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New Mothers Suffering Due to Under-Resourced Midwives



New research released by Maternal Care Action Group (MCAGNZ), has revealed serious gaps in midwives' knowledge and practice regarding perinatal depression and anxiety in New Zealand.

Researcher, Registered Nurse and Massey University Master's student Kristina Paterson set out to try and understand the reported gaps of a survey released last year by Mothers Helpers. The survey results showed that 63% of respondents had depressive symptoms that began during pregnancy, yet more than two-thirds were not diagnosed till much later after baby was born. 96% of survey respondents had risk-factors for Postnatal Depression yet 72% failed to be assessed for depression or anxiety by their midwife during or post pregnancy.

Due to the small sample size of her research, Paterson has presented an hypothesis calling for further research and investigation. Her hypothesis indicates that delayed diagnosis and treatment during the perinatal phase is likely a result of midwives' knowledge deficits in understanding the onset, prevalence, risk factors and treatment for antenatal and postnatal depression.

"The research findings showed it was not the attitudes of midwives that contributed to gaps in screening and referring women for help, but knowledge, and these findings supported both Mothers Helpers' midwifery knowledge surveys and research results in Australia where more than 800 midwives participated."

"Why this is important" says Paterson, "is that if depression or anxiety are not picked up early on during the perinatal phase, and goes untreated for a long time, there is a massive impact on the entire family. For mum, that means increasing severity and likelihood of chronic depression. And we know that perinatal depression is the leading cause of maternal deaths. For her children, it means an increase in emotional, cognitive and physical developmental issues and a higher risk of insecure attachment. That means that later in life, her child is at-risk of developing learning difficulties, mental illness, addictions, delinquency and even suicide. There is also an increased risk in partner depression and relationship breakdown."

This research comes hot on the heels of the NZ College of Midwives' Chief Executive Karen Guilliland reporting "under-staffing due to a growing exodus of midwives with fewer midwives graduating in recent years" and poor working conditions. Guilliland says this is because the maternity sector has not been a Government priority since midwives became the predominant lead carers.

"Midwives may be the only skilled health professional a woman comes in contact with during pregnancy and after birth," says Paterson. "If a midwife is struggling with workload and poor working conditions and has not been adequately resourced with the knowledge and practice skills to identify a woman needing help or further assessment for symptoms of depression, it is likely that the woman's diagnosis will be significantly delayed."

"We cannot expect midwives to be doctors or counsellors in addition to all that they have on their plate, but we can adequately train them on perinatal depression, screening and referring women for help."

In light of the results of her research, Paterson is calling for a full investigation into the knowledge and training of midwives in perinatal depression. "If suicide is the leading cause of maternal deaths in this country, I cannot understand why we do not have mandatory quality training on perinatal depression as part of the professional development of registered midwives."

Recent research by Auckland University's Dr Ian Soosay (Deputy Director of the Ministry of Health) supports Paterson's findings that midwives are not screening women for depression or anxiety. The research found that this was because midwives felt uncertain that a woman would see their GP if they referred them and were uncertain that she would fit Maternal Mental Health Criteria. Soosay intends to work on clear pathways for midwives' referrals but presently there is a lack of funding for primary care services. Approximately 97% of women with depression/anxiety would not fit Maternal Mental Health criteria.

As a result of Paterson's research, Mothers Helpers has offered universities free-of-charge lectures to under-graduate midwives and workshops to registered midwives, but the not-for-profit organisation has recently announced that after 7 years' free services to women with antenatal or postnatal depression, they are now having to charge clients to cover their costs. They acknowledge that despite some being eligible for WINZ funding, this will deter a number of women who are already having to overcome a number of internal and external barriers to getting help.

Mothers Helpers is the only primary care service in Auckland assisting women with their recovery from antenatal or postnatal depression or anxiety and their online programme is often the only maternal depression primary care service available in many parts of the country.

MCAGNZ has a petition appealing for perinatal depression and anxiety to be better addressed in this year's budget by increasing funding of primary care services and better resourcing midwives through training. They are also asking for stories of women who have experienced antenatal or postnatal depression and how it's impacted them. You can contact them at

MCAGNZ intends to deliver their petition to parliament on Mother's Day this year.

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