Postpartum Psychosis is a severe mental health problem following childbirth, with a psychotic element and associated mood disturbance. Research to date has primarily focused on mothers’ experiences, and on identifying risk factors, aetiology, and intervention efficacy. Within both research and clinical communities, there has been little acknowledgement of partners’ experiences of Postpartum Psychosis, nor the important support role that partners can provide. The aim of this study was to consider the lived experiences of partners of women who have had Postpartum Psychosis, and the impact that it has had on their lives and relationships. Participants were partners recruited through the charity Action for Postpartum Psychosis. Partners were asked to complete an online questionnaire to provide basic demographic and contextual information, followed by an in-depth, semi-structured interview regarding their experiences of Postpartum Psychosis. Interpretative Phenomenological Analysis was used to analyse the interview transcripts. Partners reported a lack of support being provided to them, and typically perceived a deterioration in the quality of their couple relationship during, and following, the episode of Postpartum Psychosis. Seven superordinate themes were extracted from the interview data: powerlessness; united vs. individual coping; hypothesising and hindsight; barriers to accessing care and unmet needs; managing multiple roles; loss; and positive changes from Postpartum Psychosis. These findings provide a rich illustration of the experiences of partners, and highlight areas in which support could be provided for partners. Limitations of the study, and implications for future research and clinical practice, are discussed.

Postpartum weight retention is commonly considered an important precursor to long-term weight gain, with existing research suggesting that failure to lose weight in postpartum has significant future health implications. While postpartum has been identified as a possible ‘window of opportunity’ for women to make health behaviour change and manage their weight, it remains unclear how mothers, and in particular ‘large’ (BMI ≥ 40 kg/m2) mothers, experience health and engage with health-related behaviours at this particular point in the life course. Existing research has done little to enhance our understandings of the lived, embodied and practical realities of caring for an infant and, crucially, how this impacts health and weight management during the postpartum period. In addition, qualitative research focusing on postpartum has largely ignored the temporal dimensions of this period and, instead, has tended to focus attentions on a single ‘snapshot’ in time. To address these gaps in the literature, this study employed longitudinal qualitative methodology to explore 15 ‘large’ (BMI ≥ 40 kg/m2) women’s lived experience of health and weight management over the first six months following childbirth. Participants were recruited from a specialist antenatal metabolic clinic based in Edinburgh, Scotland. When possible, three in-depth semi-structured interviews were carried out with each participant: the first at six weeks postpartum, the second at three months and, the third at six months postpartum. Both six weeks and six months have consistently been identified in the literature as important markers for postpartum women. Hence, it was hoped that by interviewing at these and an intervening time point (i.e. three months) it would be possible to capture and understand processes of change with regards to weight management in the postpartum period. The analysis revealed that accounts of health and weight were far from straightforward and seemed to be heavily influenced by the wider social context, which routinely pathologises, demonises and stigmatises ‘fatness’. Challenging contemporary discourses of the ‘obesity epidemic’ which frame the large body as a direct consequence of individual lifestyle, participants principally drew upon lay notions of inheritance and implicated a genetic predisposition to resist individual responsibility for weight and body size. The analysis suggests that concerns for health were largely predicated on subjective experiences and, in the absence of tangible and embodied experiences of ill-health, participants expressed little if any impetus to engage in weight management for the purpose of improving their health. In short, the idea that their weight was an indicator of poor health, or future health risk, was not a view shared by participants. Instead, they expressed more complex understandings of their weight, and their responsibilities to engage in health changing behaviour. Despite articulating often strong desires to engage in weight management ‘for the baby’, the longitudinal focus revealed a disjuncture between these intentions and the reality of those engagements. Influential in this discordance was the transition from an intensely medicalised and closely monitored pregnancy, to a period of minimal or no follow up in postpartum. The lack of ‘surveillance’ appeared to have a notable impact on participants’ engagements with health-related behaviours once at home and going about the day-to-day tasks of caring for their infant. Dominant discourses around ‘good’ mothering also made it difficult for participants to prioritise their own needs (such as weight management) ahead of those of their children and other family members. When participants reflected on their experiences of mothering they frequently drew upon understandings of themselves as relational beings and, at times, positioned themselves as phenomenologically inseparable from their baby. This relationality was often experienced as a diminishing of individual autonomy, as the body of the mother and the baby became inter-embodied and bounded. Consequently, my analysis serves to problematise the individualised expectation surrounding a mother’s ability to act autonomously and engage in health-related behaviours in postpartum. These findings also call for a stronger appreciation to be developed of the complexities surrounding engagements with health-related behaviours at this particular point in the life course. In particular this research demonstrates the importance and utility of adopting a more embodied approach, which in turn has some notable implications for public health policy and practice.

