Recently I attended my son’s annual childhood clinic check up. In Australia, these are appointments with a health professional to check on the growth and development of your child and to work together to achieve the best health outcomes for your child.
While these annual check ups are focused on the child, they in my view are not in the best interest of the parent, particularly a mother with previous mental health issues. My experiences of these check up visits to date have been anxiety provoking, making you as the mother second guess the choices you have made and actions you have taken as the parent in the best interest of your child, with the health professional making you feel as if you have made the wrong decision. I had been assuming that as my son got older, my anxiety levels around these check ups would lessen; how wrong I was.
My anxiety with these check ups started just after my son was born and we were arranging the post birth home visit with the childhood clinic nurses, which is standard procedure. As I was starting to spiral into postpartum psychosis and we didn’t know it, I was misunderstanding the screening questions I was being asked prior to the home visit. This resulted in myself becoming delusional and confused around being asked if there was knives or guns present in the house (knives yes as husband is a chef; guns no) and thinking that my son was going to be taken away from me, which is a fear that causes women with postpartum psychosis to conceal their illness (McGrath et al 2013). In between the time making the appointment and the actual appointment I descended into psychosis and therefore was not actually present for the home visit as I was in hospital.
The subsequent appointments every 3 months for the first year I used to dread going, over-thinking what they were going to ask and over-analysing what was discussed at these appointments. I see these check ups as opportunities to ask questions about my child’s development and raise any concerns I may have as a parent to see if these are valid in the eyes of a health professional. All this results in is me questioning my ability as a parent, like the time I questioned about how structured in routines my son was at the time and I was presented with the option of doing a behaviour screening questionnaire.
At the recent check up I raised some concerns I had around my son and toilet training. We had started toilet training just after Christmas this year however my son was still struggling with a few aspects. Only in the week of the appointment did my son turn a huge corner and it all came together with toileting. However, I still raised my concerns with his progress to get the health professionals view on the situation, only to be told that my son was ‘manipulating’ us as parents and that he is capable, but we as parents were not using effective reinforcement like reward charts, recommending a parenting program to us. The mother lioness came out in my and I spoke my thoughts to the nurse, informing her it was a cognitive development stage and timing issue, not a case of manipulation based on my background education in psychology and previous work experience in said parenting programs. Why do I feel like I have to go into battlefield with the health professionals using my education as armour against them, and if I am having this experience in defending my parenting skills with the level of education I have, how do other parents manage this?
Another concern I raised with the nurse at the recent check up was my son’s language development. As he has only just turned 3 I am not overly concerned with his speech, knowing from my uni studies that the syllables he is struggling with are the one that develop later. The response I was given to my concern was ‘Do you have private health insurance?’. A beg your pardon? The standard response is that they refer all children to a private speech pathologist as the public wait list is so long, and early intervention is key. Well, that is one sure way to induce a panic attack in a mother who simply raised a slight concern. The nurse hardly even listened to my son speak and proceeded to push the speech path response; so much for a health professional opinion.
My son attends family day care and is in the presence of other adults who have not raised any concerns with his development. I was quite rattled after this annual check up and it took a few days for my to bring my anxiety levels back down and under control. As a mother, I see the health professional as someone to guide parents on their development of their child, not to destroy the parents confidence.
The one thing that most gripes me about these annual child check ups with a health professional is that it is all child-focused. In a recent study by Megnin-Viggars et al (2015) several key themes were noted in the experience of care with perinatal mental health issues including this focus on children over mums, health professionals either being unable or unwilling to address mental health issues in women, the need for support as well as the need for integrated care. In all the check ups I have done for my son, only one nurse has asked how I am going and if she can do a routine Edinburgh Postnatal Depression Scale (EPDS) on me. In this case, I actually had to prompt the nurse to read the file in front of her and say that should be a routine procedure for mothers with postpartum mood disorders. The nurse had a look of surprise when she took the time to read my file! One of the stages of recovery from postpartum psychosis is the tendency to conceal the illness, particularly from professionals (McGrath et al 2013). If the health professionals were more encouraging in women being open about their experiences, this would facilitate women to seek support and aid the recovery process (McGrath el al 2013).
For women who have experienced postpartum psychosis the support of health professionals, along with support from family and friends, is the second most important factor in recovery, with the women’s own determination being the most important (Engqvist & Nilsson 2014). To have hope and faith that you will get through, to have support that you will be ok is crucial for someone who has been experienced mental illness and forming a holistic perspective with professionals can be an effective approach for recovery (Engqvist & Nilsson 2014). So for me not having the support I am looking for from a health professional is a hindrance to the recovery process. Why can’t the childhood clinic collaborate with other health professionals in the care of women with postpartum psychosis, or even with postpartum mood disorders in general? Psalia et al (2014) notes this disjoint of care from maternity services to child and family health services showing that processes and communication were lacking, such as transfer of information being reliant on discharge summaries alone, to ensure this collaboration occurs. A suggestion from Psalia et al (2014) for families ‘at risk’, which I consider mental health to be in this category, is to have regular meetings between midwives and the child and family services, particularly to ensure the understanding of each of their roles in the care provision.
I really wanted support from a health professional as I was lacking the parenting confidence, particularly as I was a first time mum, and this seems to be similar to other mums seeking support (Miller et al 2014). It appears though even with dedicated Postnatal support service (UPNCS) put in place across public health services, receiving almost double the amount of contact than normal services, there was no association between UPNCS and parental confidence or perception of the sufficiency and quality of care received (Miller et al 2014). It was noted in this study that the type of contact provided, either by midwives or Child Health nurses who have different skill sets and care focus, that further research is needed to investigate if this plays a role in the association between support received and quality of postnatal care (Miller et al 2014). From my experience, I feel that this certainly does play a role in the postnatal care and support provided, especially women with a history of postpartum mental illness.
A downside to these childhood check ups and not being focused on the mother is that symptoms of depression can persist into the early years of childhood. Horwitz et al (2009) found that depressive symptoms persist in mothers who have children of pre-school age and the pattern varies across assessments with 27.2% reporting intermittent symptoms. Socioeconomic factors, like trouble paying the bills, as well as psychological characteristics, like conflict in the family home and levels of parenting stress, play a role in the level of depressive symptoms reported (Horwitz et al 2009). This can have an impact on the child as mothers who report elevated depression symptoms report lower for their child’s health (Horwitz et al 2009). So what is best for the child may be what is best for the mother, and what is best for the mother is a health professional checking in, perhaps doing a quick EPDS, and seeing how the women is coping as a mother of a toddler.
How have you found your experiences with the childhood check ups? Do you feel that they are too child-focused?
Horwitz et al (2009) Persistence of Maternal Depressive Symptoms throughout the Early Years of Childhood
McGrath et al. (2013) The process of recovery in women who experienced psychosis following childbirth