Dissertations / Theses on the topic 'Postnatal depression; Antenatal; Motherhood'

Magister Public Health - MPH
Common perinatal mental disorders (CPMDs) are increasingly being recognised as an important public health issue including depression and anxiety. In low and middle income countries such as Rwanda, CPMDs are prevalent among women in perinatal period. In Africa, the estimated prevalence rates of depression are 11.3% and 18.3% during ante-postnatal respectively, while ante-postnatal anxiety rates are 14.8% and 14% respectively. However, in Rwanda there is limited literature on CPMDs. This study was aimed at determining the occurrence of CPMDs in a selected district hospital of the Eastern Province in Rwanda as well as the factors associated with CPMDs in the selected study area. A descriptive quantitative cross-sectional survey was conducted with a sample of one hundred and sixty five mothers in perinatal period, who were selected systematically. Demographic data and factors associated with CPMDs were determined using structured questionnaire and combined screening tools such as Zungu Self-rating anxiety scale (SAS) and Edinburgh Postnatal Depression Scale (EPDS). The Cronbach alpha values were 0.87 and 0.89 for SAS and EPDS respectively. SPSS Version 21 was utilized to analyse data. Univariate, bivariate correlational and multivariate analyses were performed. Most of the respondents (38.2%) were aged 25-29 years; Protestants (77.6%); married (44.8%); unemployed (77%) and had a primary school level of education (60.6%). With respect to participants in antenatal period (51.5%); 14.5% had a clinical level of anxiety and 19.4% had depression. In terms of participants in postnatal period (46.7%); 22.5% had a clinical level of anxiety and 29.7% had depression. However, participants in both periods (1.8%) all had a normal level of anxiety and 1.2% had depression.

The aim of this thesis was to investigate engagement in the antenatal psychosocial intervention 'Preparing for Parenthood' designed to reduce postnatal depression, run within the current maternity system, to identify factors predictive of engagement. The quantitative study investigated three components of health-promotion behaviour: health locus of control, social support and negative life events within an ongoing randomised controlled trial (RCT). Women were identified as at risk of postnatal depression by a screening questionnaire, 'Pregnancy and You', at 15-20 weeks gestation (n=400). A baseline assessment was completed 4 weeks later (n=292). Women who wished to have the opportunity to attend the intervention were randomised to an intervention (n=103) or control condition (n=106). The intervention consisted of six, 2-hour sessions held every week preceded by an initial introductory meeting and followed by a postnatal reunion session at the Leicester General hospital, run by two female course leaders whose backgrounds were in mental health. An outcome assessment of measures of engagement was completed at 3 months postnatally with all willing participants. In a qualitative study (n=82), the procedures used followed that of the quantitative study where appropriate. The same psychosocial intervention (n=15) was implemented. The outcome interview was completed between two and three months postnatally and consisted of 9 questions (n=12). Analysis using the grounded theory technique identified two main categories of themes, clustering at either the screening stage or at the intervention stage itself. Seven themes were identified as influential in initiating engagement with the intervention; and eight themes were identified as being influential in maintaining engagement with the intervention. It was concluded that actual health-promotion behaviour was not predictable using the three hypothesised measures of prediction, in this population, and for this intervention. The findings of the qualitative study enabled potential improvements to the intervention to be identified as possible ways of gaining and maintaining participant interest, and therefore engagement.

Whilst previous research has explored women's experiences of disclosing symptoms of postnatal depression (PND) to health professionals, very little qualitative research exists on women's experiences of disclosing to people in their personal support networks. Research has shown that some mothers with PND find it difficult to disclose to professionals and prefer to seek support from partners, family and friends. Aim: The current study aimed to explore the overall process mothers go through to disclose PND - to people with whom they have personal relationships, as well as health professionals. Method: Five women who experienced and disclosed PND participated in semi-structured interviews. Verbatim transcripts were analysed using Interpretative Phenomenological Analysis. Results: The analysis produced four super-ordinate themes: 'Trying to cope whilst making sense of experiences', 'Deciding whether to disclose: Facilitative and inhibiting factors', 'The two-way interpersonal nature of disclosure', 'Disclosure as part of a transformative process'. Conclusions: This study highlighted the influence of internalised expectations of motherhood and stigma surrounding PND on how mothers try to cope with their initial symptoms and on their decisions about whether or not to disclose. The participants described a cautious approach to disclosure in which they had to deal with setbacks. Consequences of disclosing were considered alongside how the disclosure process was influenced by recovery from PND.

