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Marce Society International Conference |
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| Abstracts 11 - 20
ABSTRACT 11
A SYSTEMATIC SURVEY OF THE PSYCHOSOCIAL CHARACTERISTICS OF WOMEN ADMITTED TO MASADA PRIVATE HOSPITAL MOTHER BABY UNIT
*Jane
Fisher, B Sc (Hons), Ph.D., MAPS Lecturer, Key Centre for Women's Health in Society , University of Melbourne ,, 720 Swanston Street, Melbourne, Victoria 3053, Australia
Colin
Feekery, MBBS, FRACP Consultant Paediatrician, Royal Children's Hospital, Parkville, Victoria and Medical Director, Masada Private Hospital Mother Baby Unit, Balaclava Road, East St Kilda, Victoria 3183
Objective The range of specialist services available to assist mothers and infants in the postpartum year has grown in recent years to include psychiatric units in general, obstetric and psychiatric hospitals; day stay and outpatient programs and residential parentcraft facilities. Most of these latter facilities have been funded by the state and run in the public sector. More recently, private hospital residential parentcraft facilities have been established. Masada Private Hospital opened a residential mother infant unit in April 1996. It provides brief admission, comprehensive assessment and carefully tailored psychologically informed interventions for mothers and babies in the first postpartum year. Most women are admitted because of infant feeding or settling difficulties. The psychological and sociodemographic characteristics of women admitted to both psychiatric and public parentcraft facilities have been examined in recently published systematic surveys. This paper presents the findings of a recent survey of the psychological and sociodemographic characteristics and health needs of women admitted with their infants to the Masada Private Hospital Mother Baby Unit (MBU) in southeastern suburban Melbourne.
Method All the women admitted to the Masada Private Hospital MBU between June 1st and November 31st 1997 were invited to complete a comprehensive questionnaire anonymously. The questionnaire covered socioeconomic factors; past reproductive events; index pregnancy and delivery events; relevant personal and family history; infant health, temperament and development and emotional needs and experiences. Standardised self-report psychometric instruments assessing mood, personality factors and quality of relationships with partner, mother and friends were incorporated into the questionnaire.
Results In all 108 (75%) of the 146 women to whom the questionnaire was distributed, completed it. It was found that these women, who were all of high socioeconomic status had a higher than average incidence of difficulties in conceiving; pregnancy illness; delivery and postpartum complications and breastfeeding difficulties. Their partners had professional and leisure commitments, which took them away from home for very prolonged periods. The quality of marital relationship and adequacy of practical support from fathers was compromised. A high proportion of the infants had significant temperamental difficulties. A majority of the participants were coping with distressing co-incidental adverse life events in addition to mothering new babies. There was a lower than expected incidence of personal history of psychiatric illness or sexual or physical abuse.
Conclusions The findings of this survey provide a systematic account of the correlates of mild to moderate postpartum emotional distress and identify a number of potential risk factors, which warrant further detailed investigation.
ABSTRACT 12
THE IMPACT OF OPERATIVE INTERVENTION IN CHILDBIRTH ON PSYCHOLOGICAL FUNCTIONING DURING A SUBSEQUENT PREGNANCY AND POSTPARTUM PERIOD
Jane
Fisher, B Sc (Hons), Ph.D., MAPS Lecturer,
Key Centre for Women's Health in Society, University of Melbourne 720 Swanston Street, Melbourne, Victoria 3053, Australia
Objective There is increasing evidence that operative obstetric procedures such as caesarean surgery and instrumental assistance in vaginal delivery exert at least short-term adverse effects on women's postpartum mental health. Australia's rates of use of these procedures are amongst the highest in the world and exceed World Health Organization recommendations for best practice. Most of the existing research into the psychological aspects of giving birth has only examined first-time mothers or has not explored the effects of parity. This paper reports a recently completed prospective longitudinal study into the determinants of both psychological well being and emotional distress in women during a second or subsequent pregnancy, birth and postpartum interval. In particular it investigated whether previous experiences of childbirth exerted effects on mental health in subsequent pregnancies.
Method In this study, 320 multiparous pregnant women completed telephone interviews and standardised self-report questionnaires in each trimester of pregnancy and at 2 and 8 months postpartum. Sociodemographic and personality factors, obstetric history and social and marital support were assessed at the beginning of pregnancy and after giving birth. Mood and self-reported physical and psychological symptomatology were assessed at each point.
