Radiance Symposium 2019: Together anything is possible
On Saturday 23rd February, the Radiance Network South West hosted the inaugural Perinatal & Infant Mental Health Symposium in Busselton. Radiance was established in 2016 to connect parents with local services to support their emotional wellbeing during early parenthood. I was humbled to be invited to present as one of 10 expert speakers on the topic of Mindfulness for Parents. I was moved and inspired by the other 9 speakers, and would like to share my learnings and insights from the Symposium in this blog post.
Dr Vijay Roach
Dr Vijay Roach is the President of the Royal Australian College of Obstetricians and Gynaecologists. He attended the Radiance Symposium with his wife, Cathie Knox, who is currently a member of the Board of the Gidget Foundation, a not-for-profit organisation supporting the emotional wellbeing of expectant and new parents to ensure that those in need receive timely, appropriate and supportive care. Vijay opened the Symposium with some powerful messages for all health practitioners who attended.
“If your audience isn’t listening to you, then it’s not their fault, it’s yours.”
Vijay reminded us that as health practitioners, it is up to us to give our patients permission to tell their story by listening without interrupting. Although the Gidget Foundation encourages women to “Start Talking”, his take home message for health practitioners was to Start Listening.
By listening, we are empowering mums, dads and families to heal themselves. It is our job to listen for the wisdom that a woman shares and reflect this back to her. Sharing our insights during a conversation that actively involves the patient in a dialogue allows the healing to begin. Dr Roach also suggested that it is time that doctors were moved out of the lead position in the health care team, putting the woman and her family at the centre, surrounded by her team of supportive health care providers.
Another powerful message that Vijay shared was “you can’t read one chapter and understand the whole book”. Often as doctors we spend 20 to 30 minutes with a woman in a consulting room and provide treatment advice based on the information gathered in this short period of time. Healing must happen over time with input from the whole team, most importantly the woman and her family.
Sharon Cooke and Sue Coleson
Sharon Cooke and Sue Coleson are the creators of the Mother Baby Nurture Program. This program aims to support mothers to build a healthy relationship with their infant by being with them, encouraging her to hold her new baby while being held herself by the group of mums and the facilitating health professional. This program has been running in Perth since 2009 and commenced in Busselton in 2017.
Sharon spoke about the perinatal experience as one of mixed emotions. Although many women look forward to the joy and euphoria of having a new baby, they can find themselves experiencing fear and emptiness, leaving the mother feeling shattered, numb, resentful, with nothing left to give. She explained that with the birth of the baby comes the birth of the mother, with a shattering of her old way of being, leaving her feeling broken but also able to be reformed. Motherhood can also be a time of shocking awakening, where painful experiences from her own early relationships resurface.
One of the aims of the Mother Baby Nurture group is to prevent psychological distress during this time of transition, and strengthen the mother’s sensitivity and attunement to her baby, promoting a secure infant-parent attachment. It is helpful to strengthen the mother’s reflective skills so that she can be present with her baby and respond in a way that reflects the baby’s internal world. The group encourages the mothers to speak for the baby in the first person, asking the mothers to consider what their baby would say if they could talk right now.
I particularly like one of the activities that happens during the session called “Wonder Watch” where the mothers spend 5 minutes watching their baby with wonder and curiosity, allowing their baby to take the lead. During this time they are encouraged to notice their own feelings and sensations while also noticing their baby’s movements, sounds and expressions. Once the 5 minutes is finished, the mothers share what they’ve seen, learnt, felt and heard. This process helps the mothers deepen their reflective skills and become more in-tune with their baby, such that they understand what their baby can do and how they explore and interact.
It was great to hear that this program is also evidence-based, with positive outcomes from program evaluations. These outcomes include increased maternal confidence and attachment, reduced maternal anxiety and depression, reduction in parenting stress and increased reflective functioning.
The take-away message for this presentation can be summarised beautifully in the words of Leunig’s Hymn
Keith Mowat is a clinical psychologist in Busselton with an interest in men’s perinatal mental health. He talked about the cultural changes that have occurred in parenting roles in recent times, with an equalisation in the distribution of work between parents and the father role becoming one of nurturing and co-parenting.
Keith explained that postnatal depression (PND) also occurs in fathers and is associated with a range of different factors including PND in their partner, loss of identity, low marital satisfaction, feeling redundant, disappointment and birth trauma. Importantly, he mentioned that there is an association between fathers who experience PND and subsequent psychiatric disorders in their children 7 years later.
Keith then shared a summary of the recommendations that he had gathered from his research into this topic. This included structured programs for new fathers delivered by experts, more supportive and instructional “how to” resources, and including fathers in antenatal and postnatal screening for PND.
