Why perinatal and infant mental health matters

13 June 2019  Connect

Perinatal and infant mental infant is a rapidly growing area of interest among MHPN's interdisciplinary practitioners' networks.

Practitioners in Melbourne and Launceston are set to launch two new interdisciplinary perinatal mental health networks in June.

We spoke to perinatal clinical psychologists DR RENEE MILLER and DR BRONWYN LEIGH, and MS MITZI PADERES from PANDA, about why mental health in the perinatal period is important.

With one baby being born every 101 seconds in Australia, and nearly 310,000 births registered in 2017, perinatal mental health has far-reaching effects.

MHPN Armadale Perinatal Network Coordinator Dr Renée Miller is the principal clinical psychologist and founder of the Antenatal & Postnatal Psychology Network in Melbourne.

She has spoken on the subject of ‘Why perinatal mental health is a speciality’ at many recent MHPN perinatal and infant mental health networks.

Dr Miller says the perinatal stages - conception, pregnancy, birth, and the postnatal period – ‘involve unique physical, hormonal, emotional and social readjustments for women and couples’.

In her presentation, Dr Miller explains that ‘practitioners need to be aware of the stressors and losses that can occur from conception through to the early parenting years.

They also need to be aware of the importance of the relationship between parents and babies, and be suitably trained in assessing and working with the parent-child relationship’, she says. There is a growing interest among mental health clinicians to expand their knowledge and training in the area of perinatal mental health.

This year, Dr Miller has presented to network members in Victoria at Armadale Perinatal; Kew Perinatal; and the Ballarat Perinatal and Infant Mental Health Network. She will be taking her presentation to Brisbane for a joint meeting of the Brisbane North Perinatal Network and the Metro South Perinatal and Infant Mental Health Network. Register for this meeting to avoid disappointment.

Due to multiple requests from MHPN networks for this talk, Dr Miller, MHPN and the Centre of Perinatal Excellence (COPE) are partnering to produce a free online version of her presentation. MHPN will let you know when the online video presentation is available.

‘Practitioners need to be aware of the stressors and losses that can occur from conception through to the early parenting years'.

They also need to be aware of the importance of the relationship between parents and babies, and be suitably trained in assessing and working with the parent-child relationship’, Dr Miller says.

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Why perinatal and infant mental health matters
Untreated perinatal mental illness can place women, their baby and their families, at risk of a wide range of negative and lasting consequences, including attachment trauma, relationship breakdown, parentification of older children and partner perinatal anxiety or depression, says the National Helpline and Programs Manager at Perinatal Anxiety & Depression Aústralia (PANDA), Ms Mitzi Paderes.

PANDA provides free ongoing telephone counselling, information and referral for expecting and new parents experiencing mental health challenges – from those with mild to moderate difficulties right through to those with severe mental illness.

‘With the right treatment and support, perinatal mental health disorders are temporary and treatable illnesses. Early intervention can save lives and break the cycle of intergenerational trauma. The role of practitioners during this period is therefore crucial'.

If practitioners can be aware of the unique experiences and challenges in the perinatal period it will help inform their assessments and the subsequent interventions’, Ms Paderes says.

Dr Bronwyn Leigh is the coordinator of the Outer Eastern Perinatal and Infant Mental Health Network; and clinical psychologist and Director of Centre for Perinatal Psychology, in Melbourne’s inner north.

Dr Leigh says the group also defines the perinatal period broadly, from conception to early parenting up to three years.

‘Effective care and intervention working with a perinatal population requires holding two frames in mind: a developmental frame and a relational frame. Theories from psychodynamic psychotherapy and attachment theory and therapy, help guide our understandings and interventions that are both developmentally and relationally informed. Having a baby is a family issue and does not only involve one individual, even if one person is identified with a mental health issue’, she says.

If you would like to join the Outer Eastern Perinatal and Infant Mental Health Network, please email Trish Clarke.

You need to know
Dr Miller says practitioners need to check for symptoms of anxiety and stress, not just depression. ‘There is an over-focus in the literature on postnatal depression’.

Her research ‘showed that 10 per cent of women were not detected with clinical levels of anxiety and stress, when just the Edinburgh Postnatal Depression Scale was used’.

‘Practitioners cannot assume that a woman is OK because she’s presenting well. Whilst normalising the challenges that all new parents face, practitioners can ask sensitive, empathic questions to check in on the functioning of the family unit, and the mental health of new parents’, Dr Miller says.

PANDA’s Mitzi Paderes agrees with this approach. She says ‘practitioners can play a key role in encouraging mums and dads who are struggling to seek help.

It can be helpful for practitioners to try to open up a space for their patients and clients to speak honestly and trustingly about any difficult thoughts and feelings they may be having.

This means really listening to the answers provided by patients, being respectful of their challenges and trying not to minimise any difficulties they are going through’.


Centre of Perinatal Excellence (COPE) offers a free resource for practitioners in the form of 
the National Perinatal Mental Health Guideline
s.

Why go to a meeting
MHPN networks offer interdisciplinary practitioners the chance to hear from speakers who are leaders in their field. Feedback from attendees has been overwhelmingly positive in relation to having a regular space to come together with other interested professionals to learn and share about working with parents and infants.

MHPN encourages networks to share knowledge and resources between each other, particularly when fledgling networks are starting out.           

‘The goals of our meetings are to unite health professionals across disciplines who are currently working with, or who have a desire to work with, the perinatal population’, says Dr Leigh.

Topics covered include holding the infant in mind when mum is anxious; the couple transition to parenthood; psychotropic medication during the perinatal period; treating ante- and postnatal depression; and mindfulness during the perinatal period.

Register now for a perinatal  mental health and infant network group to be invited to future meetings via these links:

Armadale, VIC Ballarat, VIC

Brisbane, QLD Essendon, VIC

Gold Coast, QLD Hobart, TAS

Kew, VIC Launceston, TAS

Maroochydoore, QLD Narrabri, NSW

North West Melbourne, VIC Ringwood, VIC

Tamworth, NSW Robertson, QLD

West Gippsland, VIC Woodville, SA

Perinatal mental health and the family unit

Ms Paderes explains that new mums and dads affected by perinatal anxiety and depression can have similar symptoms but also differ in important ways.

‘Many women struggle with their role as a new mum, including feelings of loss and grief around their changing identity, evolving relationships and feelings of uncertainty and confusion around caring for a newborn when they may have previously felt capable and in control over many aspects of their lives’.

Ms Paderes says signs that men may be struggling can include becoming withdrawn; immersing themselves in their work; or substance abuse.

‘Alternatively, men with anxiety and depression may feel wound up, frustrated, or unable to relax – a feeling sometimes described as ‘like being trapped’, or ‘pacing in a cage’.

They can have outbursts of anger or rage that are ‘not in character’, leading to feelings of shame or guilt. We know many men also feel they are expected to be ‘the rock’ and hold the family together, and many tell us it is hard to talk about their feelings, or about difficulties they might have coping when their partner has done the hard job of carrying and delivering the baby’, she says. 

Dr Leigh explains that the perinatal stages are unique and developmentally rich life-phases for both parents and infants with all family members needing to be family need to be considered, nurtured and supported.

'It is a vulnerable time for adults as they are faced with the complex psychological task of ‘becoming’ a mother or father. This transition requires psychological re-organisation of one’s internal and external worlds, a shifting of identity to one of mother/father and creating a space in mind for baby to come to life. Mental health concerns can disrupt these normative psychological processes leaving parents less equipped to manage the demands of parenthood or it may disrupt their bond to their baby’.