OPINION: New Zealand is failing today’s new mothers and their whānau, and our country’s systemic shortcomings will certainly cause intergenerational damage.
Last weekend, the Helen Clark Foundation published a report, Āhurutia Te Rito | It takes on a village, detailing the troubling state of maternal mental health in New Zealand.
The 61-page document makes reading painful and uncomfortable.
Unfortunately, as a clinical psychologist and mother of two young children, the report’s findings did not surprise me.
* Suicide is the leading cause of death during pregnancy among Wāhine Māori
* Gaps, inequities and staffing shortages in maternal mental health services
* The Department of Health orders an urgent review of maternal mental health, amid growing concern over the refusal of women
If we are to have any hope of changing Aotearoa’s mental health crisis, we must start at the beginning. This means building a meaningful and holistic infrastructure to care for new mothers from conception through their child’s young life.
Speaking from personal experience, becoming a mother is one of life’s most vulnerable transitions.
It involves losing your identity as you have always known it, an unknown pressure of responsibility for your pēpi’s life, allowing your relationship and current family unit to adjust to the presence of a new being, an extreme physical toll during pregnancy and childbirth, as well as sleep deprivation and hormonal surges.
This list does not even take into account women who are experiencing severe life stresses such as insecure housing, financial crisis, substance abuse and domestic violence, who have a traumatic birth or who have lost a baby.
According to the report, up to 50% of new parents experience high levels of distress during their pregnancy or in the first year of their baby’s life.
Holding the title of clinical psychologist did not immunize me during my own maternity journey.
I, alongside 20% of New Zealand women, experienced symptoms consistent with clinical mental illness during my perinatal period. (Covid-19 is thought to have increased this rate.)
My experience involved agitated anxiety, insomnia and an obsession with my daughter’s sleep (to panic).
For others, the symptoms may include despair, disconnection from their baby and partner, tears or tormenting anger.
Tragically for some, this translates into maternal suicide, New Zealand’s leading cause of death among pregnant women and new mothers. Our rate is seven times that of the UK. What is more disturbing is that Maori māmās are three times more likely to commit suicide than non-Maori mothers. A truly shameful statistic.
Caring for maternal well-being is important beyond the physical and mental well-being of the mother.
Recent research highlighted by Sir Peter Gluckman indicates that maternal mental health is the primary indicator of child health and well-being.
If we break down the research, that means if New Zealand wants to grow children who are physically and mentally well, cognitively developed, able to form positive relationships, and who can emotionally handle the stresses of life, we have to do everything we can to take care of ourselves. Their mothers.
If we’ve all taken a step back and asked what it takes to truly care for our expectant mothers and new mothers, the answers are in plain sight. Insight does not require psychological training, but rather common sense and an openness to recognize that the problem is complex and that the solutions will have to be multifaceted.
Where should we start:
The woman must have access to a single point of contact during her pregnancy. A relationship where they feel respected and trusted by the person caring for them, known in this country as Lead Maternity Carers (LMC’s).
This would promote the ability of women to raise their concerns without fear of being belittled or humiliated, as well as continuity of care with regular visits.
To achieve this, a diverse and well-resourced workforce is needed – a far cry from the pool of burnt-out, shrinking midwives who demand time on their working conditions.
A pregnant woman and a young whānau need a safe roof over their heads and a kai on their table. New Zealand’s housing crisis, rising inflation rates and its underbelly of domestic violence are the antithesis of these needs. Improving maternal mental health will require dedicated efforts from ministries.
Whānau and healthcare workers need to be trained on how to spot signs of concern. Given that we know how stressful pregnancy and new motherhood can be, it makes sense to raise national awareness about maternal mental health.
I think this should involve consistent training for all primary caregivers in maternity and GPs on how to spot signs of mental distress as well as how to have effective wellbeing conversations.
The Helen Clark Foundation report points out that no such training currently exists. Also, prenatal classes need an overhaul.
Currently, prenatal classes focus heavily on labor. While it’s important for expectant mothers to be educated about what the labor entails, it’s at most a two-day process on a long journey to new motherhood.
Information on the reality of becoming a mother, the theory of attachment and self-care should be essential.
Place mothers at the center of care, rather as a “complement” to babies. I remember very well after the birth of my first daughter entering my GP’s office for my six week checkup.
Following a traumatic pregnancy and childbirth, I was amazed that the doctor didn’t ask me a single question about my well-being.
Yes, my daughter was healthy, but was I the mother she relied on for her survival? The answer was no, and a simple “how are you?” would have discovered that.
Western New Zealand needs to lean on knowledge of Te Ao Māori, Pasifika and Asian cultures, where new mothers are treated as sacred. Where “mothers are mothered” in their most vulnerable moments for the good of all.
If a woman is in distress and in pain, she must be able to access support. One of the main recommendations of the report was to provide timely access to affordable and culturally appropriate therapeutic support for parents showing early signs of distress.
I agree, however, that any access to support would be a good start.
Over the past year, I have attempted to refer two women to specialized services. Both were clinically ill and their babies were affected by their condition. Both referrals were refused, with the result that all care was left to their GPs.
If, as a clinical psychologist, providing an in-depth, well-reasoned referral, I cannot access support for those who need it, how is the average Kiwi family supposed to?
For women who have had a traumatic childbirth, a clear preventative measure would be to have specialist support in place before they fall.
As you have surely understood, this is a question close to my heart.
I have struggled with severe postnatal anxiety and am in a privileged position. I have a stable home, funds to access private care, a loving family, and knowledge of how to navigate the system. I struggled to get consistent, compassionate care (my midwife was amazing, that’s documented here).
For those with prior vulnerabilities, or women who have traumatic births, they are often left behind.
It’s not OK, and it can’t go on.
Improving maternal mental health requires a cross-party and multi-departmental approach.
This is not to blame parents and whānau, or health care workers who work tirelessly to support our wāhine. It is a shameful truth that we must face collectively as a country.
One that we must prioritize in the repair. As the title of this report suggests, āhurutia te rito – it takes a village.
Where to get help
- 1737, Need to talk? Call for free or text 1737 to speak to a qualified adviser.
- Anxiety New Zealand 0800 ANXIETY (0800 269 4389)
- Depression.org.nz 0800 111 757 or SMS 4202
- Children’s line 0800 54 37 54 for people up to 18 years old. Open 24/7.
- safety rope 0800 543 354
- Mental Health Foundation 09 623 4812, click here to access its free resource and information service.
- Rural Support Trust 0800 787 254
- Samaritans 0800 726 666
- Suicide Crisis Helpline 0508 828 865 (0508 TAUTOKO)
- yellow brick road 0800 732 825
- thelowdown.co.nz Web chat, email chat or free text 5626
- What’s new 0800 942 8787 (for 5 to 18 year olds). Telephone consultation available Monday to Friday from 12 p.m. to 11 p.m. and weekends from 3 p.m. to 11 p.m. Online chat is available every day from 3 p.m. to 10 p.m.
- Youth Line 0800 376 633, free text 234, email [email protected], or find online chat and other support options here.
- If it is an emergency, Click here to find the number of your local crisis assessment team.
- In case of life danger, call 111.