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We need to protect new mothers from trauma and suicide

Research we have just published shows the deaths of 48 of the 129 women in New South Wales who died during pregnancy or within a year of giving birth were due to suicide and trauma. It suggests mothers…

Maternity services often become fragmented after women have given birth. David/Flickr

Research we have just published shows the deaths of 48 of the 129 women in New South Wales who died during pregnancy or within a year of giving birth were due to suicide and trauma. It suggests mothers may need support from integrated health and community services for the first year of their child’s life.

Suicide is one of the leading or the main cause of mothers dying within a year of giving birth in countries such as New Zealand, the United Kingdom, the United States and Australia.

Women may commit suicide because of mental health disorders, which were either pre-existing or developed during pregnancy or after they gave birth. Traumatic births or lack of support before and after the birth (or both) can also be contributing factors.

What we found

We examined maternal deaths in New South Wales from suicide and trauma in the year following birth, from 2000 to 2006. We found 37 women died during pregnancy and within 42 days of giving birth, and 92 died between 42 days and a year after their child was born.

Of the 129 women who had died, 48 deaths were due to suicide or trauma – the biggest single category of maternal death. Other major causes of death included hemorrhages, blood clots and high blood pressure, among other things.

Trauma includes accidental injury, transport accidents and homicide, and suicide is death as a result of intentional self-harm.

Of the 48, four deaths occurred during pregnancy and in the first 42 days following birth. And 44 occurred between 42 days and 12 months after birth.

So death from suicide and trauma rises significantly between nine and 12 months after birth; it is nearly four times the rate compared to the first three months following birth.

A large proportion of women who died from suicide (73%) had a history of mental illness or substance abuse, or both. Most of the women who died because of accidental injury also had a history of mental illness or substance abuse (or both).

Support services are becoming less available just as babies are becoming more demanding and sleeping less. rabble/Flickr

There’s a chance some of these latter deaths may actually have been suicide although it’s difficult to be sure. But death from a firearm discharge, for instance, may be accidental or intentional.

Some reasons why

The women who died had higher rates of intervention in birth, higher rates of early-term births, pregnancy complications and neonatal intensive care admissions. They also tended to have babies who were born with a low birth weight and were ten times more likely than other women to have their baby die.

Clearly, these women were at particular risk of ill health - mental and physical. And they may have needed extra attention from health services, for a longer period of time.

Current maternity services pay significant attention to women who are pregnant and giving birth. And we are providing better care in the immediate postpartum period than we ever did before.

We now screen women in the public health sector (this not done routinely in the private sector) for issues such as mental illness, drug and alcohol use, and domestic violence, during pregnancy and, again, in the postpartum period.

It’s after the birth that services often become fragmented and there’s a gap between maternity care and postpartum support in the community.

Most Australian states and territories offer women a home visit after they give birth, with access to community-based clinics. But this can be patchy, locally-determined and women may not know about it or choose to access it.

Our research suggests health services may be fading away at a time when mothers are most vulnerable and at greater risk of death than in previous months. These support services are becoming less available just as babies are becoming more demanding and sleeping less.

This is also about the time when women may be going back to work or feeling the financial strain of not working. Relationships may be strained because of all these factors as well. And mental health or substance abuse issues exacerbate women’s vulnerability.

There’s a general attitude in society that new mothers need a lot of support but should really be getting on with it by nine months. We clearly need to take a closer look at the type and timing of support services we are providing new mothers.

Join the conversation

25 Comments sorted by

  1. Colin MacGillivray

    Architect, retired, Sarawak

    Here in the third world there is a tradition of the "confinement lady". She moves into the home of the new born, full time night and day, to "run" the baby and the mother. They are kept private, usually upstairs, until the confinement period is complete- so no pressure on the mother for a month. The lady is paid by the parents. Research may reveal whether this tradition reduces depression and suicide.

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    1. Joan Garvan

      Research/Teaching

      In reply to Colin MacGillivray

      There is a lot of research urging the importance of social support during the early years after the birth. The postnatal phase winds up at six weeks after the birth and there are significant differences in the services available by the maternal and child health nurses across the states in Australia. A common perception from a small study in Sydney and Canberra for women who had their first baby in 2004/05 was that the nurses were really there for the baby. The women most often didn't share personal concerns with their nurse.

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  2. Janeen Harris

    chef

    Mothers today are often lacking family support that previous generations had.

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  3. Chris Saunders

    retired

    Hannah and Charlene thanks for this article sad news though it is. I would like to suggest that women be educated about pregnancy and child birth and post partum consequences while still at school. I am thinking in terms of a general health and well being course that is widely accessible. Women without family support do not receive the benefit of community knowledge and rely very much on medical staff to ‘do’ the birth and just hope that doing what comes naturally will get them through. There…

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    1. Emilie Choukry

      artist

      In reply to Chris Saunders

      Years and years ago many mothers routinely went to Tresillian for a fortnight of learning to look after their baby and themselves.New mothers were taught by women who in the main had a wealth of experience and support to pass on .This was a helpful model.

