Michelle Lensink

Social Development Committee: Postnatal Depression

This speech indicates support for the Social Development Committee: Postnatal Depression motion.

The Hon. J.M.A. LENSINK: I speak in favour of this motion of the Social Development Committee Inquiry into Postnatal Depression. Postnatal depression has been described as a description rather than a diagnosis, and it is a description of a variety of diagnoses. It is not to be confused with what is commonly called the `baby blues', which can last some 24 to 36 hours post-partum or up to three to four days after birth and which is related to a fairly straightforward drop in hormones. Postnatal depression affects about one in seven women in the postnatal period (some 15 per cent). It is characterised by mood changes, which might include tearfulness, crying and depression. One of the major problems is the irritability, which is the destructive compo¬nent and which can affect inter-family relationships.

There are also some biological features such as sleep disturbance. Women can wake up for no reason at three or four in the morning and cannot get back to sleep. They either lose their appetite and lose weight or suffer from compensatory binge eating, put on weight and become further depressed. Postnatal depression commonly comes on between two and eight weeks following the birth of the baby but can be up to and within the period of 12 months. There are no environmental factors which seem to be necessarily the main contributors, but there is some evidence that women who have more difficult babies are more likely to get depressed. Women who get depressed find it quite difficult to bond with their baby and find it difficult to be responsive to their child's needs, which causes some complications for the baby as it grows up.

The condition becomes postnatal depression when the negative mood becomes overwhelming, and the woman feels so overwhelmed by her feelings day after day, without having any good days and without experiencing pleasure from activities which would normally provide pleasure. Such mothers often lack in energy, which is a problem because, obviously without energy, they cannot provide the care that the baby needs. Some women cannot even get out of bed or concentrate to feed their child. The stigma associated with postnatal depression is much less than it was 10 years ago, but we still have a long way to go in terms of raising awareness of the issue.

There are significant long-term costs to South Australia. They have not been quantified in financial terms, but clearly there is a high emotional cost to the individuals and, in the most tragic cases, it can result in suicide. There are also effects on the family and the community, and, as I mentioned, there is also an effect on the partner and the infant. In these times when the federal Treasurer is urging us all to have more kids, women who have postnatal depression are less likely to have subsequent children because they find the experience so difficult.

 The factors impacting on postnatal depression but which cannot necessarily be called `causes' because the factors are not that clear are as follows. Some 30 to 50 per cent of women who develop postnatal depression have symptoms during pregnancy. In the instances of people who develop postnatal depression, the support of the nuclear family may have been withdrawn. More families have grandparents interstate and there is a greater number of single mothers who have fewer supports around them. Support services provided by families for women are more limited. Rural women are more at risk of complications. They do not receive as much support, and depression is more likely to go untreated for a long time and impact on their families. I note that very little research has been done on rural mental health.

Clearly, over time, we have experienced changes to the way in which our society is structured, which has resulted in a lot less support from the extended family. The effect on infants is quite marked. In relation to children whose mothers suffered from postnatal depression, when followed up at the ages of five and 13 such children were found to be cognitively disadvantaged. Postnatal depression can have very significant impacts on infants in terms of their social, emotional and cognitive development. Children of mothers with postnatal depression are more likely to have difficulty interacting with peers and have aggressive behaviours. If a mother is depressed about how she feels, she is less likely to connect to her baby. I note that boys are affected differently from girls; and, by the time boys go to school, they are more likely to have behavioural problems and learning difficulties which can even contribute to criminal activity later in life.

However, girls are more likely to internalise their feelings and lack of bonding, but it comes out later in their teenage years in ways such as anorexia, overdoses and even depression. As a community, we are losing the community-based skills and expertise in parenting because of our highly technical and industrial way of life, with people having fewer children and less contact with extended families; and the parenting practices which traditionally have been passed down from mother to daughter and from father to son are less prevalent today.

Some evidence which I found particularly interesting was from Pam Linke from Child and Youth Health. Child and Youth Health has a particular focus on the child. She referred to the universal home visiting program, which I think, in time, will prove its own value in saving dollars in the long run in keeping children out of gaol, reducing delinquency and keeping kids in the education system and out of the mental health system. Pam Linke referred to the concept of attachment, which is not so much bonding but a feeling of safety and security which a baby develops as a result of connecting with their parent. She said that children need to develop attachment to develop their template of the world properly and to relate to others. Attachment is very badly affected in children whose mothers have post natal depression because they do not get the same cues which we are all programmed to pick up from our mothers.

There is a strong association between post natal depression and poor child outcomes, especially in boys, as I mentioned. Babies are highly attuned to their mother's mood and behaviour and can detect depression in their mother at the age of three months. Post natal depression will reduce the emotional, physiological and biochemical development of children and leads to, in less than technical terms, poor wiring of the brain, leading to poor cognitive development which reduces IQ and problem solving. Alternative attachments can be formed—for instance, with the father or grand¬parents—and mothers can also be trained to mimic the behaviour of a so-called `normal' mother, and the child is able to develop in a normal way. As I mentioned, awareness is very important, particularly for early intervention, and, as with all of these things, the earlier we get involved and try to do things about it, the less the consequences will be in the long term.

In terms of treatment, there are obviously anti-depressants and also counselling services which are all quite effective in treating the condition once it has been detected. There are a number of services operating in South Australia that I think deserve to be recognised for assisting mothers and babies in this state. I believe that they operate on their own initiative, and do so because they have a very professional attitude towards caring for people in this state. They include: the Northern Women's Community Midwifery Program; the Midwifery Group Practice of the Women's and Children's Hospital (who I think have been caring for the wife and newborn of the Hon. Angus Redford); Antenatal Shared Care; Helen Mayo House; the Lyell McEwin Health Service; and Child and Youth Health.

 I encourage all members to look at this report, particularly if they have an interest in health and early childhood develop¬ment. I think it contains a number of important points to make about services, in that we need to ensure that women who are having babies have a cohesive service which is not hit-and-miss in terms of whether or not they happen to get a good service. If you go to the Women's and Children's Hospital, clearly, you are getting a very good service but, in some other places where the staff are run off their feet or are not able to follow up parents following birth, you are not so lucky as to get a good service.

I also commend our temporary research officer, Miss Sue Markotic, who put a great deal of effort into this report, and I think it reads exceptionally well. I also commend the other members of the committee. With those comments, I support this motion.

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