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Buddying or prescriptions?


It’s hard to know whether the statement last week from NICE that all new mothers should receive a ‘comprehensive mental health assessment’ during their routine six-week postnatal appointment is cause for celebration or despair.

Celebration in that maternal mental health (no mention, incidentally, of paternal mental health….?) is at last being recognised as pretty important for the wellbeing of the new family.

But perhaps a case of shutting the door after the horse has bolted? The problems as I see them are (at least) twofold. Firstly, it is generally agreed that the majority of ‘postnatal depression’ starts in the antenatal period. And that women who become depressed before or after childbirth often have a prior history of depression. So the majority of women who will be diagnosed with depression at the 6 weeks postnatal appointment should almost certainly have been on the radar months before.

The second problem is the perennial one with universal screening. If you go looking for problems, you will certainly find them. And if you find them, what then? What will be offered to the probably considerable number of women who will be diagnosed with depression? Tablets? Certainly not ‘services’ because mental health services are in very short supply indeed.

So is it appropriate to screen if you’ve nothing to offer when problems are detected?

Much better to intervene earlier than the postnatal period. There was a fantastic scheme running until recently in an area not far from where I live. Women ‘at risk’ of depression, or who were already depressed during their pregnancy, were provided with a support person – someone who was herself a mother and who had received some relevant training in the care of pregnant and new mothers. These buddies met the women once a week, or more often if they requested, to talk about how they were feeling and to make plans for after the birth.

The scheme was never evaluated. I bet it saved thousands of pounds for the NHS both in terms of the mothers’ wellbeing and their babies’. But, of course, without ‘evidence’, it quickly fell prey to the next round of cuts.

My feeling has always been that postnatal depression is over-diagnosed in this country. There are certainly a lot of women who feel ‘low’ after their babies are born. Why? As mothers-to-be, expecting our first child, we simply don’t understand the realities of 24/7 baby care because most of us have had few if any dealings with babies before we get to hold our own in our arms. So we are frighteningly unprepared.

And then there’s the isolation that’s a feature of 21st century mothering in western cultures. I remember so clearly the dead, numb feeling that descended on me each morning after my first was born when my partner left the house and I was on my own for the next 10 hours in a town where I knew nobody. My ‘depression’ (and I’m sure I could have been diagnosed as depressed) was a combination of exhaustion, profound loneliness and equally profound misconceptions about what looking after a baby is all about.

Rather than introducing more screening, wouldn’t it be better to provide more opportunities antenatally and postnatally for women (and men, of course) to meet each other and talk about ‘what it’s like’ to be pregnant, to have just given birth, to be at home on your own with a baby. And let’s have more buddying schemes. Not, for goodness sake, more prescriptions. I think a lot of women would prefer to have a coffee with someone with good listening skills than to be setting the alarm on their mobile phones to remind them to take their next tablet in four hours’ time.

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