Marce Society International Conference
Sydney, 10-13 September 2008


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1999 Conference Abstracts

Abstracts 31 - 40

ABSTRACT 31

CHANGES IN MATERNAL ROLE ATTAINMENT OF FIRST-TIME MOTHERS

Haekyung Lee, RN, PhD

The birth of a child, like puberty or menopause, is generally regarded as a critical event in a woman's life. A lot of new experiences occur rapidly, and mothers as primary caregivers, must adapt and cope with new responsibilities.

The longitudinal study presented here attempted to examine how first-time mothers attain their maternal role over time. The aims of the study is what changes occur in the level of maternal role attainment at 6 weeks postpartum, 4 and 8 months after birth.

Data was collected at three measurement periods( 6 weeks, 4 months, and 8 months after birth) with 54 primiparpus mothers. Maternal role attainment was operationlized as maternal identity that was assessed by a Semantic Differential Scale, Myself as Mother and maternal role strain was measured using a 20-item index slightly modified from Hobbs' Scale. The mothers perception of emotional support and physical support she received from her husband was measured using an 21-item index slightly modified from Taylor Inventory.

The process of maternal role attainment in which the mother achieves competence in the role and integrate the her identity as a mother did not differ over time(F(2, 171)=.113, p=.893) in this study. When role strain compared over time, there were no significant difference. But, role strain scores at 4 months after delivery were lower than the postpartum period or when the baby was about 8 months old. Also, there did not show a significant difference about support from husband. These results indicated that mothers did not receive enough support from their husband.

ABSTRACT 32

COMPLEMENTARY THERAPIES IN THE MANAGEMENT OF MOTHER-INFANT DISTRESS

A description of the benefits of an Expressive Arts Program within Karitane Residential Unit

Michele Manly R.N.,C.M.,C & FHN., N.AUDIO., Grad.Dip. N.Man.,Ma. Nursing., AFACHSE.
KARITANE P.O. Box 241, Villawood. NSW. 2163 Phone (02) 97941800. Fax (02) 97941858 Email Michele.Manly@swsahs.nsw.gov.au

The images created by contemporary society sanction the idealisation of motherhood. These representations of mother and child engender the concept of absolute happiness, of completeness and of the fulfilment of a life's dream. The reality experienced by a great many mothers contrasts these images, instead, many relate an internal conflict, evoking feelings of uncertainty, inadequacy and a sense of loss of self. All these feelings conflicting with the joy they feel in the wonderment of a new life.

Health professionals are in a key position to help women grow from their early experiences of motherhood. By assisting them to identify and draw on their inner strengths, women are able to normalise their experiences, address their distress and progress through the adjustment of early parenting to a new confidence and the development of a healthy mother infant attachment.

Karitane is setting the benchmark in holistic care by offering a program of creative arts, within their Residential Unit. Through the process of creative visualisation, photo imagery, dance, Yoga, music, meditation and reflective journal writing the facilitator is able to acquaint women with a new awareness, a certain harmony of mind and body. Sensitivities are heightened through massage and aromatherapy, and the bond felt with their infant is enhanced in the experience of infant massage.

The philosophy of the program is reflected in the words of Aristotles, " When the parts of the body and its humors are not in harmony then the mind is unbalanced and melancholy ensures, but on the other hand a quiet and happy mind makes the whole body healthy"

This paper will detail the benefits women relate upon experiencing the program. It will describe how they perceived the process helping them to find their inner strengths, to calm their inner conflict and to take a newfound joy in being a mother.

ABSTRACT 33

POSTNATAL DEPRESSION PROFESSIONALS ASSOCIATION INC WESTERN AUSTRALIA

Gally McKenzie, secretary. Joan Forward, vice chairperson

Postnatal Depression Professionals Association Inc, c/o PO Box 303, North Fremantle 6159 WA

Phone: (08) 92279032 / (08) 92278208 Fax: (08) 92275860

1986/87 saw the birth of West Australia's Postnatal Depression Professionals Association in response to a wide range of practitioners awareness of a need for structured development for women & families at risk of or experiencing Postnatal Depression. This poster aims to give an overview of PNDPA Inc's development, now in it's thirteenth year, in light of global developments in the PND field.

