Experiences of social work intervention among mothers with perinatal mental health needs

Perinatal mental health difficulties are prevalent among women, and the vulnerability of young infants makes this a time when families experiencing multiple adversities may be particularly likely to attract state intervention. However, very little is known about how mothers experience social work intervention during the perinatal period. This study explored experiences of social work intervention among women with perinatal mental health difficulties. Qualitative semi‐structured interviews were carried out with 18 women with 6‐ to 9‐month‐old babies, who had been treated in England for a perinatal mental health difficulty and also had social services intervention. Interviews were analysed using thematic analysis. Findings suggested that mothers had a predominantly negative view of children's social services, especially when social workers had significant child protection concerns. The fear of being judged an unfit mother and having their babies taken away overshadowed their encounters. Mothers felt that social workers would not accept they could be good mothers in spite of their difficulties and set them up to fail. Some felt that social workers focused exclusively on the risks to the baby and did not acknowledge the mother's own needs or understand perinatal mental health. In some cases, social work intervention was described as intensifying pressure on mothers’ mental health, leading to escalating difficulties and increased likelihood of care proceedings. At the same time, our study also included examples of mothers forming positive relationships with social workers, and of ‘turning points’ where initially negative interactions stabilised and child protection concerns lessened. Women's accounts highlighted the importance of feeling ‘known’ by social workers who understood and respected them. The findings also suggested there may be value in improving collaboration between social workers and mental health professionals to create more space for representation of women's needs as well as those of their babies.     

Infant feeding in risk society

A large percentage of British women, in common with women in other Western countries, feed their young babies formula milk. The paper reports some findings of a study of infant feeding that focussed on women's experiences of feeding their babies this way. Data about this issue were collected through detailed, qualitative face to face interviews with 33 mothers and through telephone interviews using a structured questionnaire with 503 mothers. The study found overall that mother's accounts of feeding babies formula milk draw attention to contradictions and tensions in motherhood and mothering. Formula feeding is predominantly experienced by mothers as ‘easy,’ enabling them to address a wide range of demands and difficulties that mothering a small baby poses for them. At the same time, mothers demonstrate awareness of the socio-cultural construction of the ‘moral mother’ as the mother who minimizes and avoids risk, and so does not use formula milk for infant feeding. How women react to this tension between ‘real life’ and ‘doing what is healthy’ varies, but the study reported here found a large minority of women experience manifestly difficult and debilitating feelings as they attempt to reconcile a pragmatic wish or need to formula feed with dominant constructions of the ‘moral mother.’ By detailing women's accounts of this aspect of motherhood, the paper contributes to sociological investigation of everyday experiences of risk society. To contextualize this discussion, a brief account of the relationship between eating, feeding babies and risk society is also offered.     

How formula feeding mothers balance risks and define themselves as ‘good mothers’

Breast feeding provides protection from many diseases and reduces health risks for both mother and child; however, a significant percentage of mothers in Newfoundland and Labrador, Canada choose to formula feed their infants from birth. In order to understand this phenomenon, qualitative research in the form of focus groups was conducted in three communities in the province in 2010. The data elicited from the research question ‘Why did you choose to formula feed your baby?’ were analysed using qualitative thematic content analysis. A major theme that arose was how these women define themselves as ‘good mothers’ in an environment where breast feeding is considered the optimal nutritional choice. It is about balancing the risks of formula feeding their infants with the needs of the family and themselves.     

新生儿出院前健康教育需求比较研究

目的:比较正常新生儿和母婴分室新生儿出院前其母亲的健康教育需求及希望的健康教育方式。方法:采用问卷调查法对120例正常新生儿的母亲和103名母婴分室的新生儿母亲在出院前进行相关问题的调查。结果:正常新生儿母亲和母婴分室新生儿母亲在出院前健康教育需求上有一定的区别,正常新生儿母亲更关心如何判断新生儿是否正常以及一些日常护理问题,分室新生儿母亲更关心出院后如何复查。正常新生儿母亲最希望的健康教育方式是阅读健康教育手册、材料,其次为护士个别指导;分室新生儿母亲则是护士个别指导和专家授课。设立热线电话是在新生儿出院后遇到问题时家属最希望的咨询方式,但分室新生儿母亲更希望由医生来接听。结论:须发展针对性的健康教育模式以满足不同新生儿母亲的需要。     

Accounts of health and illness: Dilemmas and representations

This paper argues that people's views of health and illness are best understood as accounts that they give to others. In that sense, such beliefs are neither the expression of fixed inner attitudes, nor evidence for shared social representations. Instead, we emphasise the importance of seeing health talk as both ideological and dilemmatic. The paper explores the way in which individuals who speak of health (or illness) in general must also give an account of their health in particular. Reviewing the distinction between ‘private’ and ‘public’ accounts, the article discusses the various rhetorical devices by which this is achieved. This shows how people's talk about health both defines their social fitness and exemplifies their claims to being ill or healthy.     

