Emotional care of women on
their journey to motherhood
Dr Sue Barker
www.bournemouth.ac.uk
Background to study
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When starting my PhD I wanted to see if I could use it in some way to improve the
care given to pregnant women and new mothers.
Literature search generated lots of studies about the aetiology of post natal
depression, treatment approaches and outcomes for children.
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Use of EPNDS
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Serious concern (Dennis and Kavanagh 2001)
Risk factors (Beck 2001)
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Higher scores antenatally (Evans et al 2001)
No individual factors (Reading and Reynolds 2001)
CBT (Prendergast and Autin 2001)
social support (Taggart et al 2000)
group therapy, (Forrester 2001)
hormones (Lawrie et al 2002)
antidepressants (Hoffbrand et al 2002)
Meta analysis of treatment (Bledsoe and Grote 2006)
cognitive restructuring, problem solving and efficacy enhancement (Ngai et al 2009)
children
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distressed mothers to be insecurely attached (Murray and Cooper 1997, Logsdon et al 2003)
aggression expressed in children exposed to maternal depression (Hipwell et al 2005).
developmental and behavioural problems (McMahon et al 2001, Lemaitre-Sillere 1998, Miller et al
1993)
whole family (Tammentie et al 2004a, Tammentie et al 2004b, Burke 2003).
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Rationale
The journey to motherhood is an emotional one for the
woman, her family and those caring for her (Mercer 2004,
Wilkins 2006).
Her emotional well being can effect her relationships with
her partner, family and most significantly her baby (Miller et
al. 1993, Lemaitre-Sillere, 1998 McMahon et al 2001, Burke
2003, Drift 2004, Tammentie et al 2004a, Tammentie et al
2004b).
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Methodology
Developed from the philosophical approach of Edmund Husserl
by Amedeo Giorgi and labelled descriptive phenomenology
(1985).
Husserl’s aim for phenomenology was to achieve a rigorous and
unbiased study of things as they appear, so that an essential
understanding of human consciousness and experience may be
gained.
The goal Holloway and Todres (2003:348) stated for
phenomenology was “describe, interpret and understand the
meanings of experiences at both a general and unique level”.
Giorgi offers a step by step approach to analysing the lifeworld
experiences of a given phenomenon (Giorgi and Giorgi 2003)
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Method
• Participants
• 8 community midwives
• Data Collection
• Presentation / Snowballing
• Interviews
• Data Analysis
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Interviews transcribed verbatim
Phenomenological Reduced Attitude
Bracketing
Imaginative Variation
Whole and parts
• Ethical Issues
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Findings
• Community midwives appear, through their ‘with women’
ideology, to provide emotional support. Offering this support
increases their emotion work.
• On going struggle between being ‘with women’ and ‘with
institution’ as identified previously by Hunter (2004)
• When midwives have decided to provide emotional care they
come alongside women using their communication skills to share
of themselves, their personal experiences and intuition.
• This is undertaken to facilitate comfort in women and ease their
passage to a new way of being.
• Boundary between being professional and being one person with
another.
• Use personal rules or intuition.
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Communication - listening
Hetty said she needed to listen to the woman, as it
was “her body, baby and world” (Hetty 41), so it
was important that she listened to the woman’s
perceptions. Some of this sentiment appeared
to be shared by Diane who said “she didn’t have
to listen to everything I was telling her, it was
her baby and she knew it in a way that I never
do” (Diane 40).
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Communication - touch
“at the end of that particular visit as I did
for all the others I gave her cuddle
which drew us close together” (Betty)
“and I was holding her hand I took her hand to
offer her some physical attention I said to her
do what you want to do” (Gina)
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‘with woman’ ‘with profession’
“I suppose that is why it is emotionally draining at
times, exhausting, because it is quite a thin line
between giving emotional support and relating part
of your own life but also keeping a distance”
(Fiona).
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Conclusions
• All women need emotional care on their
journey to motherhood.
• Midwives are ideally placed to offer emotional
care to women.
• They need excellent communication skills,
good role models, support and recognition to
manage their emotion work.
• Emotional care appears to facilitate comfort
and reduce suffering.
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Implications
• As mental health nurses we have a unique knowledge
base and specialist skills that can be used to support
the care given to women on their journey to
motherhood.
• To support and encourage the ‘with woman’ philosophy.
• To work alongside midwives sharing our knowledge and
skills
• Explore the boundaries between ‘with woman’ and ‘with
profession’
• Consider our use of intuition and self in our emotional
care
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References
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Beck, C.T., 2001. Predictors of Postpartum Depression, an update. Nursing Research vol 50 no. 5.