The purpose of the research project was to examine the effects of exercise and social support for postnatal women who reported experiencing Postnatal Depression (PND). PND is a serious condition that affects up to 10%-15% of women (O'Hara & Swain, 1996). Many previous studies have reported an improvement of depressive symptomatology following a pram walking intervention. However, no published research exists which assesses postnatal women who report experiencing PND. A randomised controlled trial was used, where pre-test data were compared to post-test effects. Two studies were conducted. In study 1 (n= 20) a multi-intervention group (exercise and social support) was compared to a control group who received no intervention. Study 2 (n= 19) was conducted 20 months later on a different group of women and involved a pram walking intervention group and a comparison social support group. Structured questionnaires assessing depressive symptomatology, general health and levels of social support were administered at pre-test phase, week 6 and 12. A sub-maximal fitness test was conducted the week before the program started and at week 12. The chief investigator was present at all sessions to guide the participants. Study 1 (S1): The multi-intervention group attended 3 pram walking sessions per week. After the exercise session the group met for refreshments in a local hall. The control group was only required to perform the fitness tests and answer the questionnaires. A 6-week alternative program of exercise and social support was offered to all the women at the completion of the intervention period. Study 2 (S2): The pram walking group met for 2 exercise sessions and were required to make up the third session independently. The comparison social support group met once per week for morning tea with the children. The samples for both studies were drawn from the Gold Coast region in Australia. Women of childbearing age who were experiencing depressive symptoms were recruited. For S1 their child had to be less than or equal to 12 months and for S2 the age cut off was increased to less than or equal to 18 months. The participants were screened to ensure that they did not have a medical condition that would prevent regular aerobic exercise and they were also excluded if they had a previous history of mental illness or could not speak English. Demographic data were obtained from each participant and details such as height, weight and age were collected for use in analysing fitness levels. The data for each study were collected across three time points (pre, week 6 and week 12) using widely tested instruments. Some additional questions relating to the participants experiences were collected at the completion of the study from the women allocated to the intervention groups. Data were also collected on fitness levels (pre and week 12) and the instrument was tested for its reliability. Both pram walking intervention groups were required to complete a weekly exercise diary. For each study, to test for the effect of the intervention over time, a two-way analysis of variance was conducted on the major outcome variables. Group (intervention versus control) was the between subject factor and time (pre-test, week 6, week 12) was the within subject factor or repeated measures factor. Due to the small sample size, further tests were conducted to check the assumptions of the statistical test to be used. The results showed that using Mauchly's Test, the Sphericity assumptions of repeated measures for ANOVA were met. Further, tests of homogeneity of variance assumptions also confirmed that this assumption was met. Data analysis was conducted using the software package SPSS for Windows Release 10.0. (Norusis, 2000). Overall, the findings from both S1 and S2 showed that the groups who received the pram walking intervention improved their depressive symptomatology and fitness levels when compared to those of the control (S1) and social support group (S2). Social support levels did not alter for either group from both studies. These results are encouraging and suggest that a pram walking program is an effective form of intervention for postnatal women experiencing depressive symptomatology.

The aim of the study was to explore expectant Asian mothers' constructions of pregnancy and motherhood, including their perceptions of postnatal depression, and views on help-seeking for the postpartum. Relatively few studies have examined these areas previously, and there was a need for a thorough and rigorous investigation of these issues from the perspective of the individual.;Data was collected from seven first-time pregnant mothers of South Asian origin, from a variety of backgrounds using semi-structured interviews. The chosen methodology was a social constructionist revision of grounded theory. Through the use of systematic procedures, this approach enabled the diversity of individual accounts to be addressed and the influence of the researcher's perspective to be considered.;The results identified a number of related themes, suggesting that women positioned themselves in relation to two competing versions of pregnancy and motherhood, described as naturalised and problematic. In addition, the findings indicated that participants used a psychosocial framework for understanding maternal distress. The usefulness and relevance of the label 'postnatal depression' to define the experiences of women during this period, was therefore discussed. It was demonstrated that there were several interacting factors involved in the process of deciding whether, and how to access help for postnatal difficulties.;Shaping women's perceptions and expectations was a number of cultural and social factors. The analysis indicated that women interpreted their ideas in terms of their relationship to two competing stories around womanhood, identified as traditional and non-traditional. This had particular implications for the probability of engaging in help-seeking for emotional distress.;The results are discussed in relation to the existing literature. Recommendations for professionals and services working with Asian mothers, as well as suggestions for future research are presented.