Results It was found that multiparous parturient womens' psychological functioning is primarily governed by personality characteristics, the quality of relationship with partner and socioeconomic status. The effects of having had a previous instrumentally assisted vaginal or emergency caesarean delivery were complex, given that in Australia they are used disproportionately among those of high socioeconomic status. They were associated with an increase in late pregnancy anxiety, but significant adverse effects were not apparent until 8 months after giving birth. These psychological sequelae of operative intervention appear to be evidence for Posttraumatic Distress of delayed onset.
Conclusions These findings provide further evidence that operative obstetric procedures are not psychologically benign and that health policies to reduce their use to WHO recommended levels in Australia should be developed.
ABSTRACT 13LEARNING ABOUT MOTHERHOOD
Cathrine
Fowler NSW, Australia
The decision to become a mother is frequently based on beliefs of mothering being a natural state; fulfilment of a woman's ultimate "role" in life; and that a mother will innately know how to care for her baby. These circulating discourses of motherhood regularly draw on maternal instinct to provide a safety net which will "naturally" equip women with the ability to mother. A potential outcome of these essentialist discourses of motherhood is the silencing of women about their mothering experiences and the development of unrealistic expectations which cause potential distress, feelings of failure, incompetence and disappointment, resulting in possible long-term implications for the infant, other children and the family.
Fortunately, a counter reading of how women acquire mothering skills is possible and will be provided in an attempt to stimulate and offer a more productive way of thinking about motherhood and working with women. This counter reading allows an argument to be developed, that instead of mothering ability being an outcome of maternal instinct, mothering is learnt through the everyday experiences we have had as infants, children and young adults.
This paper comes out of a doctoral research project which utilises feminist and post-structuralist research practices. A limited longitudinal study of 9-to-12 months duration has been completed to gather data from a group of 15 women. The data consists of three extended semi-structured and dialogic interviews with each woman. The interviews explore the women's learning and experiences of pregnancy, childbirth and the first months of mothering.
ABSTRACT 14
ART THERAPY: ITS APPLICATION FOR POST NATAL DEPRESSION
Patricia
Galante and Bianca Morrison. Professional Affiliation: La Trobe University Melbourne,Mercy Hospital for Women: Mother Baby Unit. Austin Hospital: Banksia House, Mother Baby Unit. Rosebud Hospital: Mother Baby Unit.
1st. Presenter. Patricia Galante, R.N.; R.M.; Bachelor Psychiatric Nursing; Bachelor Nursing Honours. Address: 5 Robinson Court, Donvale 3111, VIC. Phone: 9872 3776 (home)9270 2501 (work) 2nd. Presenter Bianca Morrison, Advanced Certificate of Art and Design; Bachelor of Arts (Craft); Bachelor of Education. Address: 26 Murray St. Rye, 3941, VIC. Phone: (03) 59859859.
Art therapy has been successfully used within Psychiatry in both America and Great Britain for many years, however, its introduction to Australia has only just begun. Currently, there are three Australian Universities (Perth, Western Australia; Sydney, New South Wales; and the most recent Latrobe University, Melbourne, Victoria) offering "Visual Art Therapy" education at a Masters level. The following paper, presented by two final year Art Therapy students from La Trobe University, examples the versatility of art therapy through its successful utilisation with women suffering post natal depression.
Herein, each student describes their appliance of Art Therapy, through group process, within two Victorian Post Natal Depression Units. The first example describes art therapy's usage in developing a self as well as mother/infant awareness, while the other highlights the use art therapy within a series of semi-structured, educational groups, derived at improving mother/baby interactions and communications.
ABSTRACT 15
RISKY BUSINESS - IDENTIFICATION OF RISK FACTORS, ACTIONS AND OUTCOMES
Margaret
Gibbons, Clinical Nurse Consultant, Child and Family Health Sue Tomkins,
Social worker, Family Care Centre, Parramata. Parramatta Community Health Centre, 158 Marsden Street, Parramatta 2150
In this paper the presenters will give an overview of maternal, family and infant risk factors that have been identified through a universal home visiting program for all postnatal women. The referral process, management and outcomes to secondary services will be examined. The home visiting program was commenced 1998 in a large area of western Sydney.