Keith mentioned a number of useful resources that have been developed for dads, including
The Dad Handbook from Beyond Blue
Beer and bubs childbirth education classes for dads at the pub
Keith’s take home message was that fathers want to be involved but often don’t know how. Dads want clear instructions from experts on what to do to be the best partner and dad they can be.
CJ Heins shared her personal journey of recovery from postpartum psychosis. You can read CJs story here. CJ received a standing ovation for her courageous presentation, and also for the incredible work she has done raising awareness of perinatal mental illness. She has already raised $15 000 from a fundraising clothes swap, which was put towards establishing the Radiance Network South West, and she will be running another event on 13th April in Yallingup to raise more funds for this important cause.
Leanda Verrier, coordinator of the State Wide Perinatal & Infant Mental Health Program (SWPIMHP), provided us with a snapshot of the history of perinatal and infant mental health programs and policy in WA and Australia since 2003. Leanda showed that screening for postnatal depression using the Edinburgh Postnatal Depression Screening tool increased to 90% in WA by 2018. The SWPIMHP provides support to health professionals, clinical networks and researchers, including education on the various tools and resources available.
Leanda also reminded us of the recent updates to the National Guidelines on Perinatal Mental Health, which include the importance of screening for risk factors during pregnancy using an antenatal risk questionnaire. Finally, Leanda highlighted that we are one of the most well-resourced states in Australia, with a total of 16 Mother Baby Unit beds at King Edward Memorial Hospital and Fiona Stanley Hospital, as well as access to Childbirth and Mental Illness (CAMI) clinic for preconception counselling and pre-birth planning, and Perinatal Telepsychiatry services for rural women.
Belinda Butler-O’Halloran, registered psychologist working in Busselton, shared the findings of her thesis “What new parents really want”. Belinda conducted qualitative research to get an understanding of the barriers that mothers faced to seeking support in the postpartum period and suggestions for improved care. She shared that the barriers included stoicism, insufficient contact with health services and feelings of vulnerability and isolation. The suggested solutions included providing women with a pathway of care that is easy to navigate and forming therapeutic relationships with their health care providers. It was also suggested that women could be supported by a perinatal health care provider who follows them throughout her pregnancy, birth and postpartum and is their first point of contact for support. Belinda also expressed that the Radiance Support Group is a wonderful place for vulnerable mothers to meet and support one another during the postpartum period.
Professor Megan Galbally
Prof. Megan Galbally in a perinatal psychiatrist at King Edward Memorial Hospital and Murdoch University who has done extensive research in the field of perinatal mental health. Megan is currently leading the Pregnancy Emotional Wellbeing Study in metropolitan rural WA to add to the data previously collected at Mercy Hospital, Melbourne. Megan provided a fascinating summary of what is known about the role of hormones such as oxytocin and cortisol on mother-infant relations and maternal depression. She also discussed research into the relationships between breastfeeding, infant sleep, neonatal adaptation and anti-depressant use in mothers. Interestingly she reported that long-term follow up of offspring of mothers who used anti-depressants in pregnancy were cognitively no different from offspring of non-depressed mothers who were not on antidepressants. She also reported that breastfeeding has a possible positive effect on maternal mental health and women on antidepressants who breastfed for 12 months had a lower Edinburgh Depression Scale score compared to untreated women with depression. She also informed us that there is no association between infant sleep patterns and maternal depression, but in fact the biggest predictor for infant sleep issues was the mother’s attitude towards sleep.
Dr Andrew Lewis
Dr Andrew Lewis, clinical psychologist and researcher, provided a thought-provoking session on infant attachment and how it can predict mental health disorders in children and adolescents. Andrew defined attachment as an enduring social affiliative with biological imperative; a behavioural system that is switched on by the threat of danger and switched off after the care-giver successfully comforts the infant. Andrew explained the neurobiology of attachment and the features of disorganised attachment, which is associated most strongly with psychosocial risk and biological dysregulation. Andrew also outlined the requirements for healthy attachment and risk factors for disorganised attachment, including unresolved trauma and loss.
Finally, Cathie Knox from the Gidget Foundation, shared with us her personal journey of healing from postnatal depression, as well as the incredible steps she took to make a positive difference for women at risk of perinatal mental illness by establishing a private hospital screening program and her involvement in the Gidget Foundation. Her take home message was that COLLABORATION is the key to success with any program or organisation, combined with patience and persistence.
In summary, this Symposium was incredibly inspiring, bringing together so many passionate and dedicated people with a common drive to support and empower women and families during the perinatal period. I feel so positive about what we can achieve through effective collaboration and I can’t wait to share more news from the Radiance Network in the months and years to come.