ABSTRACT 34

THE USE OF GROUPS AS A CLINICAL INTERVENTION: THE STRENGTHS AND WEAKNESSES OF DIFFERING THERAPEUTIC APPROACHES

Anne Pratt
 School of Psychology, Edith Cowan University, Joondalup Campus, Perth.
Tel: 94005168 (ECU) 9401 5325 (Home) Fax: 9401 5224

Postnatal Depression has been the subject of research for a number of years. As a result, more is now known about the cause of the disorder, yet little has been published on its' management. Sixty-three women with Postnatal Depression participated in a study designed to test the efficacy of groups and their therapeutic value in treating the disorder. The women participated in one of three groups; a support group, an eclectic group and a waiting list control. The measure used was the Edinburgh Postnatal Depression Scale (Cox, Holden & Savoskis, 1987). Using as Anova 3x2 split-plot design it was found that though both the support group and the eclectic group resulted in some improvement for women, only the eclectic group was statistically significant at the <.05 level.

This workshop will explore some of the reasons why women may have benefited more from the eclectic model.

ABSTRACT 35

TO DEBRIEF OR NOT TO DEBRIEF - THAT IS THE QUESTION

Susan Priest

In 1995 NHMRC funded a randomised, single blind control trial of a brief intervention using a specially devised, structured interview (The Maternal Individual Debriefing Schedule (MIDS) to see if stress debriefing after childbirth could reduce the prevalence of postnatal disorders.

Aims: To investigate maternal outcomes in the year after delivery of a full term infant , following a stress debriefing intervention

Method: 1755 English speaking mothers were randomly allocated to an intervention group or a control group. Research midwives trained to use the MIDS held a discussion session with women in the intervention arm, whilst they were in hospital, within 96 hours of delivery of a full term infant. Maternal outcomes were assessed by self report questionnaires (Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ-28), after delivery and at 2 and 6 months. All mothers who scored above 12 on the EPDS along with a stratified, random sample of those scoring below 13, were interviewed using the Schedule for Affective Disorders and Schizophrenia (SADS) ,by a Research Clinical Psychologist blind to intervention status. Research Diagnostic Criteria were used to used to diagnose clinical disorders.

Results: 882 women were debriefed (Intervention Group) and 873 were controls. There were no significant differences between groups in gestation,parity, previous history of psychological disorder, demographic measures, type of labour and delivery, or maternal ratings of labour, and delivery. Nor were there differences on the EPDS, BDI or GHQ28 at any assessment period. By 6/12 post delivery 498/1755 women had been interviewed on the SADS. Diagnoses were: Depression (Major or Minor) 274 (15.6%); Stress Disorders 95(5.4); GAD12(0.07%);Phobic 35

( 2.0%) Panic Disorder 20 (1.1%);Other 109 (6.2%). When data was combined across two assessment periods and diagnosis of Major and Minor Depression were grouped together there were no significant differences in diagnostic outcomes between the group who were debriefed and the controls.

However further analyses of groups broken down by diagnosis at each assessment , revealed a significant effect of the intervention in relation to women who became depressed. By 6/12 there were twice as many women in the Intervention Group with Minor Depression and half as many with Major Depression. Women with a negative perception of their labour and delivery, and those with a prior history of contact with a mental health professional, were more likely to receive a diagnosis of Depression but there were no significant interaction effects on these variables across the Intervention and Control groups on these variables. (Adjusted OR .890 ; 95%CI .68-1.16)

Conclusions:

Psychological disorders are common after term delivery. A single stress debriefing intervention did not reduce the overall prevalence of depression (combined Major and Minor) but it did alter the ratio of Major to Minor episodes. Women who were debriefed were more likely to be diagnosed with Minor Depression rather than Major Depression by 6/12 post delivery when compared with controls.

