In the world of mental health and parenting, November 8-14 marks a week of raising awareness for perinatal mental health and anxiety. In honour of a topic that’s close to all of our hearts here at Swell Mag, we sat down with Fiona Little, a Nurse Practitioner from Tamworth who specialises in Perinatal Care.
Can you please tell me a bit about yourself and your professional background?
My background is mental health nursing, and I’ve been working in mental health pretty much most of my nursing career – thirty-something odd years. Although I’ve worked in metropolitan areas, I’ve spent most of those years working in rural areas.
Something always brings me back to the country. For the past ten years I’ve been working for an NGO, specifically in perinatal mental health.
Not many people know that a nurse practitioner is clinically one of the highest levels that you can achieve in nursing (aside from going into management or academia), and it was something that I had always wanted to do.
Perinatal mental health was an area that I was really interested in because it’s about the really early stages of intervention. You can’t get any earlier than a mum pregnant with a baby in utero.
The antenatal phase is also really important to actually work with mums and families, and bring them into a service if they’re struggling, or if they’ve had a history of mental health in the past.
It’s really incredible the work you do, and I have so many questions! But first, what keeps you going back to the country? I’ve spent a lot of time all over Australia, but I can definitely understand the pull to rural areas. What is it about country Australia, especially in the health industry, that keeps drawing you back?
I was born and bred in the country, so for me, the country way of life is very easy to adjust to. The thing that I really like from a healthcare perspective is the fact that we get to utilise all of our skills.
For instance, because there’s no perinatal mental psychiatrist here at all (actually, there’s no psychiatrist in Tamworth, or Armidale or Inverell), so that was perfect for me as a nurse practitioner to be able to utilise those advanced skills.
The other thing about country areas is there’s this level of stoicism, which is both a good thing and a bad thing. By that I mean people sometimes don’t access care as early as they probably should. And really, stigma is still a real issue.
We don’t see it as much in metropolitan areas because it’s a lot easier for people to blend into the crowd. If someone has a mental health problem in a very small community, keeping that from the town or their neighbourhood, from a privacy point of view, is sometimes challenging.
I definitely know that people can be a little more closed off and more private at times in country areas, especially when it comes to health issues. Do you think there are barriers in terms of helping those who need to find support networks? For example, they might have a next-door neighbour who’s going through exactly the same thing as they might be? Is that an issue that you’re seeing as well?
Definitely, it’s in the research, which says that the level of acuity for conditions in rural areas is often greater, meaning that people are often a lot worse off when they get help (if they can get the help).
There’s definitely still some stigma around it. When it comes to perinatal mental health, one of the biggest things that I see, working with mums, is they have this level of expectation.
There’s a level of expectation built around the notion of ‘because I’m a mother, I should be able to do all of these things’. They compare themselves on social media – there’s always this element of judgement to say, ‘why aren’t I coping?’ That then becomes a problem when you’re looking at accessing healthcare because it isn’t promoted well.
For perinatal depression and anxiety, it’s as common as any other mental health condition, but the context around it is different. When I’m talking to some of these mums, and they’re struggling with sleep or breastfeeding, the biggest thing is that they see themselves as failing as a mother.
Yes, absolutely! That really resonates with the theme for perinatal anxiety and depression awareness week, which is about breaking down barriers.
Yes! It is really important that we look at talking to women about the possibility of developing a mental health problem during pregnancy, and how they can step that through in terms of their delivery phase, and getting care when they’ve got their baby at home.
It’s very communal with perinatal mental health – we don’t work in silos. I work with child and family health nurses, I work with obstetricians and I work with midwives – both in the hospital and in the community.
Also, GPs are pivotal to any care in primary health care, especially when there are no specialist services around.
Are you finding that you’re working with both parents? Regardless of the dynamics of the relationship, the other parent who is not carrying, there would be an element of anxiety and depression there as well?
Yes, yes, there definitely is. And I learned very quickly going into perinatal mental health that you can’t do this without involving the entire family.