‘Men are leavers alone and women are worriers’: Gender differences in discourses of health

This paper explores gender differences in health talk, how such talk is informed by discourses at a societal level and the extent to which talking about health is a way of ‘doing gender.’ It draws on in-depth interviews with 48 women and men in their twenties and thirties showing that gender influences both the way people talk about health and their willingness to engage in health talk. It explores the way cultural constructions of gender influence the propensity to take risks with particular reference to HIV/AIDs and recreational drug use and the extent to which discourses of risk inform health talk. We discuss how changes in the occupational structure and the associated influx of men into ‘women's’ work are associated with more ‘feminized’ masculinities and a recognition among some men of the male body's vulnerability. They are also associated with men's health talk becoming more like women's. We conclude that cultural constructions of gender not only have an impact on health talk but also on the regulatory power of discourses of risk and risk management.     

‘I am still confused as to what caused the problem’: Perceptions of mothers on communication regarding newborn illness and death in Northern Ghana

ABSTRACT

Neonatal morbidity and mortality remain a significant challenge in Ghana. Given the relationship between care-seeking and understanding of illness, this study aimed to explore mothers’ perceptions of the cause of illness and/or death in Northern Ghana. All neonatal deaths and near-misses (babies who survived a life-threatening complication) in 2015 and 2016 were identified through a community – and facility-based surveillance system. Mothers of the deceased or ill infants participated in open narrative qualitative interviews. Narratives that included discussion of whether the mother understood what caused the baby’s illness or death were analysed. Interviews with 155 mothers included discussion of their perception of the cause of newborn illness or death. Of the 155 interviews, 108 interviews involved mothers whose babies died, and 47 interviews involved mothers whose newborns survived a life-threatening illness, a neonatal ‘near-miss’. Very few expressed a clear understanding of the cause of death or illness. Those mothers who did not understand were either not told or did not understand the cause of illness or death. Newborn health outcomes may be improved by increased maternal awareness and understanding of neonatal illnesses. Future interventions need to address communication issues that impair mothers’ understanding, facilitate recognition of danger signs, and prompt timely care-seeking.     

Women's experiences of care after stillbirth and obstetric fistula: A phenomenological study in Kenya

Background

Stillbirth and (obstetric) fistula are traumatic life events, commonly experienced together following an obstructed labour in low- and middle-income countries with limited access to maternity care. Few studies have explored women's experiences of the combined trauma of stillbirth and fistula.

Aim

To explore the lived experiences of women following stillbirth and fistula.

Methods

Qualitative, guided by Heideggerian phenomenology. Twenty women who had experienced a stillbirth were interviewed while attending a specialist Hospital fistula service in urban Kenya. Data were analysed following Van Manen's reflexive approach.

Results

Three main themes summarised participants' experiences: ‘Treated like an alien’ reflected the isolation and stigma felt by women. The additive and multiplying impacts of stillbirth and fistula and the ways in which women coped with their situations were summarised in ‘Shattered dreams’. The impact of beliefs and practices of women and those around them were encapsulated in ‘It was not written on my forehead’.

Conclusion

The distress women experienced following the death of a baby was intensified by the development of a fistula. Health professionals lacked an understanding of the pathophysiology and identification of fistula and its association with stillbirth. Women were isolated as they were stigmatised and blamed for both conditions. Difficulty accessing follow-up care meant that women suffered for long periods while living with a constant reminder of their baby's death. Cultural beliefs, faith and family support affected women's resilience, mental health and recovery. Specialist services, staff training and inclusive policies are needed to improve knowledge and awareness and enhance women's experiences.

Patient or Public Contribution

A Community Engagement and Involvement group of bereaved mothers with lived experience of stillbirth and neonatal death assisted with the review of the study protocol, participant-facing materials and confirmation of findings.     