      I feel that women have been sold a lie since the 70s .
      Many women my age will recall that in the late seventies we were fed stories about women who popped out the baby and got straight back to work...who pops out a baby ? A baby is not a…

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    2. Chris Saunders

      retired

      In reply to Emilie Choukry

      Yes, it has been worrying me that women's options appear to have narrowed rather than broadened. Tresillian sounds like a wonderful idea. With such wide access to the internet nowadays, there is a lot that a motherhood site could offer to women especially if equipped with a forum to provide an opportunity for women to interact with others and to seek advice from all and summary and where comments can be verified. Such a service if monitored by midwives and other medical staff would be a wonderful beginning without the awkwardness that a week or fortnight away might imply for the modern woman.

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    3. Joan Garvan

      Research/Teaching

      In reply to Chris Saunders

      There are a number of these that are very active .. the Bub Hub and maternity.com are a couple. Then there are loads of blogs - I personally like one called blue milk but her offspring are going to school now I think.

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    4. Emilie Choukry

      artist

      In reply to Joan Garvan

      I agree there are some fantastic sites for information which is an improvement but what I feel mothers need more than anything else is practical help and sleep.
      Someone to hold the baby when it won't settle causing mothers to get anxious , someone to hang
      the washing out, someone to cook a meal while you take a rest because your circadiun rhythm is shot [it has links to depression], or someone to babysit while you go and do the grocery shopping or have your 6 week check up etc..
      Tresillian…

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    5. Chris Saunders

      retired

      In reply to Joan Garvan

      Thanks for your suggestions, I had in mind a less women's magazine style, more The Conversation style academic and discussion level, including current news, a free correspondence/on-line course of various aspects of pregnancy, child bearing and caring, post partum care, an archive of information sheets etc, demonstration videos, an active free expression forum and government funded. In other words a fount of real information, not paternalistic or maternalistic claptrap, or particular philosophy/theology to sell and certainly no ads. It would not be so difficult to put up or run. Someone like the authors of this article would be right suitable.

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    6. Chris Saunders

      retired

      In reply to Emilie Choukry

      Well that’s the ideal; to find help and you know I have been looking after grandchildren on a three days a week basis for years now, which our parents never did. I am not the only one and with the extended working age this opportunity will be lost eventually too. Not that I think this is an ideal situation anyway. My husband and I had to rely on each other and you just could not both work and bring up kids when they were little; child care then was even more expensive relatively than it is now. It is possible of course to put your child into care for half a day a week to be able to get business or chores done that need doing on your own. I wonder too if the ladies the article talks about are able to reach out and ask for help when it is needed. That’s why I think an internet site would be a good starting point. Maybe, it needs a phone line added.

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    7. Joan Garvan

      Research/Teaching

      In reply to Emilie Choukry

      Yes, I agree about the practical support. Anyone have thoughts about the organisation Good Beginnings? They work to support struggling women and families in the early years after the birth. They don't have a program in the ACT - I'd like to find a group that I could work with to support women and families during this time - recommendations? It seems that the services have gone heavily into case management rather than development support programs.

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  4. Amy Tuteur

    logged in via Facebook

    The scientific paper is poorly done, poorly analyzed and shows nothing.

    The egregious flaws in the paper include:

    1. Why are suicide and trauma lumped together? There’s a big difference (in cause, effect, a preventive approaches) between dying at your own hand and dying in a car accident. There is no possible justification for including trauma in an analysis like this besides artificially inflating the purported scope of the problem.

    2. How does the supposed high suicide rate in the postpartum…

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    1. Emilie Choukry

      artist

      In reply to Amy Tuteur

      Could you have not been so hell bent to highlight the deficiencies you write about this article by, from my reading of you comment, attacking the authors who are only trying to improve a woman's lot.
      Instead be collaborative and show how in your opinion they could improve their analysis in more positively constructive fashion.
      Clearly you have a very good mind.
      Early settler women in Australia were throwing themselves into dams to end their either ongoing depression or suffering in general or postpartum depression, so we still have a long way to go to improve mental health of all kind.
      I thought your comment that they utterly failed to show that being postpartum "is the relevant risk" was a given to any reader reading this.
      Services might not fix all problems but if we have little services we will never know if they do.

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    2. Amy Tuteur

      logged in via Facebook

      In reply to Emilie Choukry

      No, I don't believe they are trying to improve the lot of women. I believe they are trying to bash modern obstetrics.

      The paper showed nothing, but Dahlen has been quoted in multiple publications for lay people using the study to insinuate that current obstetric care is substandard.

