Later this month, Science & Sensibility contributors will share their hopes for the year 2012: what we would like to see accomplished in the ensuing months on behalf of mothers, babies and families, and the maternity care industry as a whole. One of my hopes for the coming year(s) is that childbirth education organizations like Lamaze will increase their attention to issues revolving around maternal mental health; training birth professionals to screen, recognize, support and appropriately refer women with whom they work who may be suffering from one of the myriad perinatal mood disorders (PMDs)we now understand exists.

To that end, I'd like to share with you a study that recently crossed my desk (thank you, Walker Karraa) which assessed online resources pertaining to PMDs. Donna Moore and Susan Ayers published their findings from A Review of Postnatal Mental Health Websites: Help for Healthcare Professionals and Patients in the Archives of Women's Mental Health in November of last year. The aim of the study was to conduct a systematic review on any and all current websites that maintain a primary purpose of discussing postnatal health with particular interest in the depth, breadth, quality and technological excellence of sites that specifically discuss postnatal mental health.

Studies show that 10-15% of new mothers are diagnosed with postnatal mental illnesses, and potentially one in four women may have significant distress without meeting criteria for a disorder.' (Baker et al. 2009a, b;Czarnoka and Slade 2000)... However, there is now increasing evidence that anxiety disorders are also prevalent in between 3% and 43% of women in the postpartum period (Glasheen et al. 2009).'

The four major search engines were employed (Google, Bing, Ask Jeeves and Yahoo) and the top 25 results for each key word entered were then analyzed.

Disappointingly, the publication of results does not list all sites scrutinized (I would like to see what their search results generated) but the authors did list the top five websites, according to their criteria for excellence which included accuracy of information, available resources for mothers, and website (technical) quality:

Table 1

*Table 1 re-purposed directly from publication

The websites were examined for their quality of information and navigability based on the basic criteria list above, as well as by the following sub-categories:

1. Accuracy of Information
   a. symptoms (of postnatal mood disorders...not only PPD but anxiety, psychosis and PTSD
   b. risk factors (psychosocial, medical history and additional factors)
   c. impact (of postnatal mood disorders upon the mother, infant and her partner/family)
2. Available Resources
   a. self-help
   b. tools for mothers
   c. support for mothers
   d. additional resources.
3. Website Quality
   a. authority
   b. contact ability
   c. up-to-date
   d. navigation
   e. presentation
   f. advertisements (appropriateness or lack there-of, distracting, misleading...)
   g. accessibility

As concluded by the authors:

Information was often incomplete and tended to be about symptoms, predominantly depressive symptoms, such as tearfulness. Coverage of other symptoms of anxiety, puerperal psychosis or PTSD was minimal. This could reinforce the misconception that postnatal mental illness is solely depression or simply an extension of the 'baby blues'.'

What type of information, as certifying organizations, are we providing our educators? What kind of information are we, as childbirth educators, providing our clients? Are we providing information that is accessible (understandable), readily available (are we not shying away from difficult-to-discuss topics) and high quality (evidence-based)? Are we acknowledging that somewhere between ten and forty-three percent of the women we teach will end up suffering a postnatal mood disorder? Are we discussing risk factors and approaches to late pregnancy and birth that might help them avoid this outcome?

Invitation for reader feedback: How are YOU implementing postnatal (or perinatal) mood disorders into your curriculum?

Posted by: Kimmelin Hull, PA, LCCE, FACCE

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