Experiences with health professionals for antenatal and postnatal depression

Parents experiencing perinatal depression can access support from a range of health professionals. During pregnancy these include midwives, obstetricians, and shared antenatal care GPs while in early parenthood they include maternal child health nurses, early parenting centres (also known as ‘sleep schools’), mother and baby units, mental health crisis team (CAT team) personnel, and parenting helplines. GPs, psychiatrists, psychologists, counsellors, and other helplines such as PANDA, Lifeline, beyondblue, and Healthdirect can assist across both pregnancy and early parenthood. Parents who experienced distress, depression or anxiety during pregnancy and/or early parenthood told us about the different health professionals they encountered, and their experiences of them.

GPs were often parents’ first point of call when seeking help for perinatal depression. Several mothers said a GP had diagnosed them with postnatal depression, though they also provided advice and information, referrals to other services or to a psychologist via a mental health plan, or prescribed antidepressant medication. Many people were appreciative of their GP’s support or advice. A mother of six, Erin lived in a regional town and spoke highly of her GPs’ care while experiencing post-traumatic stress disorder and postnatal depression after surviving the life-threatening condition placenta percreta: ‘Oh, I can’t rave enough about – seriously, these guys are amazing – because you’re in a small town, they know you. So I’ve felt very, very looked after.’

Tina, an immigrant mother from Iran who experienced postnatal depression after her first baby, initially found her Australian GP’s advice to take care of herself as well as her daughter ‘ridiculous’. Later she came to appreciate it.

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Some women had less positive experiences or did not feel comfortable asking their GP for assistance. Zara described visiting an all-hours clinic on advice from PANDA. She explained: ‘The GP just gave me a couple of prescriptions, didn’t talk about anything. It was a really poor experience’.

Elly felt ‘sad and disconnected’ after struggling with breastfeeding her first child, but couldn’t tell her GP. She reflected on where she might seek help if these feelings resurfaced with her second baby.

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Mothers described maternal and child health nurses providing advice and referrals and administering the Edinburgh Postnatal Depression Scale to screen for perinatal depression (see Identifying antenatal and postnatal depression and finding help). Several comments they made suggested maternal child health nurses provided good support once mothers disclosed they were struggling with depression or distress, but were not necessarily good at ‘picking up’ postnatal depression.

Some mothers felt this was because maternal child health nurses were mainly focused on the baby. Chandrika, a migrant mother from Sri Lanka living in a regional town, struggled caring for her new baby without family support while her husband spent long hours studying. She explained that at the time: ‘I don’t know there’s a mental health support here. I don’t know anything. [The maternal and child health nurse] – she didn’t tell much, just about injections only.’

Other mothers acknowledged that not being ‘honest’ about how they were feeling made it hard for nurses to identify distress. A few said it depended on the degree of ‘rapport’ they had with their maternal child health nurse. As Elly commented, ‘you need to find someone that you can really talk to and trust’.

Although Georgia experienced postnatal depression after both her children, she was not diagnosed until after her second child. She thought a better relationship with her second maternal child health nurse led her to answer the EPDS ‘truthfully’.

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Elizabeth felt maternal and child health nurses focussed on babies rather than mothers, but acknowledged mothers putting on a ‘mask’ made it difficult for nurses to ‘really see what’s going on’.

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A number of parents saw psychologists, psychiatrists and / or counsellors as part of their treatment for postnatal depression, or were diagnosed by a psychologist or psychiatrist. Psychologists and counsellors provided various kinds of counselling, while psychiatrists either provided counselling in conjunction with supervising antidepressant medication, or supervised medication only. A few mothers consulted a psychiatrist for medication and a psychologist for counselling, while others tended to consult only one of these health professionals.

While describing experiences with psychologists, psychiatrists or counsellors parents discussed rapport, cost and availability.

A few parents talked about needing to consult a few different psychologists or counsellors before finding one they could relate to. Elizabeth initially sought counselling from a psychologist then changed to a ‘brilliant’ counsellor. This was because after five sessions the psychologist had still not been able to remember her children’s names, which Elizabeth felt indicated she had not ‘taken on board anything’ from their previous sessions.

Some parents were concerned about the cost of counsellors or private psychiatrists, including Melanie who said about her counsellor: ‘Money’s always a factor, it’s expensive, and so I can only really see her once a fortnight’. Those who accessed subsidised psychologists through the Better Access to Mental Health Care initiative or their employers were grateful for this. Maree said due to financial concerns her partner was ‘stoked’ she could see a psychologist through a ‘free mental health plan’, while Fred explained: ‘We have an employee assistance program, where I’ve received counselling through a psychologist. That’s been fantastic.’ Availability of counselling services was mentioned more often by people in regional areas.

Deb lived in a regional area and when first experiencing postnatal depression went to stay with her aunt who lived on the fringes of a large city. She contrasted the services available locally with those in her aunt’s area.

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The role of ‘professionals’ as compared with family members or friends in providing support for postnatal depression was mentioned by several people, particularly in relation to avoiding ‘burdening’ family or friends. As Melissa explained: ‘The clinical psychologist for me was great because I felt while my husband was very supportive, to just sit there and whinge to him about the day I’d had, it’s not fair on him. So talking to someone else, even if she didn’t say anything, just blurting everything out was fantastic.’

After two ‘episodes’ of postnatal depression, Anna talked about learning to ‘surround’ herself with professionals to help her avoid further ‘relapses’.

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Sometimes women had help from other health professionals. Zara was diagnosed with postnatal depression by a mental health crisis team (CAT team) who came to her house after her intrusive thoughts prompted her to call PANDA, while Erin’s post-traumatic stress and postnatal depression were addressed after she went to see her obstetrician for a check-up after recovering from hospitalisation following placenta percreta.

Melissa’s experience of getting help for postnatal depression began when she called a maternal and child health hotline for advice about her baby’s unsettledness.

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For information on treatment for perinatal depression see:
* Experiences of medication for antenatal and postnatal depression
* Experiences of hospitalisation for antenatal and postnatal depression
* Non-medical approaches for antenatal and postnatal depression