This is part two of a two part series on the support needs of women who experience postpartum psychosis and their partners and is written by regular contributor Walker Karraa. Part one can be found here. - SM

In part two of a review of the recent JOGNN study, Support Needs of Mothers Who Experience Postpartum Psychosis and Their Partners (Doucet, Letourneau, & Blackmore, 2012), partner perception of support needs is highlighted. In the multisite, exploratory, qualitative design, eight partners (Canada, n = 7, United States, n= 1) of women who had experienced postpartum psychosis were interviewed using one-on-one, in-depth, semi-structured, interviews lasting 45-120 minutes. Partners were interviewed separately from the mothers, and verbatim transcriptions were produced from audio recordings. Using inductive thematic analysis (Braune & Clarke, 2006) thematic content regarding support for partners emerged in the categories of (a) support needs; (b) support preferences; (c) accessibility to support; and (d) barriers to support.

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Partner Support Needs

Instrumental, Informational, and Emotional

Identical to the mothers interviewed for the study, all partners expressed wanting instrumental or physical support, at home-help with caring for the baby, their partner, and the basic running of the house. One father reported:

I found for a long time it was at least a two-person job to manage things. Because one person had to take care of the baby, and usually I had to take care of my wife. (Doucet, Letourneau, & Blackmore, 2012, p. 241).

Informational support for partners was indicated as imperative, as none of the partners had "any prior knowledge of postpartum psychosis" (p. 241). Partners reported needing information on partner's health status, treatment plans, long term prognosis, and how to manage partners' illness at home:

I needed advice on how to handle the illness and what to say. Also, information on the early signs of relapse to watch for and if it was to the point that I needed to get help "(p. 241).

Many of the partners reported needing emotional support in the form of "a listening ear" or "an emotional outlet" (p. 241). Hospitalization of their partner proved emotionally taxing. One father reported:

I needed emotional support. I felt I was becoming depressed. It was everything, the long days at the hospital. I saw things that I never saw before and that affected me. I kept thinking, when is she going to snap out of it? Why is this happening? I thought having a baby was going to be the best thing to happen. (p. 241)

Another partner shared:

I was an emotional wreck but felt I had to gather myself together for my wife. And I didn't want my parents to see me going downhill emotionally. I felt I couldn't have any issues, someone had to be strong (p. 241)

Similar to their counterparts, partners reported tremendous isolation, and needing "reassurance from someone who had gone through a similar experience or who was actually going through it" (Doucet, et al., 2012, p. 241).

Partner Support Preferences

Partners overwhelmingly reported wanting instrumental support from informal networks, and informational support from trained professionals. The preference was for a combination of one-to-one support from trained professional and group support in the form of the partners of women who experienced postpartum psychosis.

Partner Accessibility to Support

Regarding partners finding access to support, the themes of both limited professional support and limited community support emerged. The majority of partners had no access to professional help, reporting they were too proud to ask. Partners had universal difficulty in gaining access to information on community support for themselves and their partners. One father reported:

I called five psychiatrists in the community before we found one. It was hard finding the appropriate support. We could have been given contact information when leaving the hospital. And even then, have them set it up. Take some pressure off us. Just walk out, and walk into community support. (p. 243)

Partner Barriers to Support

Interestingly, partner barrier to support emerged in themes of health care provider barriers and personal barriers. Partners reported health care providers as universally uncaring, and not flexible in treatment plans-for example not giving them access to their partners in the hospital, and not allowing them to bring their babies to see their mothers. One partner described:

Being put in isolation rooms and separated from babies. That's pretty inhumane. I'm not really in a position to describe exactly what a better system might look like, but it would be a lot gentler on the mothers. (Doucet, et al., 2012, p. 243)

Partners felt dismissed by care providers, and that providers had predetermined treatment plan based solely on the diagnosis, rather than individual need of the mothers:

Health care providers are very hesitant to take those affected into account. They are more interested on where they peg you on the spectrum and what that diagnosis implies and that's how they treat you. (Doucet, et al., 2012, p. 243)

Finally, partners reported they found it difficult to seek help from family, friends, community, or professionals due to fear of stigma and pride. One father reported regret for this dynamic in this way:

I wish I was able to send an SOS out to bring us casseroles or to help around the house. I couldn't do that because I have difficulty asking for support. It's a guy thing. (Doucet, et al., 2012, p. 243)

Discussion

The loss and suffering for partners of mothers with PP could not be more poignant than the work of Aaron Polson, who lost his wife Aimee Zeigler to PP at age 40. His story of raising his sons following her death is brings this topic home, and I hope you all get to read it.

Creative Commons photo by anathea

This first study on the needs of mothers who experienced PP and their partners speaks to many areas of consideration for the childbirth professional. Here, we hear not only about the "symptoms" and "pathology", but perhaps more importantly, the voices of mothers and partners speaking to specific needs. The opportunity is presented to reflect and review how this information resonates with our own practice, perceptions, and potentials for growth. This conversation, I believe, is one of the keys to preventing perinatal psychiatric illness from the social stigma and silence that contribute to such suffering.

Doucet et al., (2012) concluded that their findings may serve as a guide for future research and interventions. Hopefully we, too, can begin a dialogue of how we might apply this information to our future. How do you see this informing your practice, your continuing educational needs, or support networks within your practice? I look forward to hearing your words of wisdom.

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About Walker Karraa

Regular contributor Walker Karraa is currently the President of PATTCh, an organization dedicated to the Prevention and Treatment of Traumatic Childbirth. Walker is a doctoral student at Institute of Transpersonal Psychology, a certified birth doula, freelance writer, and maternal mental health advocate. She holds an MA degree in Clinical Psychology from Antioch University Seattle, and a BA and MFA degree in dance from UCLA. Walker is a contributor to the Lamaze sites, www.givingbirthwithconfidence.org and www.scienceandsensibility.org. She lives in Sherman Oaks, California with her husband, and two children.

References

Doucet, S., Letourneau, N., & Blackmore, E. R. (2012). Support needs of mothers who experience postpartum psychosis and their partners. Journal of Obstetric, Gynecological & Neonatal Nursing,41(2), 236-245.

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