So, I was very fortunate to be able to work with an amazing psychiatrist by the name of Professor Brian Barnett. He was very strong in advocating for men and fathers, and it’s now offered with every single appointment. I will have an appointment with a mother and an invitation is extended to both parents.
It’s important to help both parents understand that they’re also vulnerable to depression and anxiety, and what their role can be. The other parent often feels displaced, especially with the first baby.
The context of having a baby is what makes perinatal anxiety and depression different. If you were to look at the list of symptoms, perinatal depression and anxiety does look exactly the same as ordinary depression and anxiety.
But, you’ve got all this contextual stuff around it. You’ve got the extra responsibility – like a living being that you’ve never had before. You’ve got no track record of how to care for this little thing. Also at times, you’re often getting all this conflicting advice.
The best advice you can give to a mother is to get to know your baby and work out what works for you. And there are companies and organisations that can help mums do that. So just knowing when your baby’s tired, knowing when your baby’s hungry, and knowing what certain cries mean.
I guess speaking about comparisons and pressure on new parents, how do you think that social media is playing into instances of perinatal depression in terms of there being so much misinformation out there? And so many elements of comparisonitis… It must be hard to be continually looking at people who look like they have it all together. And they probably don’t because that’s really what social media is all about: showing a version of our lives. Have you seen a general increase or any effect of that in any way?
It’s hard to say -I don’t know if we actually measure the amount of time new mums spend on social media in comparison. But it definitely has an impact – whether they’re first time mums or having their third or fourth baby.
And if that happens it’s generally because those earlier pregnancies have had some element of mental health involvement in it, but the mother hasn’t actually reached out for help, because their level of functioning was too low to keep them going.
When any mum, or parent for that matter, talks about social media and the impact, the advice I was given is to get off (social media)! The moment other parents start opening up and saying things like ‘sometimes I really don’t like it (parenting), because it’s actually a lot of hard work!’
Also, things like ‘I love my baby, but I don’t like the work’. These are the moments new parents in particular struggle to share because they feel like they’ll get labelled a bad mother.
Yeah, exactly. And it’s really tough because I’m sure everyone has had thoughts like that at one point or another!
I mean, I love my two children, but I didn’t necessarily like the work that came with them.
There’s also this element of compassion fatigue, I think that doesn’t get recognised in perinatal mental health because you’re doing the same thing every day. It’s Groundhog Day. You’re getting up and your day isn’t set by you – it’s set by someone else.
On the flip side, there’s often not a lot of routine – sometimes mums really struggle to find a way to get any time to themselves or even to go out for a night out with the girls. And sometimes, getting mothers to agree to do that is often their own demise, because they feel that they’re abandoning their child.
Finally, because I want to really make sure we leave readers with a bit of a takeaway, are there any particular resources that you want to make people aware of this Awareness Week?
I think PANDA (Perinatal Anxiety and Depression Australia) does a great job in championing awareness. If you go onto their website, there’s an enormous number of organisations, and resources at your fingertips.
There’s also a wealth of places that families and parents can go to seek help in person as well. More so in metropolitan areas, but here in Tamworth for example, we have a clinic called the Early Outreach Clinic.
It’s designed specifically for women who are planning on having a baby and have had a history of mental health problems, or they’re looking at having their first child and they know they’ve got anxiety or depression.
But definitely PANDA would be my go-to for a starting point in terms of seeking support.
Oh and the other thing I would just like to say, if your GP says that you shouldn’t be sleeping just because you have a baby, go get another GP!
Because sleep deprivation is the devil! It is the number one thing that’s going to unravel any mum with a young baby. Imagine waking up every two hours for the next ten days and see how you’re gonna feel!
So, I really would just like to hone in on the fact that the focus does need to be on maintaining a degree of sleep wherever possible, knowing that it’s going to be challenged.
That’s such great advice, and you’re right I would absolutely not function on that amount of sleep!
If you, or someone you know is also struggling with perinatal depression or is simply looking for someone to point them in the right direction, as Fiona said, the best place to start would either be your GP or visit PANDA for more information.
