Pregnancy
Perinatal Mental Health Project screen This screen should only be conducted if resources are available for referral, e.g. mental health nurse, social worker, NGO or a medical officer. Before screening, use words like: ‘We would like to know about all the women who come here; how they are doing physically and emotionally. This helps us to understand the best sort of care we can offer. Please may I ask you three questions about how you are emotionally? Please answer ‘yes’ or ‘no’ to each question.’ In the last 2 weeks, have you on some or most days felt unable to stop worrying or thinking too much?
Yes
[1]
No
[0]
In the last 2 weeks, have you on some or most days felt down, depressed or hopeless?
Yes
[1]
No
[0]
Yes Refer
[1]
No
[0]
In the last 2 weeks, have you on some or most days had thoughts or plans to harm yourself or commit suicide?* TOTAL SCORE
1 >>>>>>>>>>> no referral 2 >>>>>>>>>>> refer 3 >>>>>>>>>>> refer
Offered counselling
Yes
No
Accepted counselling
Yes
No
* The self-harm question will require urgent referral if there are both thoughts AND plans. If there is a history of previous attempt, referral is required even if there are thoughts alone.
Midwives can play a vital role Women suffering from CMDs need someone who can listen, guide them gently and provide information. They may feel isolated and vulnerable, and need to be encouraged to make social connections and form support systems. Once detected, the management of CMDs should be based on these five principles: 1. Empathic care All women benefit from empathic care. Empathic engagement includes creating a safe, caring environment, actively listening, being respectful and non-judgemental, providing the opportunity to explore possible solutions. Pregnant women suffering from emotional distress should hear: • You are not alone • You are not to blame for how you feel • There is help available 2. Psycho-education Psycho-education involves providing information about mental health and mental illness in an understandable way, and providing options for how she can manage her situation. 3. Early treatment Early treatment reduces the risks for both mother and child. The first line of treatment for mild to moderate CMDs would be one of the talking therapies, such as problem-solving therapy, cognitive behavioural therapy and interpersonal therapy. For women who do not
respond to talking therapy or those with moderate to severe CMDs, more specialised care, including medication, may be needed. Antidepressants (particularly the selective serotonin reuptake inhibitors, or SSRIs) may be prescribed for pregnant and breastfeeding mothers. They have been considered relatively safe compared to the risk for both mother and child of untreated CMDs. 4. Holistic management Holistic management includes assessing the underlying causes or factors that may increase the risk of CMDs. This may include referrals to social or community-based services that offer specific interventions for issues such as food insecurity and domestic violence. Helping a mother to link to supportive social networks could be of great benefit. In making referrals, it is useful to explore with the mother whether she is able and willing to attend. A successful referral does not stop at making a recommendation, but rather needs to be followed up to see if the referral was useful. 5. Suicide risk assessment This calls for immediate referral.
What about the health providers? Health providers who are involved with women around the time of pregnancy and birth play a vital role in the physical and psychological health of these women and their children. The work may be very rewarding but can also be stressful and lead to burn-out. Caring for your own physical and emotional wellbeing is extremely important! See references on page 34
eSensitive Midwifery Magazine
8
Issue 43