More than baby blues: improving the wellbeing for women and their families.

Pregnant women with depression are still falling through the gap, according to researchers. Annie May reports.

The arrival of a new baby can be one of the happiest events in a women’s life. It can also be a difficult and stressful time.

Research indicates that each year around one in 10 Australian women experience depression during pregnancy and almost one in five experience depression in the weeks and months after giving birth.

If left untreated, this can have a negative impact on new mothers, their babies, families and friends, including relationship problems and difficulties bonding with children.

Many women who experience perinatal depression are not identified and so do not receive adequate support, placing them at risk of more serious problems.

This can be due to women not wanting to admit they are not coping, or show they are a bad mother - not wanting to be judged as “mad, bad or sad”.

There is under-reporting by women and misdiagnosis by professionals. Referral pathways can be difficult.

Working in the fields of both midwifery and mental health nursing, Dr Kay McCauley- Elsom understands the need of better care, support and treatment for expectant and new mothers experiencing perinatal depression.

McCauley-Elsom, a senior lecturer at Monash University’s School of Nursing and Midwifery is leading a research team in investigating how clinicians assess depression and suicide intent in pregnant women.

The project - which won the Mona Menzies Postdoctural Nursing Research Grant for 2010 – was partly motivated by reports from the UK and the US about women committing suicide when pregnant or in the postpartum period. The data shows that suicide during this time is increasing, says McCauley-Elsom.

Research has also found that women who commit suicide while pregnant or after birth are more likely to choose a violent method – such as hanging, shooting and drowning – while non-pregnant women prefer ‘gentler’ methods such as overdosing.

The study is particularly timely, McCauley-Elsom says, as the Department of Health Services is preparing to implement proposals from the National Perinatal Mental Health Action Plan, to improve mental health and wellbeing for women and their families during pregnancy.

The study will use survey tools such as the Edinburgh Postnatal Depression Scale (EPDS) which identifies anxiety and depression and includes a question on self-harm, as well as vignettes.

In particular, the researchers will examine whether midwives and maternal child health nurses have the confidence and skills to effectively use survey tools to identify depression and suicidal feelings in pregnant women and refer them to appropriate health professionals.

While some child health nurses have training and experience in mental illness, most midwives don’t, says McCauley-Elsom.

“What should midwives or maternal child health nurses do if a pregnant woman ticks the box indicating that she has considered self-harm? They need to have the skills to assess the woman while she is there and recommend appropriate referral,” McCauley-Elsom says.

Her previous research demonstrated that midwives lacked the skill and knowledge for mental health assessment and referral.

She believes the system could make better use of mental health nurses trained to counsel pregnant women.

“We would like to see this resource linked to the midwifery and MCH service. It could be a useful step so that these women don’t fall through the gaps,” she says.

“Perinatal depression may not hold as much stigma as it did in the past, but blocks to receiving help still do exist – both personal and professional. Mothers fear the stigma of being labelled with depression and fear they will look like a bad mother, while some professionals still misdiagnosis the symptoms. This could be partly because they haven’t received the correct training,” says McCauley-Elsom.

The research team includes clinicians who can use the findings in their own health care settings, as well as a number of. Professor Louis Appleby, who has written tools to assess maternal morbidity in the UK has also joined the team as an advisor.

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