Through identification of risk factors and ongoing joint management with the referring agent, we will identify the difficulties and the positive outcomes that have been encountered for parents and families.
This area of Western Sydney Area Health Service has a commitment to Early Identification and Intervention principles through the CHASP process and this home visiting program was developed to further this practice. Overwhelming literature support worldwide also underpins the philosophy. The program focuses on risk issues of depression, breast feeding, child protection and immunisation.
Detailed statistical information is gathered monthly to highlight risk identification and ensure appropriate management and referral. A research project is currently being undertaken to measure women's responses to the program.. In this presentation, case material will be used from clients attending secondary services that have been followed through from the home visiting program.
A commitment to optimal mental health of mothers, fathers and infants in this area of Western Sydney Area Health Service is paramount for the third millenium.
ABSTRACT 16
GOAN WOMEN'S EXPERIENCES OF MOTHERING IN A NEW COUNTRY
Ruth
De Souza Email: rdesouza@unitec.ac.nz, Internet: www.unitec.ac.nz
There is limited research into the incidence of Postnatal distress (PND) amongst minorities and immigrants, despite what appears to be additional disadvantages in terms of access to health services, separation from family networks and lack of recognition by health providers of traditional health practices. I intend to begin a qualitative study into the experiences of Goan/Indian women living in New Zealand, focusing on the transitions of migration and childbirth, particularly where both occur simultaneously.
This presentation includes a brief overview of the literature and concludes with strategies that can assist in therapeutic intervention based on my personal and professional experience as a clinician, and migrant Goan woman. This is the first time such research has been undertaken with the New Zealand -Goan Community. Goa was a former Portuguese colony on the South-West coast of India.
ABSTRACT 17
IS THERE AN ASSOCIATION BETWEEN MATERNAL POSTNATAL DEPRESSION AND FAILURE TO THRIVE?
Heycock
EG, O'Brien LM, Hanna M, Cox JL.
Aims: To report preliminary findings from a community based study designed to determine any association between maternal postnatal depression (PND) and Failure to Thrive (FTT) in their infants. Methods: All infants are routinely weighed as part of their general health surveillance. Children under 2 years of age, born at full term, were recruited into the FTT (index) group if their weight fell across 2 centile lines or beneath the 2nd centile on standardised growth charts. Control infants were recruited at a rate of 3:1 and were matched to the index infant for sex, age, ordinal position and postal sector. All mothers of recruited children completed the Edinburgh Postnatal Depression Scale (EPDS). Mothers who scored ³9 were offered a structured Clinical Interview Schedule (CIS). ICD-10 diagnoses of depressive disorder were derived from the CIS. Results: One hundred and seventy nine infants have been recruited to the index group, together with 454 control infants. Using the EPDS as an accepted first stage screen for PND confirmed that the prevalence of PND in the control group was representative of the general community of North Staffordshire. Two thirds of mothers in both index and control groups who were interviewed with the CIS fulfilled the ICD-10 diagnostic criteria for depressive disorder. Preliminary analysis of all mothers recruited indicates that 16% of the index group had an ICD-10 diagnosis of depressive disorder, compared to 10% of the control group (p=0.03). Conclusion: This research indicates that there is a significantly higher prevalence of depressive disorder in mothers of infants who are failing to thrive, than in the general community. These findings could have significant ramifications for service provision to mothers of infants presenting with poor weight gain.
ABSTRACT 18
A HISTORY OF ABANDONMENT - A BRIEF SOCIAL STUDY OF BORDERLINE PERSONALITY AND ADDICTION IN RELATION TO THE CARE OF MOTHERS, FATHERS AND INFANTS INTO THE THIRD MILLENNIUM
Brian
J. Hunt, Phone Contact: 9665 4734 Email: z8439842@student.unsw.edu.au
Masterson refers "to Bowlby's studies of children's response when removed from their mothers in the early separation -individuation stage of development. He describes them as going through three stages, first, protest and wish for reunion; despair; and finally detachment if the mother is not restored. In other words after a certain level of deprivation, the child removes all emotional investment in the object and the affect becomes detached from the object. What appears to be relatedness is really manipulation for gratification". Masterson, J. F. (1981, p. 46) This paper will attempt to describe addiction as a symptomatic manifestation of Borderline Personality Disorder and will explore the implications of this by way of a social history and vignettes from numerous case studies of the following
In an effort to define the nature of the problem I will examine the historical evidence of its increasing dimensions. This will begin with an illustration, Hogarth's "Gin Lane" (1751) which dates from the beginning of the industrial revolution and follow the cause of its development to the present time.