This thesis frames the transition into motherhood as a rite of passage; proposes a new model for the rite of passage into motherhood based on the four seasons; and highlights the importance of contextual and specific ritual actions or sequences to navigate the transition. Qualitative data from semi-structured interviews with ten western women, from a middle class, Christian background, who had all become mothers through childbirth, are examined under three main headings. Firstly, the women’s experiences of their transition are explored using rites of passage theory as a lens. Although significant differences emerge, particularly from a gender perspective, important themes within the women’s experiences are highlighted, including the nature of relationships; the importance of support; journaling; and the telling of birthing stories. The influences of contemporary cultural aspects such as the medicalization of childbirth and myths about motherhood are also taken into account. Secondly, the field of ritual studies is explored in order to provide a framework in which to situate the women’s ritualizing. Existing rituals associated with motherhood are analysed and gaps are identified in existing Christian liturgical resources for this area, specifically for ritual actions or sequences marking motherhood as a rite of passage, and for the expression of birthing stories. A working definition of ritualizing is also established and the research findings are divided according to time frame, exploring the women’s ritualizing before birth, around birth and after birth. Thirdly, spirituality in relation to childbirth and the transition into motherhood is explored and its place within healthcare and theological literature examined. Nicola Slee’s theory on women’s faith development is used to draw out some of the patterns that emerge from the interviewees’ experiences, and the sacramental nature of birthing is considered. The thesis concludes with a critique of implications and associated suggestions for those within a church or healthcare context with responsibility for the pastoral and spiritual care of women during their transition into motherhood.

Thesis (MA)--University of Stellenbosch, 2002
ENGLISH ABSTRACT: This review examines the medical model's conceptualisation of postnatal depression (pND) from a feminist perspective. The arguments are fourfold: Firstly, it argues that the fundamental problem underlying the concept of PND is its conception as existing on a continuum with psychosis at the most severe end and maternity blues at the least severe end. The link with psychosis implies that it is potentially pathological requiring medical and psychiatric intervention. On the other hand its link with maternity blues gives scientific credence to continued research on emotional sequelae of reproduction that are below the psychiatric threshold of urgency. Secondly, the medical model's construction of PND implies that women are predisposed to mental illness because of their ability to bear children and thus pathologises normal experiences of childbirth. Thirdly, the medical model's preoccupation with classification and categorisation has become little more than an exercise in labeling that has removed women from their own experiences. Focusing on birth as an activity that is separate from the rest of pregnancy objectify women and ignores the socio-political context within which they give birth and care for their infants. Fourthly, it is argued that a different way of researching postpartum mood disorders is necessary to overcome a reductionistic and pathological model of childbirth. This is important if healthcare delivery hopes to provide adequate treatment for all women in the postnatal period. Especially in South Africa, where the dominant culture has for many years defined the experiences of the 'other', it is important to generate research that should include the 'voices' of the 'other' to prevent hegemonic practice from assuming an expert understanding of PND. This review does not deny the contributions from the medical establishment, but argues that a critique of its underlying assumptions is important to prevent women from being further marginalised by ignoring the socio-political context in which their lives are embedded. The implications for research within South Africa are also addressed.
AFRIKAANSE OPSOMMING: Hierdie oorsig ondersoek die mediese model se konseptualisering van postnatale depressie vanuit 'n feministiese perspektief. Die argument is vierledig: Eerstens blyk die konseptualisering van postnatale depressie, naamlik dat dit op 'n kontinuum bestaan, met psigose aan die mees disfunksionele kant en 'maternity blues' aan die minder ernstige kant, 'n fundamentele, onderliggende probleem te wees. Die verband met psigose impliseer dat postnatale depressie potensieel patologies is en mediese en psigiatriese insette benodig. Die verband met 'maternity blues' aan die ander kant, bied wetenskaplike begronding vir volgehoue navorsing op die gebied van emosionele aspekte van kindergeboorte wat nie van psigiatriese belang is nie. Tweedens impliseer die mediese model se konstruksie van postnatale depressie dat vroue 'n predisposisie tot geestessiektes het bloot deur die feit dat hulle die vermoë het om kinders voort te bring. Sodoende word patologiese kenmerke gekoppel aan normale ervarings van kindergeboorte. Derdens het die mediese model se beheptheid met klassifikasie en kategorisering verval in etikettering wat vroue van hul eie ervarings vervreem. Deur te fokus op geboorte as 'n aktiwiteit wat verwyder is van die res van swangerskap maak van vroue objekte wat verwyderd is van die sosio-politieke konteks waarbinne hulle geboorte skenk en sorg vir hul babas. Vierdens word dit beredeneer dat 'n nuwe benadering tot navorsing oor postpartum gemoedsteurings daar gestel behoort te word om 'n reduksionistiese en patologiese model van kindergeboorte te voorkom. Dit is belangrik as gesondheidsorgdienste hoop om toereikende behandeling te bied vir alle vroue in die postnatale periode. Veral in Suid-Afrika, waar 'n dominante kultuurgroep vir so lank die ervarings van ander omskryf het, is dit belangrik om navorsing voort te bring wat die 'stemme' van die 'ander' insluit om sodoende te verhoed dat die heersende praktykvoeringe van die dag 'n eensydige deskundige-verstaan van postnatale depressie voorveronderstel. Hierdie oorsig ontken nie die bydraes van die mediese model nie, maar beredeneer die feit dat 'n kritiese beskouing van die onderliggende aannames belangrik is om sodoende te verhoed dat vroue verder gemarginaliseer word deurdat die sosio-politieke konteks waarin hul lewens gegrond is, buite rekening gelaat word. Die implikasies vir navorsing binne 'n Suid-Afrikaanse konteks word dus ook ondersoek.

