 1

Why not start with REFLECTING on what you understand about the mental health requirements of the women that you are currently working with (or have worked with recently), or maybe about your own current mental health.

  • How are you feeling today?  Do you need someone to talk to?  Do you have someone that can assist?  If you need immediate support please reach out to Beyond Blue or Life Line. 
  • Were you able to provide the support the women required?  Do you know enough about resources available?
  • Do you know how to administer and score the EPDS?
  • Do you know enough about and can you administer and score the ANRQ? (opens as a PDF file)

Why not take a look at the different RESOURCES that are available from some of these leading agencies, who all focus on mental health in our communities.  You can add their contact details to your toolkit ready for sharing with women when it is appropriate.

STEP 2

Your next step might be to READ one of the many articles available in the ACM journal – Women and BirthOr check out the upcoming June 2018 issue of the Australian Midwifery News as this issue of the magazine will be focussing on mental health so will be packed full of articles addressing this health topics from a wide range of angles.  ACM Members - the magazine and the journal are included in your membership.  Not a member and want access to both fabulous resources?  Join today!

STEP 3

Alternatively you might chose to WATCH one of the many webinar recordings we have available.  The multifaceted scope of maternal health and mental health has been addressed in a variety of webinars.  
(links below go to the shop.  ACM members can ACCESS the webinar recordings directly in Midwives Learn our online portal for courses, as long as you have the Self-enrolment access key (this is a Members only benefit and can be found on the member benefits pages).  If members do use the shop links below you must remember to log in to your member portal or you will only see the non-member pricing. Non-members you will need to make a purchase from the shop using the links below for each webinar recordings you wish to access, or you can Join ACM today and get access to all of the webinars listed below as well as over 50 more and a huge range of other benefits whilst also saving >$300 (if you purchased all listed recordings).  Join today!)

 


Or you can REGISTER for the November Live Webinar “How to manage fear and anxiety during birth"

STEP 4

When you have come full circle in your enquiry, don’t forget to REFLECT on what you have learnt (about yourself, your practice and the evidence (or lack of) that is out there).  You may consider just writing it for yourself, or sharing it with your peers but at the very least, when next you have a conversation with a woman about her state of mind, make sure you have the time to sit and listen to her response and the tools to hand to refer her if needed.
We have some reflective activity templates you might like to use as a start here.

Don’t forget that ACM members can now access all webinars (live and recordings) for free!