ABSTRACT 36

BELIEFS ABOUT THE CAUSES OF POSTNATAL DEPRESSION AMONG WOMEN WITH YOUNG CHILDREN IN SYDNEY

Roufeil, L.M., Elliott, L.A., & Tyson, G.A

School of Social Science and Liberal Studies, Charles Sturt University, Bathurst, NSW, Australia.

Email: lroufeil@csu.edu.au

While the literature on women's experience of postnatal depression (PND) is expanding, little is known about lay people's beliefs about the disorder. Beliefs about the causes of PND held by women with young children are important: firstly, because they may provide health professionals with insight into the type of support and advice that proliferates in the informal support networks of young mothers; secondly, they may shed light on the decision by many women with PND not to seek professional assistance. In the first study to be reported, 58 members of the general population were asked to respond to an open-ended question: "What do you think causes postnatal depression?" Beliefs mentioned by participants (in addition to those drawn from the literature) were used to construct items in questionnaire subsequently given to 284 women with preschool children. Participants were required to indicate how important they felt each of the items was as a possible cause of PND. Responses were factor analysed in order to determine the underlying structure of causal beliefs. Five factors emerged: stress surrounding childbirth and childcare, social support, social expectations, psychological and biological variables. Beliefs were related to knowing someone with PND, level of participation in the paid workforce, and exposure to PND through professional training. The theoretical and clinical implications of these findings will be discussed.

ABSTRACT 37

CHILDBIRTH EXPERIENCE, EARLY MOTHER-INFANT CONTACT AND LATER MATERNAL WELL-BEING.

Heather Rowe Murray, B Sc (Hons), Jane Fisher B Sc (Hons), PhD, MAPS

Key Centre for Women's Health in Society, University of Melbourne, 720 Swanston Street, Carlton 3053, Victoria, Australia

Evidence is emerging that childbirth experience can influence early postpartum mood. In particular it appears that those who experience operative obstetric intervention are at heightened risk of postpartum emotional distress. While there has been extensive investigation into early mother-infant attachment, little specific research has addressed the question of a relationship between childbirth experience and early mother-infant contact, and there is little evidence available regarding the psychological consequences of these procedures for infants or mother-infant relationships.

This study investigated relationships between childbirth experience, aspects of the first contact of mothers with their newborn babies, and mothers' physical and emotional wellbeing. Two hundred and three first-time mothers were interviewed in hospital in the first few days after giving birth, providing details of their labour and delivery, the first contact with their babies and their feelings at that time. They also completed two standardised self-report psychometric mood questionnaires. Eighty percent of these women (163) were able to be followed up when their babies were 8 months old. At that time, they completed a questionnaire providing details of their physical and emotional wellbeing and their adjustment to motherhood. In addition, they completed the same two standardised self report mood questionnaires and a third which assessed infant temperament.

Women were compared according to three different modes of delivery: spontaneous vaginal delivery, instrumentally assisted vaginal delivery and caesarean section.

Measurable differences were found between the three groups in both the quality and quantity of early contact they had with their babies. Adverse `sequelae of operative intervention were evident at eight months postpartum.

ABSTRACT 38

'REBUILDING THE VILLAGE': NEW MOTHERS' GROUPS AS SOCIAL NETWORK INTERVENTIONS

Associate Professor Dorothy Scott
School of Social Work, University of Melbourne, Parkville 3052 Tel: 9344 9435 Fax: 9347 4375
email: d.scott@socialwork.unimelb.edu.au

This paper will report on recent research conducted on Victorian maternal and child health nurses' First Time Parent Groups in two growth corridor municipalities on the outer fringes of Melbourne. These groups are offered to all first time parents in Victoria and consist of 8 group sessions focussed on adjustment issues, infant settling techniques, safety in the home, child development etc. Nurses in both municipalities were interviewed about the way they facilitated the groups and a sample of 243 women who had participated in such groups were followed up one to two years later to determine the degree to which contact between the women had continued and the nature of social support exchanged. In one municipality 80% of the women reported having continuing contact and having formed significant relationships with one another. In the other municipality, which had a higher proportion of women returning to full-time employment within 12 months of birth, 67% of those who joined the groups reported the same outcome. Given the significance of low social support as a contributing factor to psycho-social problems such as maternal depression and child abuse and neglect, this study has implications for how universal services can intervene to strengthen peer based social support for families in transition to parenthood. The study also has implications for the way such groups might be best facilitated if their potential for the creation of self-sustaining social networks is to be achieved.

