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Perinatal Mental Health
A Guide for Health Professionals and Users
Jane Hanley
School of Health Science
Swansea University
Carmarthen
Wales
A John Wiley & Sons, Ltd., Publication
iii
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Perinatal Mental Health
i
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Why does it take a
smart executive
3 hours to
file a report?
BECAUSE IT
DOES !!!
Postnataldepression
ii
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Perinatal Mental Health
A Guide for Health Professionals and Users
Jane Hanley
School of Health Science
Swansea University
Carmarthen
Wales
A John Wiley & Sons, Ltd., Publication
iii
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Thiseditionfirstpublished2009
(cid:1)C 2009JohnWiley&Sons,Ltd.
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LibraryofCongressCataloging-in-PublicationData
Hanley,Jane.
Perinatalmentalhealth:aguideforhealthprofessionalsandusers/JaneHanley.
p.;cm.
Includ esbibliographicalreferencesandindex.
ISBN978-0-470-51068-1(pbk.)
1.Postpartumdepression–xNursing. I.Title.
[DNLM:1.PostpartumPeriod–psychology–Nurses’Instruction. 2.Depression,Postpartum–Nurses’
Instruction. 3.MentalDisorders–Nurses’Instruction.WQ500H514p2009]
RG852.H362009
618.7(cid:2)60231–dc22
2008044813
AcataloguerecordforthisbookisavailablefromtheBritishLibrary.
(cid:1)
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PrintedinSingapore
1 2009
iv
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Contents
1 Women’s mental health: from Hippocrates to Kumar 1
2 The antenatal period 10
3 Postnatal depression and bipolar disorder 34
4 Puerperal psychosis 50
5 Problems associated with perinatal mental health 67
6 Possible causes of postnatal depression 82
7 Recognition and detection of perinatal mental health
disorders 94
8 The effect on the family 100
9 Effects on society 119
10 Management of postnatal depression 132
11 The multidisciplinary team 159
12 Global cultural practices 188
13 An overview of women’s perinatal mental health 193
References 203
Appendix1 230
Appendix2 235
Index 238
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1
Women’s mental health:
from Hippocrates to Kumar
Blessingsonthehandofwomen!
Fathers,sons,anddaughterscry,
Andthesacredsongismingled
Withtheworshipinthesky–
Mingleswherenotempestdarkens,
Rainbowsevermorearehurled;
Forthehandthatrocksthecradle
Isthehandthatrulestheworld.
WilliamRossWallace1819–1881
An overview of perinatal mental health
Itisstatingtheobviousthatchildbirthisnotanewphenomenon,norhasthestudyof
itbeenneglectedovertheyears.Forthemostpart,andupuntilrecentyears,research
has focused more on the actual physical side of childbearing, with little regard given
toanypsychologicaloremotionalfactors.Thereisnowagrowingbodyofresearchers
whosuggestthatthereisoverwhelmingevidencetorecommendthatthegoodmental
healthofmothersbemaintainedduringtheperinatalperiod.Thisisbecauseitisnow
believedthatitiscrucialtosecureahappyoutcomeforthemother,herinfant,andher
family,anditisthroughthisresearchthatmethodsandmanagementstrategiesmaybe
discovered in order to achieve these outcomes. Despite the evidence of risk to infant
development and factors which could harm the mother and her family, the study of
maternalandinfantmentalwelfareremainsasubjectthatisoftenmisunderstoodand
misrepresented.
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2 PerinatalMentalHealth
Criticism has been levied about the weakness and lack of rigour of some pieces of
researchintoperinatalmentalhealth.Itseemsthatfewresearchprojectsconcentrateon
producingtheresultsfromrandomisedcontroltrialsandthereareveryfewofthetype
of ‘gold standard’ research. The reasons for the failure to conduct rigorous research
may be many, but not least that it is the overall sensitivity of the condition together
with the reluctance of ethics committees to grant permission for such studies. There
is apprehension that any enquiries into a mother’s mental health may endanger her
mentalstateevenfurtherbyhavingthepotentialtoresurrectthoughtsandfeelingsofa
mother’spreviouslydepressedstateofmind.Theseobjectionsmakeitdifficulttocarry
out sufficient studies of research into the subject. Many of the studies, particularly of
aqualitativenature,havehadtobecarriedoutretrospectively,capturingthethoughts
andfeelingsofaneventwhichhaspassed.
A recent UK Government commissioned report: the Darzi Plan –, High Quality
Care for All (Darzi, 2008), which is set to revolutionise the vision of the future of
health care, highlighted the necessity for services to be focused on individual needs,
with the choice for services being centralised. It advocated integrated partnerships,
maximisingthecontributionoftheworkforceandanintentiontopreventpolicieson
healthinequalitiesanddiversity.Nowhere,however,diditmentiontheimportanceof,
orevenreferto,perinatalmentalhealth.Eveninthisenlighteneddocumentthemental
health needs of mothers were overlooked. Mental health has, historically, been an
areaofcontentionwhendiscussingthenextpriorityforgovernmentfunding.Itwould
appear that those perceived as the more common biological diseases of cancer and
theheartoverrideanyneedforthesolutionofproblemsincurredinmentalill-health.
Thealleviationofmentalillness,coupledwiththestigma,remainsasbigaproblemin
thetwenty-firstcenturyasiteverwas,eventhoughdealingwithmentalillnessandits
concomitantdilemmasinvolvesagreatdealoftheworkforceandeventhefinancesof
thecountry.
Opinionsastowhetherpostnataldepressionisaspecificdiseasehavebeendebated
since the time of Hippocrates. From the time of Louis Marce´ (1858) the theories of
itsorigin,rangingfromhormonal(Dalton,1985),tosocial(Guscott&Steiner,1991;
Oakley,1975)havebeenconsideredanddisputed.However,itisonlyinthelastthirty
years or so that in-depth study of the subject has revealed the high incidence of this
distressingcomplaint(Gerrardetal.,1993).Ithasbeenarguedthattherearestilltoo
manywomen,who,togetherwiththeirfamilies,aresufferinginsilence(Kelly,1994).
Recent television and newspaper coverage has stimulated some interest in postnatal
depression.However,muchremainstobedonetoeducatethepublicatlarge,ensuring
thatagreaterawarenessoftheprevalenceofthisconditionanditsdamagingsymptoms
canberecognisedandmanaged.
Thedebate,however,isnotnew.Itisreputedthattheincidenceofpostnataldepres-
sion,asamajormentaldisorderfollowingchildbirth,hasbeenthesubjectofmedical
observationsincethedaysofHippocrates.ThisancientGreekphilosopherrecognised
thathealthanddiseaseareinterdependentupontheinterplaybetweenhumanactions
and the environment of man. The customs, values, climate, diet, and modes of life
and age determined the characteristics of each disease. The additional requirements
whichdeterminedaperson’shealthstatusincludedthewholeofthepersonaandwere
involvedwiththeexaminationindetailofaperson’sinnermostthoughts,theirspeech
patternsandthesilencescontainedwithinthem.Thereasonsforthemannerismswere
