"Nobody Listened". Mothers' Experiences and Needs Regarding Professional Support Prior to Their Admission to an Infant Mental Health Day Clinic.

Tinne Nuyts,Binu Singh,Neeltje Crombag,Susan Garthus-Niegel,Marijke Anne Katrien Alberta Braeken,Susan Ayers,Sarah Van Haeken,Annick Bogaerts

doi:10.3390/ijerph182010917

Abstract

Challenges during the perinatal period can lead to maternal distress, negatively affecting mother-infant interaction. This study aims to retrospectively explore the experiences and needs regarding professional support of mothers with difficulties in mother-infant interaction prior to their admission to an infant mental health day clinic. In-depth semi-structured interviews were conducted with 13 mothers who had accessed an infant mental health day clinic because of persistent severe infant regulatory problems impairing the wellbeing of the infant and the family. Data were transcribed and analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL). Three themes were identified: ‘experience of pregnancy, birth, and parenthood’; ‘difficult care paths’; and ‘needs and their fulfillment’. The first theme consisted of three subthemes: (1) ‘reality does not meet expectations’, (2) ‘resilience under pressure’, and (3) ‘despair’. Mothers experienced negative feelings that were in contradiction to the expected positive emotions associated with childbirth and motherhood. Resilience-related problems affected the mother-child relationship, and infants’ regulatory capacities. Determined to find solutions, different healthcare providers were consulted. Mothers’ search for help was complex and communication between healthcare providers was limited because of a fragmented care provision. This hindered the continuity of care and appropriate referrals. Another pitfall was the lack of a broader approach, with the emphasis on the medical aspects without attention to the mother-child dyad. An integrated care pathway focusing on the early detection of resilience-related problems and sufficient social support can be crucial in the prevention and early detection of perinatal and infant mental health problems.

Highlights

Becoming a mother is a unique life event that can be overwhelming [1]
Four mothers were admitted to a crisis psychiatric ward during admission to the infant mental health (IMH) day clinic
Van Haeken et al (2020) conducted a concept analysis and Delphi survey of perinatal resilience which found it can be understood as a circular process towards greater wellbeing in the form of personal growth, family balance, adaptation, or acceptance when faced with stressors, challenges, or adversity during the perinatal period

Summary

Introduction

Becoming a mother is a unique life event that can be overwhelming [1]. Important factors that facilitate the transition to motherhood are social support [2,3,4,5], correct and realistic information [4,5], and attention to the psychological changes [4]. Unrealistic expectations, feelings of stress and loss of control, lack of sleep, and lack of adequate health care may compromise this transition [2,5]. A variety of psychological, social, and biological determinants challenge mental health during or after pregnancy [6,7]. Perinatal mental health problems occurring during pregnancy or in the first year following birth, affect approximately 20% of women [8,9], making them an important public health issue [10]. Infant regulatory problems like excessive crying, feeding, or sleeping problems can negatively influence the mental health of the child in the long term [14] and compromise the mother-infant relationship [15], if not treated adequately

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