Background: Antenatal Psychosocial Assessment (APA) has recently been introduced into routine antenatal care, but the ways in which maternity service providers assess and respond to maternal stress are subject of debate. There is a lack of consensus on the instrument(s) of choice and lack of evidence regarding appropriate interventions. Further, national guidelines have not kept apace with the conceptual shift from ‘postnatal depression’ to ‘perinatal anxiety and depression’. Adopting the Medical Research Council Complex Interventions Framework, the ARMS research aimed to inform the development of interventions that support women who are experiencing, or at risk of, mild-moderate mental health disorder in pregnancy. Methods: A mixed methods approach was adopted. In the quantitative element (Study Part 1) participants (n=191) completed a questionnaire when attending for their first formal antenatal appointment, using a procedure and materials that had been previously tested in a pilot study. Details including mental health assessment and referrals were obtained from their health records, following delivery. In the qualitative element (Study Part 2) a sub-sample of women (n=22) experiencing high levels of maternal stress took part in up to three serial in-depth interviews during pregnancy and the early postnatal period.Findings: Maternal stress was found to be common. Using the Edinburgh Postnatal Depression Scale (EPDS) threshold of ≥10, approximately 1 in 4 women were classed as high depression (halving to 1 in 8 at the more conservative threshold of ≥13). Almost 1 in 3 women were classed as high anxiety, using the state scale of the State-Trait Anxiety Inventory (STAI-S, threshold ≥41), compared with 1 in 5 using the two-item GAD (threshold ≥3). Fewer than half of the women identified as high anxiety were identified by both measures. Factor analyses of the symptom measures were consistent with wider literature suggesting a three-item anxiety component of the EPDS; however, concurrent validation using regression analyses did not indicate that the EPDS could be used as an anxiety case finding instrument. Women reported that maternal stress had significant impact on their lives that may not be captured with existing clinical approaches. Women commonly found it difficult to self-assess severity of maternal stress and the assessment process could itself act as an intervention. The research provided the first validation of the depression case finding questions in UK clinical practice. The Whooley items completed in clinical practice identified only half of the possible cases identified by the EPDS, at both commonly adopted EPDS thresholds. Inclusion of the Arroll 'help' question as a criterion improved specificity of the assessment completed in clinical practice but substantially compromised sensitivity, missing 9 in 10 possible cases. Women’s mental health history and treatment history were similarly under-reported, particularly concerning anxiety. APA was introduced into routine clinical practice without attention to topics of relevance to women, context of disclosure or to provision of adequate resources for consistently responding to identified need. Women experiencing, or at risk of, mild-moderate disorder were thus usually ineligible for further support. Implications: Care pathways are needed that encompass both assessing and responding to maternal stress, where communication with health professionals, subsequent referral and management are addressed. The development, implementation and evaluation of low-cost resources embedded in such pathways are a priority and the research presented in the thesis offers a foundation on which to build.