In the first part of my PhD I explored the link between childbirth and mood disorders in a retrospective sample of over 1500 parous women with mood disorders, recruited as part of ongoing molecular generic studies. Around two thirds of participants reported at least one episode of illness during pregnancy or the postpartum. Women with bipolar I disorder reported an approximately 50% risk of a perinatal major affective episode. Risks were lower in recurrent major depression and bipolar II disorder at around 40%. The majority of perinatal episodes occurred within 4 weeks of childbirth. Episodes of mania or psychosis had an earlier onset than those of depression. For bipolar II disorder, onsets of psychiatric episodes were more spread out over the perinatal period with more onsets in pregnancy and later in the postpartum. Moreover, childbirth did not seem to be a specific trigger for the majority of perinatal episodes of bipolar II disorder. Primiparity was associated with postpartum mania/psychosis and unipolar postpartum depression in women who experienced their first lifetime episode within 6 weeks postpartum. My findings raise the possibility of a relationship between postpartum mood disorders and other disorders influenced by parity, such as pre-eclampsia. In the second part of my PhD I designed and piloted a prospective study aimed i) to replicate and ii) to extend the findings on the retrospective sample, exploring the influence of a range of variables on the vulnerability to develop an episode of severe illness in pregnancy or the postpartum. Over 14 months of recruitment 19 women completed the follow-up assessment. To capture the clinical complexity of bipolar disorder in pregnancy and the postpartum period very large scale longitudinal studies are needed. These studies must be based on a strong collaboration with the NHS.

Following decades of research on stress and its impact on behaviour, it is now widely accepted that selective psycho-pathologies, in particular clinical depression are more prevalent in humans with prior history of life-stress events. Interest in stress has led to questions about how it might affect the physiology and behaviour of animals exposed indirectly during gestational development. Not unexpectedly gestational stress has been shown to affect the offspring in several ways: endocrine responses to stress are elevated, fear, arousal and affective disturbances are all subject to vary if the pregnant animal is subjected to periods of aversive stimulation. Beginning in 1997, Michael Meaney of McGill University produced a series of publications suggesting that peri-natal events influence offspring and infant development, not via physical discomfort or physiological disturbance, but does so through modifications of maternal behaviour. Highly nurturant mothers (those who engage in active arched-back nursing (ABN), and spend more time licking and grooming (L/G) their pups), programme their offspring with improved cognitive abilities, decreased anxiety and fear, and reduced HPA axis hormone secretion. Low-nurturant mothers, who engage in less ABN and less L/G, tend to programme the opposite responses in their offspring. Our initial foray into this field was to investigate if gestational stress might also produce responses in the offspring via changes in maternal behaviour, and indeed ABN and L/G were reduced in dams which were subjected to gestational stress. We queried why stressed Dams would be less maternal towards their infants, and tested gestationally-stressed Dams in the Porsolt test for depressive-like behaviour. Our results suggested that these stressed Dams were actually depressed and this resulted in less maternal behaviour. Human mothers with depression are also less maternal and have been shown to divest themselves of infant care much like our prenatally-stressed Dams. On this basis we have proposed that gestational stress induced decrements in maternal behaviour represent a novel rat model for postnatal depression with face and construct validities. In the present work we have attempted to replicate the findings of Smythe's group (Smith et al., 2004), and have investigated the potential for antidepressants to alter the influence of gestational stress on maternal behaviours and depressive-like response, and whether or not the offspring are modified by maternal treatment with ant-depressants. Approximately 140 time-mated, lister hooded rats were generated in house, and subjected to gestational stress on days 10-20 (1hr restraint/day) or remained undisturbed in their home cages. Following birth, cohorts of control and stressed Dams were administered vehicle or an antidepressant (imipramine 15mg/kg; or sertraline 10mg/kg) once daily until postnatal day 10. We assessed maternal Porsolt activity, nurturance (ABN, L/G, nest building) and anxiety-like behaviour in the elevated plus maze (EPM). Representative offspring of each Dam's treatment conditions were maintained post weaning and assessed in the Porsolt and EPM to determine if any changes in maternal behaviour elicited by the antidepressants altered their behavioural programming. Our findings confirm that Dams show depressive-like symptoms following gestational stress, and that administration of antidepressants to the Dams reduces depressive-like behaviour and increased maternal care. We propose that rat gestational stress is a putative model for human postnatal depression. Prenatal stress effects on maternal behaviour in the rat Dam represent a novel, and innovative model for human postnatal depression.

Whilst previous research has explored women's experiences of disclosing symptoms of postnatal depression (PND) to health professionals, very little qualitative research exists on women's experiences of disclosing to people in their personal support networks. Research has shown that some mothers with PND find it difficult to disclose to professionals and prefer to seek support from partners, family and friends. Aim: The current study aimed to explore the overall process mothers go through to disclose PND - to people with whom they have personal relationships, as well as health professionals. Method: Five women who experienced and disclosed PND participated in semi-structured interviews. Verbatim transcripts were analysed using Interpretative Phenomenological Analysis. Results: The analysis produced four super-ordinate themes: 'Trying to cope whilst making sense of experiences', 'Deciding whether to disclose: Facilitative and inhibiting factors', 'The two-way interpersonal nature of disclosure', 'Disclosure as part of a transformative process'. Conclusions: This study highlighted the influence of internalised expectations of motherhood and stigma surrounding PND on how mothers try to cope with their initial symptoms and on their decisions about whether or not to disclose. The participants described a cautious approach to disclosure in which they had to deal with setbacks. Consequences of disclosing were considered alongside how the disclosure process was influenced by recovery from PND.