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Changes required as women with PND continue to slip through the cracks

Changes required as women with PND continue to sli
Photo: Changes required as women with PND continue to slip through the cracks
While awareness about the prevalence and implications of post-natal depression is high, women continue to slip through the cracks, left undiagnosed despite current processes that aim to spot the signs of PND.

Currently, women are screened using the Edinburgh Depression Score (EDS) which is an internationally verified tool for screening for postnatal depression.

It is used during pregnancy by around 12 weeks or at hospital booking to identify women who may have an underlying depression during pregnancy. 

It should be repeated at 36 weeks and at least once, four weeks after birth. 

While all midwives are trained in implementing this tool, the tool is design purely to identify a problem, the issue then becomes what to do next if a woman does score highly, signifying PND.

“There are insufficient resources available in many models of care to support the midwives to access assistance for women with postnatal depression,” says Midwife Liz Wilkes.
“Additionally, midwives often do not see the women for long enough after birth to assess adequately whether postnatal depression is developing.”

Ms Wilkes says the current process doesn’t go far enough, with post birth following up too soon after the birth, and insufficient community-based support and services for women who do develop PND.

“PND can develop any time during the first 12 months and midwives play an important part at the beginning of that period. 

“There is not enough focus on midwifery care after birth and often insufficient access for women to midwifery care during the first six weeks after birth.”

Funding is a major barrier to success, Ms Wilkes says, as is access treatments, particularly in regional or remote areas.

As a result, many women slip through the cracks, left to deal with PND alone.

“Research shows that around one-quarter to one-third of our working mothers will experience depression, and statistically our stay-at-home mothers are even more vulnerable,” says Midwife and author Kathy Fray.

“I would roughly estimate at least half, maybe two-thirds, slip through the system, typically because their PND is mild enough that they still function, or they experience another child and that tips them from 'functional' to 'malfunctional' and they seek help.

“Or sometimes, they put it down to fatigue and busyness and genuinely have no clue they have PND, and live their life no longer able to feel genuine joy deep down inside.”

On top of that, many women are reluctant to disclose how they feel, and this deception goes unnoticed.

“Oh, there is huge reluctance! Massive. Gargantuan. The ‘not coping’ embarrassment and shame barriers are rampant.

“I mean, look at mothering Instagram sites with so many new mums posting so many beautiful ethereal motherhood photos.

“Who wants to admit they're actually seething inside with insidious levels of rampant paralysing sadness?”

Ms Fray says continuity of midwifery care has been proven to lead to better healthcare, both physically and mentally, as well as emotionally and spiritually.”

“Maternity HealthCare knows that fact - it's just that Governments will often state that such a Gold Standard is unaffordable.

“Women since time immemorial have battled on with motherhood, and for the past thousands of years in a dominantly patriarchal society.

“Midwives themselves can't get pay equity - let alone their clients getting what they need.

“A legal comparison was presented to the High Court in New Zealand as Government sexism of pay inequity with the example of self-employed Electricians versus self-employed Midwives.

“Both can be on-call, both highly skilled, both dealing with complex management - midwifery is female dominated, electricians are male dominated.

“Electricians earn twice what Midwives earn.

“Despite this, mothers get on with what we need to get on with. It's what women do - but especially, it's what mothers do.”

But Ms Wilkes says the potential consequences of undiagnosed PND are at best significant, and at worst, catastrophic for both mother and baby.

“Infants of women with postnatal depression and mental health issues exhibit signs of their own problems and delays, and therefore it is an essential and important issue for the baby as well. 

“For mum, obviously there are major concerns as suicide is one of the leading causes of maternal death in the perinatal period.

“Models of care where women see multiple midwives or don't even see a midwife prior to or after birth are major problems with the current system. 

“It is critical that relational based care becomes the norm so that women develop a relationship with their care provider that provides for time to unpack mental health issues, and develop strategies to prevent issues and solutions for the issues that do develop.


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Nicole Madigan

Nicole Madigan is a widely published journalist with more than 15 years experience in the media and communications industries.

Specialising in health, business, property and finance, Nicole writes regularly for numerous high-profile newspapers, magazines and online publications.

Before moving into freelance writing almost a decade ago, Nicole was an on-air reporter with Channel Nine and a newspaper journalist with News Limited.

Nicole is also the Director of content and communications agency Stella Communications ( and a children's author.