The aim of this study was to examine how expectations may affect a new mother during postnatal depression, both her own expectations and he expectations she feels from her surroundings. The result is based on seven interviews with mothers who have had postnatal depression. It is not uncommon for women to suffer from postpartum depression after childbirth, studies show that approximately ten percent of all new mothers are affected. Symptoms of postpartum depression are, besides the symptoms for regular depression also feelings of worthlessness and hopelessness or she might difficulties feeling happy about the situation and the baby. Qualitative content analysis was used to analyse the material. The study shows that those feelings does not go well together with the so called mother myth, that the new mother is supposed to feel instant love towards the baby and be the more responsible parent. This leads to the mother feeling guilty and ashamed. Because of this, several mothers feel reluctant to seek help. This is due to emotions of guilt and shame. The study also showed that the women felt a lack of professional care and the need for development in the professional field. Three important factors in the care were presented: Information, knowledge and understanding.

Introduction : La dépression périnatale est un sujet majeur de santé publique. Les effets néfastes qui en découlent pour la grossesse, le développement pré- et postnatal de l’enfant et le lien mère-enfant sont largement documentés. Les études montrent que les femmes avec des troubles anxio-dépressifs et bipolaires sont plus à risque d’en développer une en période périnatale.Ces dernières années, différentes interventions non-médicamenteuses ont été mises en place. En France, l’Accompagnement Personnalisé en Réseau Coordonné (APRC) en est un exemple. Si depuis 40 ans il apparaît comme un nouveau paradigme de soins périnataux pour les futurs parents vulnérables, son efficacité au plan scientifique reste à démontrer.Objectif principal : évaluer si l’APRC permet de limiter les effets néfastes des troubles anxio-dépressifs et bipolaires pour la mère et le bébé lors du postpartum.Objectifs secondaires : évaluer a) les effets de l’APRC, b) leur stabilité à 3, 6 et 9 mois du postpartum, c) leur lien avec les différents facteurs de risque et de protection intra- (antécédents psychologiques et obstétricaux, ressources personnelles) et interpersonnels (étayages).Méthodologie : Il s’agit d’une étude comparative, longitudinale et prospective en deux temps avec une approche mixte :1) Comparaison des dyades ayant bénéficié de l’APRC (groupe clinique, n = 40) avec des dyades ayant eu un accompagnement classique (groupe contrôle, n = 30) à 3 mois du postpartum. Pour l’évaluation quantitative, nous avons évalué la dépression (EPDS, PDSS, HADS) et l’anxiété postnatales (STAI-Y), la santé mentale générale (GHQ), le vécu de l’accouchement (LAS), le stress post-traumatique du postpartum (PPQ), le développement psychomoteur du bébé (BLR) et la présence de retrait relationnel chez le bébé (ADBB). Nous avons aussi exploré les ressources personnelles (PBI), le soutien social (SSQ), ainsi que les relations dyadiques, parentales et familiales (DAS, PAI, QSC, FRI) et l’efficacité parentale (PEPP). Pour l’évaluation qualitative, nous avons effectué des entretiens semi-directifs et des observations cliniques.2) Évaluation de l’évolution des dyades du groupe clinique à 3, 6 et 9 mois du postpartum, avec les outils et l’approche mixte précédemment décrits.Résultats : 1) Lors de la comparaison inter-groupes, les dyades du groupe clinique montrent significativement de meilleurs résultats pour la plupart des mesures. Au T1, 40% des femmes du groupe clinique dépassent le seuil à l’EPDS, contre 73,3% du groupe contrôle. Seulement, 22,5% des femmes déprimées en anténatal du groupe clinique développent une dépression postnatale (DPN), contre 40 % du groupe contrôle. Selon l’analyse de régression, l’état de stress post-traumatique et la dépression anténatale sont plus prédictifs de la DPN chez le groupe contrôle, tandis que les antécédents dépressifs ne le sont que pour ce dernier. Globalement, les bébés du groupe clinique présentent des scores significativement supérieurs au BLR et inférieurs à l’ADBB par rapport au groupe contrôle, moins de retard psychomoteur (10% versus 40%) et de retrait relationnel (17,5% versus 40%). Nous n’avons pas trouvé de corrélation entre la DPN et les troubles chez l'enfant pour le groupe clinique contrairement au groupe contrôle.2) Lors de l’étude longitudinale du groupe clinique, nous avons noté une amélioration de la symptomatologie maternelle pour toutes les mesures de dépression et d’anxiété état. L’évolution maternelle positive se reflète aussi sur l’état des bébés : leurs scores à l’ADBB diminuent tandis que les scores au BLR augmentent de manière significative
Introduction: Maternal depression is a major public mental health issue. Its impact on pregnancy, the pre- and postnatal development of the infant and the mother-infant relationships are well established. Besides, studies show that women with anxio-depressive and bipolar troubles are at high risk of developing perinatal depression.The last decades, several non-pharmaceutic interventions have been created. In France, the Personalized Interdisciplinary Network Care (PINC) is an example. Even if it is considered as the paradigm of perinatal care for vulnerable parents for more than 40 years, its efficacy has yet to be assessed with a quantitative and qualitative method.Primary objective: to assess the PINC efficacy in limiting adverse maternal and infant outcomes for women with anxio-depressive and bipolar disorders and their babies.Secondary objectives: to assess a) the PINC effects, b) their sustainability at 3, 6 and 9 months postpartum, c) their link to the different intra- (psychopathology, obstetric antecedents, personal resources) and interpersonal (supports) risk and protection factors.Methods: A comparative, longitudinal and prospective study with a mixed protocol in two timepoints:1) Comparison of two groups of women and their infants who received either PINC (clinical group, N=40) or classic obstetric/midwife care (control group, N=30) at 3 months postpartum. For the quantitative part, we measured postpartum depression (EPDS, PDSS, HADS) and anxiety (STAI-Y), general mental health (GHQ) and postpartum post-traumatic stress (PPQ), the infants’ psychomotor development (BLR) and sustained relational withdrawal (ADBB). In addition, we investigated the personal resources (PBI), the social support (SSQ), the dyadic, parental and family relationships (DAS, PAI, QSC, PES, FRI) and the parental efficiency. For the qualitative part, we utilized semi-structured clinical interviews and observations.2) Evaluation of the mother-infant evolution for the clinical group at 3,6 and 9 months postpartum with the same tools and mixed approach as described above.Results: 1) Intergroup comparative analysis: Women and infants whose mothers received PINC showed significantly better outcomes at most measures. At 3 months postpartum, 40% of the PINC mothers developed a postpartum depression (PPD), compared to 73.3% of the controls. Only 22.5% antenatally depressed women of the clinical group developed a PPD, compared to 40% of the controls. Regression analysis showed that the postpartum post-traumatic stress disorder and the antenatal depression were more predictive of PPD for the controls than for the clinical group, while prior history of depression was predictive only for the former. Overall, the babies of the clinical group presented higher scores for the BLR and lower for the ADBB compared to the controls, less psychomotor delay (10% vs 40%) and relational withdrawal (17.5% vs 40%). No correlation was found between the maternal depression and disturbances in the infant’s development for the clinical group.2) Longitudinal follow-up of the clinical group: The maternal symptomatology was improved at all the depression and anxiety-state measures. The positive maternal evolution was reflected on their babies, too (their scores were significantly reduced at the ADBB and increased at the BLR)