ABSTRACT 39

EXPERIMENTING WITH WOMEN'S HEALTH: THE CHALLENGES OF EVALUATING HEALTH PROGRAMS AND THE CASE FOR A COMMUNITY RANDOMISED TRIAL TO REDUCE MATERNAL DEPRESSION AFTER CHILDBIRTH

Ms Rhonda Small and Dr Stephanie Brown, Prof Judith Lumley, Ms Lyn Watson

Centre for the Study of Mothers' and Children's Health, School of Public Health, La Trobe University, 251 Faraday Street, Carlton Vic 3053 Australia

This workshop will examine methodological issues in the design and evaluation of programs which aim to reduce maternal depression after childbirth.

Designing effective evaluation of social and health programs presents a challenge to both researchers and health service providers. Questions to be faced include:

  • how do we base our intervention programs on the best available evidence?
  • how do we design evaluation to determine if programs, once implemented, are really effective?
  • what are the arguments for and against the randomised trial as an evaluation tool?
  • how do we know if an intervention is giving us good value for money?

The importance of these questions becomes clear when considering the considerable amount of program activity aimed at reducing postnatal depression in Victoria over the last decade. Curiously, there has been little interest in rigorous evaluation of funded programs. Comparisons of women 'receiving' programs with women not involved have been rare Programs have often come and gone, attaining little more than pilot status. Many programs ignore the social contexts in which women become mothers, despite the weight of evidence in support of such factors being critical to women's experiences of depression. Some programs have simply become part of standard care with little or no evaluation of the outcomes for mothers.

Drawing on their experiences of researching maternal depression in Victoria over the last decade and, more recently of designing a primary care and community based intervention program to improve the emotional and physical health of mothers after childbirth, the presenters will argue the need for randomised trials in evaluating health programs and present the case for a community randomised trial to improve maternal emotional health after birth - and they invite other conference participants to join them in lively debate.

ABSTRACT 40

SCHIZOPHRENIA, MENTAL STATE AND MOTHER-INFANT INTERACTION: EXAMINING THE RELATIONSHIP

Martien Snellen, Kerry Mack, Tom Trauer.

Correspondence - Albert Road Centre for Health, Level 2 No. 60 Albert Road, South Melbourne Victoria 3205. Tel: 03 9682 0380.

It is recognised that maternal mental illness may have a number of potentially deleterious effects on infant development and, although there are a number of potential pathways to such outcomes, disturbance of mother-infant interaction has been hypothesised to be one significant variable. This study specifically examines the role that disturbance of mental state of mothers with a postpartum schizophrenic illness plays in determining the quality of mother-infant interactions. We examined the relationship between the nature and severity of maternal symptomatology and the quality of her interactions with her infant in a sample of 15 mother-infant dyads admitted to a psychiatric Mother-Baby Unit. Data were obtained at admission and discharge.

Analysis of the results supported the two research hypotheses: i.e. that the severity of psychopathology in mothers with a postpartum schizophrenic illness correlates with the severity of disturbance of mother-infant interaction, and that a change in the severity of psychopathology correlates with a change in the quality of interactions.

Mothers with florid psychotic symptoms and prominent negative symptoms of schizophrenia and their infants were identified as being at particular risk of displaying disturbed interactions. The adverse contribution of negative symptoms was often not evident until after the positive symptoms had resolved. Given that negative symptoms are often treatment resistant and slow to change, optimal care of schizophrenic mothers and their infants needs to involve ongoing therapeutic interventions which specifically address disturbance of mother-infant interaction. The clinical significance of these findings is further elaborated upon.

 

 

 

 

 

 

 

 

 

 
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