Bledsoe, S.E., Grote, N.K., 2006. Treating Depression During Pregnancy and the Postpartum: A
Preliminary Meta-Analysis. Research on Social Work Practice. Vol 16 No 2 109-120
Burke, L., 2003. The impact of maternal depression on familial relationships. International Review of
Psychiatry, 15, 243-255.
Dennis, C.L., Kavanagh, J., 2001. Psychosocial Interventions for Preventing Post Partum Depression. The
Cochrane Collaboration: Wiley Publishers. www.thecochranelibrary.com
Drife, J., 2004. Why Mothers die: the sixth report of the confidential enquiries into maternal deaths in the
United Kingdom. London: RCOG Press.
Evans, J., Heron, J., Francomb, H., Oke, S., Golding, J., 2001. Cohort study of depressed mood during
pregnancy after child birth. British Medical Journal, 323 (4th August), 257-260.
Forrester, M., 2001. Managing depression in the community. Mental Health Nursing. Vol 21 no 5 23-25
Giorgi, A., Giorgi, B., 2003a. Phenomenology In: Smith J. A. ed. Qualitative Psychology, a practical guide
to research methods. London: Sage Publications, 25-51.
Hipwell, A. E., Murray, L., Ducournau, P., Stein, A. 2005. The effects of maternal depression and parental
conflict on children’s peer play. Child: Care, Health & Development 31 (1), 11-23.
Hoffbrand, S., Howard, L., Crawley, H., 2001. Antidepressant treatment for post-natal depression. The
Cochrane Collaboration: Wiley Publishers. www.thecochranelibrary.com
www.bournemouth.ac.uk
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References continued
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Holloway, I., Todres, L., 2003. The status of method: flexibility, consistency and coherence. Qualitative
Research, 3 (3), 345-357.
Hunter, B., 2004. Conflicting ideologies as a source of emotion work in midwifery. Midwifery, 20, 261-272.
Lawrie, T. A., Herxheimer, A., Dalton, K., 2002. Oestrogens and progestogens for preventing and treating
postnatal depression. Issue 4. The Cochrane Collaboration: Wiley Publishers. www.thecochranelibrary.com
Lemaitre-Sillere, V., 1998. The infant with a depressed mother: destruction and creation. Journal of
Analytic Psychology, 43, 509-521.
Logsdon, M.C., Wisner K., Hanusa, B.H., Phillips, A., 2003. Role functioning and symptoms remission in
women with postpartum depression after antidepressant treatment. Archives of Psychiatric Nursing. 17 276283.
McMahon, C., Barnett, B., Kowalenko, N., Tennant, C., Don, N., 2001. Postnatal depression, anxiety and
unsettled infant behaviour. Australian and New Zealand Journal of Psychiatry, 35, 581-588.
Mercer, R.T., 2004. Becoming a mother versus maternal role attainment. Journal of Nursing Scholarship,
36, 226-232.
Miller, A.R., Barr, R.G., Eaton, W.O., 1993. Crying and motor behaviour of six week old infants and post
partum maternal mood. Paediatrics, 92 (4), 551-558.
Murray, L., Cooper, P.J. 1997. Effects of postnatal depression on infant development. Archives of Disease
in Children, 77, 99-101.
www.bournemouth.ac.uk
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References continued
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Ngai, F-W., Chan S.W-C., Ip, W-Y., 2009. The effects of a childbirth psychoeducation program on learned
resourcefulness, maternal role competence and perinatal depression: A quasi-experiment. International
Journal of Nursing Studies. 46, 1298-1306
Prenderast, J., Austin, M.P., 2001. Early Childhood nurse-delivered cognitive behavioural counselling for
postnatal depression. Australian Psychiatry. Vol 9 no 3 255-259
Reading, R., Reynold, S., 2001. Debt, Social disadvantage and maternal depression. Social Science and
Medicine. Vol 53 no 4 441-454.
Taggart, A.V., Short, S.D., Barclay, L., 2000. ‘She made me feel human again’: an evaluation of a volunteer
home based visiting project for mothers. Health and Social Care in the Community. Vol 8 no 1 1-8
Tammentie, T., Tarkka, M., Kurki, A., Paavilainen, E., Laippala, P., 2004a. Journal of Psychiatric and
Mental Health Nursing, 11, 141-149.
Tammentie, T., Paavilainnen, E., Astedt-Kurki, P., Tarkka, M., 2004b. Family dynamics of postnatally
depressed mothers – discrepancy between expectations and reality. Journal of Clinical Nursing, 13, 65-74.
Wilkins, C., 2006. A Qualitative study exploring the support needs of first-time mothers on their journey
towards intuitive parenting. Midwifery, 22, 169-180.
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