The aim of the paper is to emphasize the importance of understanding the history and etiology of addiction as a social disorder so that we may attempt to find solutions that will enhance our ability to care for mothers babies fathers and families into the third millenium. REFERENCE Masterson, J. F. (1981) 'Differential Diagnosis'. The Narcissistic and Borderline Disorders. Bruner-Mazel, New York. p 46.
ABSTRACT 19
THE ROLE OF ANXIETY IN POSTPARTUM 'DEPRESSION'
Ms Ann-Louise
Hordacre B.A. Hons,
Dr Don
Pritchard M.A., Ph.D., M.A.P.S., Chartered Psychologist (Clinical) Affiliate Senior Lecturer & Clinic Director, Psychology Department, University of Adelaide, North Tce, Adelaide 5005, Phone: (08) 8303 4924 Email: psyd-pri@psychology.adelaide.edu.au
There is continuing debate amongst researchers and clinicians as to the relationship between depression and anxiety, with the general (although not universal) belief that they are distinct diagnoses. Recent research has attempted to identify the specific psychological and physiological aspects of each disorder that are exclusive to that disorder. Such debate appears to be absent from studies on postpartum women with Odepression¹ the only non-psychotic psychiatric diagnosis available for women who are experiencing symptoms of emotional distress specifically related to the postpartum period. This is problematic as the primary symptom of postpartum depression is said to be Oanxiety¹. It therefore seems likely that anxiety and depression, which are often clinically confused by psychologists and psychiatrists, are also confused during the postpartum period making treatment problematic. For researchers, this problem is compounded by instruments such as the Edinburgh Postnatal Depression Scale (EPDS) which is widely reported in the research literature and contains many questions commonly considered to define anxiety, along with questions more specifically on Odepression¹. In an effort to tease out these matters, this study examines patterns of responses given by women who are between 6 and 12 weeks postpartum (and a non-postpartum cohort) on 4 self-report instruments: the EPDS; the State-Trait Anxiety Inventory (STAI); the Center for Epidemiologic Studies - Depression Scale (CES-D); and the Depression, Anxiety and Stress Scale (DASS). The study aims to assess the contribution of depression and anxiety in postpartum women using statistically independent measures and to test the validity of the EPDS as a measure of Odepression¹ in the postpartum period. The study also examines the response differences between the depression and anxiety experienced by a sample of unselected postpartum women and that of non-postpartum women.
ABSTRACT 20
EFFECTIVENESS OF A PSYCHOSOCIAL PREPARATION FOR PARENTHOOD SESSION AT REDUCING POSTNATAL DISTRESS IN NEW PARENTS
Stephen
Matthey, Bryanne Barnett, D. J. Kavanagh, P. Howie, M. Charles. Institution: Park House (Paediatric Mental Health Service), 13 Elizabeth, Street, Liverpool 2170. Sydney NSW, Australia. Ph: (02) 9827 8011; Fax: (02) 9827 8010; email: pmhs@unsw.edu.au
Results from a study investigating the effectiveness of providing a psychosocial intervention in standard preparation for parenthood classes will be presented. Over 200 couples attending these evening classes were randomly allocated to one of three conditions : The usual six session class (UC); the usual six sessions plus one session focussing on couple empathy and practical coping strategies in the early postpartum period (E); or the usual six session plus one session Focussing on playing with the baby in the early postpartum period (thus controlling for non-specific effects) (BP).
Couples were then interviewed at home at 6 weeks postpartum, and the mother was again interviewed at six months postpartum with additional information obtained form the father via questionnaires at this time.
The focus of this presentation will be on the maternal and paternal adjustment measures, and in particular the significantly lower EPDS scores for women with low self-esteem who attended the Empathy sessions. Video footage of some of the session components will be shown.
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