Red News Readers,
This letter of mine was published in the SMH today 18.5.10:
Tanveer Ahmed has done the world a favour in cutting through the hype that now surrounds birthing, and addressing the issue of class in relation to the provision of public mental health services for women suffering post natal depression. What a disgrace that there are no public mental health beds that specialise in the care of these women!! Why is that? Is it because our society still does not understand the seriousness of post natal depression? Is it because those who suffer post natal depression are women? Is it because many think they should be happy at the birth of the child and they will "just get over it"?
The need for specialist public bedsand services for women suffering post natal depression has long been recognised as a dire need in our public health system. These women are often cared for at home by distressed husbands and families, with no appropriate health and welfare support. Some couples are ashamed and hide the mother. But you can't hide a severely depressed or psychotic woman who kills her baby. Even hospitals need to rethink how they support these women. I can well remember a mother who threw her baby over a hospital balcony, only a couple of years ago. That woman was placed in a mental health admission unit with persons suffering all sorts of mental illness and disorders. These women need specialist care. It is a great heartlessness in our health system that they don't get it.
When mothers cry out for tender care
Author: Tanveer Ahmed - Tanveer Ahmed is a psychiatry registrar at St John of God Private Hospital, Burwood.
Publication: Sydney Morning Herald
Section: News and Features
I have treated mothers who have thought of killing their babies. The illness is rare and usually improves rapidly, but it has resulted in tragedies.
There are few more confronting conditions than this one, grounded in a misguided love where mothers feel their babies are better off dead than growing up without them.
I work in a hospital that has the state's only private, post-natal unit. Patients are often transferred from public hospitals, where they are inappropriately treated alongside sufferers of intractable drug addictions or schizophrenia. They usually arrive traumatised by their experience.
Only a minority can afford private health insurance.
NSW does not have a public psychiatric unit for mothers and their babies. It did have hospital beds funded for such purposes several years ago, but they were abolished due to safety concerns.
Phillip Boyce, professor of psychiatry at the University of Sydney and a peri-natal expert, says that was not based on evidence but to save costs. Mothers suffering post-natal mental illnesses require extra, highly trained nursing care to monitor both them and their babies.
He believes any savings are merely costs being transferred to other agencies such as the Department of Community Services, or to families and charities through the necessary out-of-home care.
The developments coincide with recent reports that the number of very young babies being taken into care has risen by almost 70 per cent in two years. Each day in NSW an infant under four weeks old will be removed from the mother, according to government data provided to Parliament last month.
Professor Boyce says a proportion of these mothers suffer mental illness, and believes they could have retained custody of their children if better quality peri-natal services existed. "Once babies are taken, magistrates are very reluctant to give them back to their mothers," he says.
This all coincides with a time when the nature of motherhood, pregnancy and delivery has undergone dramatic changes.
Boyce thinks expectations of pregnancy and motherhood have never been so unrealistically high. "Their grandmothers had a very real risk of dying while giving birth but women today feel pregnancy and delivery are virtually risk free."
Tanya Evans, a social historian of motherhood undertaking a PhD at Macquarie University, says the current generation of women are used to controlling every aspect of their lives.
"Becoming a mother is often the first time when some of that must be relinquished," she says. The decline in the extended family, she believes, combined with the disappearance of affordable domestic services and a commercialisation of motherhood through an explosion in mummylit, prestige prams and other baby products places enormous pressure on new mothers.
Instead of the threat of death, the backdrop to the modern delivery is a thorough birth plan, whale music, digital photos and delivery suite discussions about who is going to cut the cord. These bourgeois aspirations are unlikely to apply to the average patient who may require a public psychiatric bed. Nor is the same demographic likely to be pushing their babies in expensive prams.
But regardless of social class, the experience of modern motherhood can be lonely and isolating. When combined with a mini baby boom - state figures indicate a 9 per cent rise in births over the past five years - the demand for peri-natal services of all kinds has never been greater.
The most common cause of maternal death, defined as a mother dying within 42 days of giving birth, is psychiatric illness, according to a British study in 2004, Why Mothers Die.
Statistics in Australia suggest suicide remains the greatest cause of death among pregnant mothers, but reliable statistics after delivery are yet to come.
A spokesman for the state minister responsible for mental health, Barbara Perry, says the government is focusing on funding community services to screen for vulnerable mums and treat them in the community.
While this is an important plank in an overall strategy, there will be a proportion for whom hospitalisation is unavoidable.
NSW has fallen behind in many areas after a decade of a shabby government. The lack of a high-quality mother-and-baby unit is depriving a needy and poorly understood group. For some, this gap means they will lose custody of their children forever.