Supporting mothers: Bring back the tribe

Mothers need real, practical support in those first few months, not just people who want to gush over and hold the baby, according to Professor Hannah Dahlen.

Professor of Midwifery and Higher Degree Research Director at Western Sydney University, Professor Dahlen advocates for bringing back a mother’s tribe.

“If we care about having a society that is healthy, mentally and physically, we have to start with mothers,” says Professor Dahlen.

“We are so dismissive and judgemental of mothers, and we spend so little time trying to understand how we can support them from their point of view, and we have to change.”

In her study looking at women and babies admitted to residential parenting services (RPS), Professor Dahlen found that some mothers struggle more than others in those first few months.

Over a period of twelve years, admissions to Australian RPS like Tresillian and NSW’s Karitane, were examined to understand why some mothers required additional support in the early stages of parenting.

“We found that sleep and settling was the main reason women were admitted to these services,” says Professor Dahlen.

“But we found these women were significantly anxious, depressed and flummoxed by motherhood.”

The research uncovered that factors like the mother’s mental health, birth interventions and lack of support increased a new mother’s likelihood of experiencing difficulties.

“What we need to keep in mind is that women in this study only accessed RPS in the first year after birth, but many don’t get in for several weeks or even months after the birth,” Professor Dahlen notes.

“So, in this time, they have been struggling.

“Their mothering has been affected.

“The baby’s developmental milestones have been affected.

“There are ripples that keep on going, and we need to get the support right from the very beginning.”

Improving outcomes for new mothers

The research found over half of the women admitted to RPS had a history of mental health and one in ten women experienced mental health issues due to the birth.

Professor Dahlen says that this could be because pre and post-natal psycho-social assessments aren’t always routinely conducted across the health sector, especially in the private sector.

In 2010, NSW Health put in place an early intervention package to promote an integrated approach to the care of women, their infants and families in the perinatal period.

The package consists of three parts: one being the SAFE START Guidelines: Improving Mental Health Outcomes for Parents and Infants.

It proposes a range of coordinated responses to the various risk factors and mental health issues identified through assessments and screening immediately before and after birth.

“These screenings give professionals an idea of which pathway to put these women in for extra support,” Professor Dahlen says.

“Women who miss out on these screenings might find motherhood overwhelming as they haven’t had the right support from the very beginning.”

Another contributing factor to a mother’s mental health is their birth experience.

“One of the big things that came out of the research is the high rates of intervention that these women had experienced compared to those who weren’t admitted to RPS,” adds Professor Dahlen.

In 2012, research conducted by Professor Dahlen and her colleagues found that low-risk women having their baby in NSW private hospitals had a much higher rate of birth intervention than those in the public system.

“One in 10 women in this study had mental health issues resulting from the birth,” says Professor Dahlen.

“Birth trauma is whatever a woman says it is and it is largely about how a woman was treated during the birth.

“We know from research that birth trauma is rising, and it has a massive effect on the relationship between the mother and child.

“We are now doing a second part of this study to understand the extent of birth trauma.”

The research also found that women with baby boys were more likely to seek RPS support, although there is no clear evidence why this is so.

Finally, mothers with a baby experiencing reflux were more likely to be admitted to RPS.

Professor Dahlen explains that birth interventions may increase the likelihood of a baby suffering with reflux, so this could be the mother’s anxiety or disturbance of the microbiome or both interacting.

“A mother with anxiety is five times more likely to have a baby with reflux,” she says.

“A baby with reflux is often unsettled which starts a cycle of stress.”

The impact of a mother’s mental health

“If a mother has a history of mental health issues, or is currently experiencing mental health issues, it can hugely affect their confidence in their ability to settle their newborn,” explains Professor Dahlen.

“They can spiral into a really dark space.”

Professor Dahlen explains that suicide is one of the leading causes of death for women in the first 12 months after birth and emphasises that we need to take a mother’s mental health seriously.

She adds that a mother’s mental health not only affects her relationship with her baby, but also the baby’s development.

“A mother who is depressed engages in less eye contact with her baby, she speaks less words, she interacts with her baby in a different tone,” Professor Dahlen says.

“We know that early learning and literacy is all tied up in how and what your mother says to you and how she says it, so a mother who isn’t engaging with her baby could impact that baby’s future literacy.  

“We also know through research that babies of mothers who had very stressful situations, anxiety or depression, pre or post-natal, their brains are rewired differently and that those babies will grow up with more educational and health disadvantages.”

What needs to change

Professor Dahlen advocates for routine mental health assessments for all pregnant women.

“There is work being done behind the scenes with conducting routine mental health assessments across the sector,” says Professor Dahlen.

“We also need to reprioritise midwifery care and understand the importance of continuity of midwife care.”

In 2018, the World Health Organisation released recommendations on birth care.

One of the recommendations for care throughout labour and birth was midwife-led continuity-of-care throughout the antenatal, intrapartum and postnatal continuum.

“Midwives take the time to be able to focus on a woman’s mental health and all the social factors that surround her and impact on her,” says Professor Dahlen.

“We have found that women who had the same midwife through pregnancy, birth and post-partum, had fewer medical interventions and were more satisfied with the birth.”

Professor Dahlen adds that we also need to look at how we are educating mothers on the birth.

In recent research, Professor Dahlen and her colleagues found that it is possible to dramatically reduce interventions in the birthing process through delivering a two-day workshop for women and their partners.