      I suspect that this is part of an overall stragety for dealing with the mounting evidence that homebirth isn't safe, midwifery care isn't particularly beneficial and that modern obstetrics is evidence based while…

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    3. Emilie Choukry

      artist

      In reply to Amy Tuteur

      From their article I would not read their intent was to bash modern obstetrics nor to promote home births.
      Your comment "The argument goes like this : ...." is in no way an argument that I would have jumped to and I am sorry that you feel so under siege .
      Why don't we ask the authors their intention?
      That would be the most useful method as I am not a mind reader and take their intention at face value.
      By the same token I would not have read your first comment as that of someone who felt they were bashing obstetrics....you have to be fair and look at your motives too.
      People can disagree on the process but the objectives can still be the same..to improve outcomes.

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    4. Joan Garvan

      Research/Teaching

      In reply to Amy Tuteur

      A review of midwifery literature shows that Obstetricians most often leave postnatal care to Maternal and Child Health nurses - who have, in turn, been primarily concerned with infant health and wellbeing and the physical recovery of mothers. A small qualitative study of women who birthed their first child in 2004/05 Sydney and Canberra found that close to two years after the birth 3 of the 16 women were still grappling with the effect of a traumatic birth experience.

      A recently released National…

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    5. Chris Saunders

      retired

      In reply to Joan Garvan

      This is not weird stuff, and please understand I am not on anybody’s side in this seemingly eternal midwifery versus obstetrics debate, and I am not necessarily putting the antagonists in that order. Medical personnel exist in specialities, how could they be in anything else when there is so much knowledge and skill to get over? If obstetricians are to be blamed at all for not realising their patients (and if I am right in this case, this means the mother) have postpartum mental difficulties it…

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    6. Joan Garvan

      Research/Teaching

      In reply to Chris Saunders

      I should say that I am not a midwife. My research was looking at tensions between structure and the agency of women as new mothers. An international body of research shows high levels of depression and high levels of martial dissatisfaction after the birth of an infant. Today there are legendary issues related to identity along with a significant gap between the expectations and the experience of women as mothers. There's a lot of research citing the need for social support in the early years after the birth. But unfortunately the burgeoning early childhood industry is diverting much needed funds away from these brave new families. The competing Paid Parental Schemes are all well and good but they are really about keeping women attached to the workplace. What about the requirements of care that couples need to negotiate, particularly in those early years after the birth. It's not more doctors but support networks that we need more of.

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    7. Chris Saunders

      retired

      In reply to Joan Garvan

      Joan, I’m not sure whether you got my point or whether I fail to realise what it is you are saying. It’s probably the latter. What I wanted to say was that there should be agreement initially on who does what, and that all angles are covered. Then we can look at what remains to be done e.g. your suggestion social support which, forgive me, can mean a lot of things to my mind, but probably has much more specific and sensible meaning in yours. These are things which need to be filled out. To say…

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    8. Joan Garvan

      Research/Teaching

      In reply to Chris Saunders

      Wow, I haven't frequented this site 'the conversation' but it is heartening to have some discussion. Too often on the net there is the - proposition/article/blog and then pretty much parallel reply, without people talking to each other much. I'll definitely keep an eye out here.

      I'm sorry about these terms, I am not trying to be difficult. Since graduating I've been attempting to work in the gap between the academic work and the practitioners. It is a challenge for me to drop the jargon but…

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    9. Chris Saunders

      retired

      In reply to Joan Garvan

      No, I did not think you were trying to be difficult, I just assumed they were the latest terms containing specific meaning as usually in a developing, growing discipline terms do not always retain the same meanings, but owe their new meaning to more recent research which the general public of course have no access to. You probably need to keep the jargon so that people of your own depth of knowledge and understanding of the subject can keep talking and understanding each other. I however, certainly…

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  5. Cutting Depression

    logged in via Twitter

    This news is so disheartening. I hope the mothers get the help they need.

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  6. Ruth DeSouza

    logged in via Facebook

    I am really grateful for the attention given to the issue of maternal support and mental health. I was involved in setting up a maternal mental health service in Auckland, New Zealand and I also developed the content for the NZ Mental health foundation PND brochure. I completed a PhD about Migrant Maternity a few years ago.

    More than anything I would like to see the demise of the ideology of intensive motherhood where responsibility for parenting is individualised. The need for a village to raise…

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    1. Chris Saunders

      retired

      In reply to Ruth DeSouza

      Doing child minding three days a week, it is absolutely imperative that I make some provision for my three year old granddaughter to have freedom of movement to run and just sing and have her own thoughts and move and not constantly feel the eyes of the child minder upon her and also provide the company of other children. City/suburban parks of course are the obvious places for this to occur on a casual and safe basis. A surprisingly beneficial other resource is the MacDonald’s plastic playgrounds…

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  7. Allan Gardiner

    Dr

    Not until such time that Mother Nature herself is seen to totally fill the breech in turning things around -- sans any outside assistance -- will the cessation of post partum suicides obtain...for it's her baby.

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