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No description available.

The research question “What does it mean for a woman to be diagnosed with postnatal depression?” indicates three main overlapping areas of investigation: women, including issues of gender, discourses around womanhood and the roles and expectations being a woman carries; diagnosis, which is the categorising of experiences deemed to be outside of what is considered normal and includes discourses around mental health and mental illness; and mothers, including expectations of mothers and motherhood. All of these areas interlink and are arguably socially and culturally specific. There is also an underlying concept of identity as a woman, a mother and a mentally ill person, both separately and as an intersection of the three. It is therefore an important area of investigation within counselling psychology, a discipline that concerns itself with subjective experience and is therefore well placed to interrogate the process of medicalised diagnoses. The social and cultural influence also suggests Charmaz’s constructivist grounded theory as the appropriate method as it uses ideas of social constructionism. In this study semistructured interviews were carried out with eight women who believed they had been given a diagnosis of postnatal depression. They were asked about the circumstances leading up to their diagnosis and what they felt the impact was. These interviews were transcribed and analysed using a Grounded Theory methodology (Charmaz, e.g. 2006). A theory of how women view their experience of being diagnosed with postnatal depression, as well as how social factors influence the way the women make sense of this experience, is proposed. This theory takes the form of a process in which women described a dissonance between their expectations of motherhood and their lived experience. They understood this as a lack in themselves and as a result hid their struggles to a point at which they felt they could no longer avoid seeking professional help. The subsequent diagnosis of postnatal depression led to an opening of a dialogue around the difficulties they were experiencing as well as options of possible treatments. The implications of this process are discussed.

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No description available.

Childbirth can be associated with short and long-term psychological morbidity including depression, anxiety and trauma symptoms. Some previous studies have used psychological interventions to reduce postpartum distress but have primarily focussed on attempting to relieve symptoms of depression with little recognition of trauma symptoms. Furthermore, the intervention used in these studies has generally been poorly documented. The first aim of the present study was to develop a counselling framework, suitable for use by midwives, to address psychological trauma following childbirth. Multiple methods were used to develop the intervention including focus groups with women and midwives. Both the women and midwives gave unequivocal support for postpartum debriefing. Themes that emerged from the focus groups with women included the need for opportunities to talk about their birth experience, an explanation of events, an exploration of alternative courses of action that may have resulted in a different birth experience, talking about their feelings such as loss, fear, anger and self-blame, discussing social support, and discussing possible future childbearing. There was a high level of agreement between the women's and midwives' views. These themes were synthesized with contemporary literature describing counselling interventions to assist in reconciling a distressing birth experience and a model for understanding women's distressing birth experiences to develop a counselling framework. The counselling intervention was then tested using a randomised controlled study involving 400 women recruited from antenatal clinics of three public hospitals. When interviewed within seventy-two hours of birth, 103 women reported a distressing birth experience and were then randomised into either the treatment or control group. Women in the intervention group had the opportunity to debrief at the initial postpartum interview (< 72 hours postpartum) and at four to six weeks postpartum. The prevalence of posttraumatic stress disorder was quite high; 9.6% of participants meeting the diagnostic criteria for acute PTSD at four to six weeks postpartum. Fewer participants (3.5%) met the diagnostic criteria for chronic PTSD at three months postpartum. As with previous research relating to childbearing women, few demographic factors or antenatal psychological factors were associated with the development of a PTSD symptom profile following childbirth. The development of PTSD symptom profile was strongly associated with obstetric intervention and a perception of poor care in labour. This finding is also consistent with previous research. Emotional distress was reduced for women in the intervention group in relation to the number of PTSD symptoms [t (101) = 2.144, p = .035], depression [c2 (1) = 9.188, p = .002], stress [c2 (1) = 4.478, p = .029] and feelings of self-blame [t (101) = -12.424, p <.001]. Confidence about a future pregnancy was higher for these women [t (101) = -9.096, p <.001]. Although there was not a statistically significant difference in the number of women with a PTSD symptom profile at three months postpartum, fewer women in the intervention group (n=3) than in the control group (n=9) met PTSD criteria. Likewise, there were fewer women in the intervention group (n=1) with anxiety levels above mild than in the control group (n=6). Importantly, this study found that offering women who have had a traumatic birth the opportunity for counselling using the framework documented in this dissertation was not harmful. This finding is in contrast to previous findings of other studies. The intervention was well received by participants. All the women in the intervention group found the counselling sessions helped them come to terms with their birth experience. Maternity service providers need to be cognizant of the prevalence of this debilitating condition and be able to identify women at risk for early intervention and referral to a mental health practitioner if appropriate. This research offers further support for the compelling need to implement changes to the provision of maternity services that reduce rates of obstetric intervention and humanise service delivery as a means of primary prevention of birth-related PTSD.