Parents’ views on how health professionals should work with them now to get the best for their child in the future

Background Pregnancy and the first years of life are important times for future child well‐being. Early identification of families and children who might be likely to experience poorer outcomes could enable health professionals and parents to work together to promote each child’s well‐being. Little is known about the acceptability and feasibility of such an approach to parents. Objective To investigate parents’ views about how health professionals should identify and work with families who may benefit from additional input to maximize their children’s future health and well‐being. Design A qualitative study using focus groups. Setting and participants Eleven focus groups were conducted with a total of 54 parents; 42 mothers and 12 fathers living in the north of England. Results Parents welcomed the idea of preventive services. They strongly believed that everyone should have access to services to enhance child well‐being whilst recognizing that some families need additional support. Making judgements about who should receive additional services based on specific criteria evoked powerful emotions because of the implication of failure. Parents projected a belief in themselves as ‘good parents’ even in adverse circumstances. Conclusions Targeted additional preventive services can be acceptable and welcome if health professionals introduce them sensitively, in the context of an existing relationship, providing parents are active participants.     

‘The best thing for the baby’: Mothers’ concepts and experiences related to promoting their infants’ health and development

Mothers and pregnant women in contemporary western societies are at the centre of a web of expert and lay discourses concerning the ways they should promote and protect the health and development of their foetuses and infants. This article reports the findings from an Australian study involving interviews with 60 mothers. The findings explore in detail four topics discussed in the interviews related to pregnancy and caring for young infants: disciplining the pregnant body; promoting infants’ health; immunisation; and promoting infants’ development. Itis concluded that the mothers were highly aware of their responsibilities in protecting their foetuses and infants from harm and promoting their health and development. They conceptualised the infant body as highly vulnerable and requiring protection from contamination. They therefore generally supported the idea of vaccination as a way of protecting their babies’ immature immune systems, but were also often ambivalent about it. The mothers were aware of the judgemental attitudes of others, including other mothers, towards their caring efforts and attempted to conform to the ideal of the ‘good mother’. The emotional dimensions of caring for infants and protecting their health are discussed in relation to the voluntary participation of mothers in conforming to societal expectations.     

‘I think he is immune to all the smoke I gave him’: how women account for the harm of smoking during pregnancy

Despite women’s awareness of the risks of smoking in pregnancy to the developing foetus, a significant minority continue to smoke during pregnancy. In this article, we use a discourse analytic approach to analyse interviews with 12 Australian women who smoked during a recent pregnancy. We used these data to examine how women accounted for their smoking and identities in the light of the implicit but ever-present discourse that smoking in pregnancy harms babies. We found that the women in our study deployed two rhetorical devices in their talk, ‘stacking the facts’ and ‘smoking for health’, allowing them to situate their smoking within a discourse of risk or as a potential benefit to their health. Women ‘stacked the facts’ by citing personal observable evidence (such as birthweight) to draw conclusions about the risks of smoking in pregnancy to the baby. ‘Stacking the facts’ allowed women to show how they had evaded the risks and their babies were healthy. This device also allowed women to deny or cast doubt over the risks of smoking in pregnancy. Women’s accounts of ‘smoking for health’ involved positioning quitting as stressful and, as a result, more harmful than continuing to smoke a reduced amount. We found complex and counter-intuitive ways in which women dealt with the discourse that smoking in pregnancy harms babies and how these ways of accounting served to protect their identities. We argue that health promotion messages conveying the risks of smoking in pregnancy would benefit from contextualising these messages within women’s personal accounts (e.g. by ‘stacking the facts’ or ‘smoking for health’) and hence providing more ‘realistic’ health risk messages.     

Parents’ constructions of normality and pathology in child mental health assessments

Central to a contemporary understanding of childhood is the developmental and clinical-medical construct of the ‘normal’ child. When judged to fall outside of culturally, socially and historically situated parameters of ‘normality’, children become labelled as ‘deviant from the norm’; for instance, in mental health contexts where this may provide the basis for psychiatric diagnosis. However, judgements of a child's ‘normality’ are further complicated by the range of individuals who may have a stake in that construction, including parents/carers, professionals and the child themselves. Using discursive psychology, we analysed 28 video-recorded UK child mental health assessments, to examine ways that parents presented concerns about their children's development. They did this by drawing on notions of ‘ab/normal’, in ways that functioned to legitimise their need for services and built a rhetorical case to demonstrate clinical need; often by contrasting the child with other ‘typical’ children and/or contrasting the same child's behaviour in different settings or contexts. We concluded that given the growing crisis in child mental health, initial assessments play a crucial clinical role in determining diagnosis and labelling, and therefore, a critical discussion of these concepts and processes is essential.     

‘My special time’: Australian women's experiences of accessing a specialist perinatal and infant mental health service

Women who have few social supports, poor health and a history of stressful life events are at risk of poor mental health during the perinatal period. Infants of parents whose parenting capacity is compromised are also at risk of adverse outcomes. Specifically, poor perinatal mental health can impact maternal–infant attachment. To identify women at risk of poor perinatal mental health, psychosocial assessment and depression screening in the antenatal and early postnatal periods are recommended. This qualitative study is part of a larger mixed methods study, which explored two specialist perinatal and infant mental health (PIMH) services in New South Wales (Australia). Eleven women who had accessed and been discharged from a PIMH service participated in either face‐to‐face or telephone interviews. Data were transcribed verbatim and analysed thematically. One overarching theme, ‘my special time’ and three sub‐themes, ‘there is someone out there for me’, ‘it wasn't just a job’ and ‘swimming or stranded: feelings about leaving the service’, were identified. The themes describe the women's experiences of being a client of a PIMH service. Overall, women reported a positive experience of the service, their relationship with the clinician being a key component. Findings from this study highlight the importance of the relational aspect of care and support; however, women need self‐determination in all therapeutic processes, including discharge, if recovery and self‐efficacy as a mother are to be gained. Importantly, further research is needed about how clinicians model a secure base and how mothers emulate this for their infants.     

Mother protection,child survival: narrative perspectives on child mental health services underutilization

In the United States, increased national attention has generated a wealth of public health and epidemiologic research examining disparities in African American children’s mental health services utilization. Research has not yet been extended to examining the social structural mechanisms that keep these disparities stable and in place. Drawing from a larger urban ethnographic field study exploring the ‘everyday’ of health and illness within and across African American families living in an inner city public housing community, in this article I document the narratives of four African American mothers to illustrate how social structural mechanisms shape their decisions to seek or not mental health services for their children. I frame mothers’ decisions in terms of everyday violence, drawing attention to the institutionalized injustices that are normalized and rendered invisible because of their routine pervasiveness. I conclude with a discussion of integrating structural interventions to modify or reduce disparities in African American children’s mental health services utilization.     

The construction and navigation of riskscapes in public health advice and mothers’ accounts of weaning

This paper adds to critical studies of risk and mothering by illustrating and conceptualising how risk is constructed in public health advice and mothers’ accounts of weaning. Previous research points towards a gap between public health scientific definitions of risk and mothers’ contextual understandings and experience of handling complex and often conflicting risks linked to food and feeding. It has been suggested that public health discourse misses out on or even silences risks defined by women in their everyday care practices. Therefore, our aim is to conceptualise and map various co-existing constructions of risk and discuss how an awareness of the multiplicity of risk can inform public health advice that take mothers’ point of view into account. Using the concept ‘riskscape’, we explore and compare how public health and mothers’ constructions of risk diverge and overlap. Our findings illustrate how mothers belong to a community of practice where weaning is understood and practiced in relation to their everyday life and eating practices involving multiple concerns that are not addressed in public health advice, especially the wider food and information landscape. The study also indicate that this divergence can provoke feelings of insecurity and anxiety among mothers and make public health advice seem less relevant. In sum, our findings suggest a need for public health to acknowledge mothers’ experience of weaning as a compound practice similar to their own eating practices and to widen the present focus on risk as a domestic and individual responsibility.     

I am just a ‘maae’ (mother): experiences of mothers injecting drugs in Thailand

Mothers who use drugs face much discriminatory action as society in general finds female drug users’ modes of caring for their children unacceptable. In this article, I explore the ways in which Thai women's injecting practices revolve around the role of mother ‘maae’ and the ways they employ tactics to challenge the motherhood discourse. This article draws on in‐depth interviews with 30 Thai mothers injecting drugs. Thai mothers injecting drugs struggled with stigma and self‐blame. They internalise the values of the mother ‘maae’, that is, what the mother is supposed to be; attempting to combine their drug use with their parental responsibilities. Having a child is treated as a means for many women to manage the hostile social impacts of being an addict mother as well as anxieties about the future of their children. To maintain identity as a mother, as gender norms dictates, the mothers employ several tactics to defend that identity from the threats. In conclusion, the findings have implications for harm reduction and reproductive services for women using drugs in Thailand; health care providers need to appreciate the ramifications of the lived experiences of the women who take drugs.     

Everyday health and the internet: a mediated health perspective on health information seeking

This paper explores the relationship between internet use and individuals’ health experience. Adopting a ‘mediated health’ approach, it presents four cases studies of households using the internet for health information. The study shows that participants use the internet as it offers personalised information in line with individuals’ and families’ health needs affecting their everyday routines. The internet emerges as an everyday helper linked to the intimacy of health experiences. Agency is manifest in study participants’ choice of both becoming more informed as well as having the possibility of ignoring information. Case studies also show how personal internet use is confronted by informational surroundings generating flows of information that may induce uncertainty on the information seeker's side. The paper calls for a perspective which considers together personal health experience and media use to embed online health information seeking within an everyday context of internet use.