The aim of this study is to give an in-depth understanding of the representations of a depressed woman who killed her baby. The representations under study is based on “The motherhood constellation” by Stern (1995) and focus on the woman’s representation of her mother as mother-of-herself-as-child, herself-as-mother and her representations of her children. Pregnancy is an important phase in a woman’s life. Parent-infant psychotherapies are a rapidly growing field of infant mental health as many psychological problems have their roots in infancy. Neglect, trauma and abuse and prolonged maternal depression can cause a child to develop a range of problems. The work of Winnicott (1965a) and Bion (1988) put the mother’s fantasy life about her infant as one of the major building blocks of the infant’s construction of a sense of identity (Stern, 1995). Fraiberg (Fraiberg, Adelson&Shapiro, 1980) with her “ghosts in the nursery” revolutionised this perception by placing the maternal representation at the core of the parent-infant clinical situation (Stern, 1995). The way the research developed and the nature of the research problem necessitated a pure qualitative mode of enquiry. A single case study was done about the representations (of self-as-mother, mother-as –mother–of–self-as-child- and of the children) in an extreme case where the mother’s depression led to her murdering her baby. Data collection was done through semi-structured interviews and documents from the psychiatric hospitals she attended. Data was also obtained from field notes, before and after the interviews and also while transcribing the audio-taped interviews. Data analysis was done by the procedures of data reduction and organising it into categories on the basis of themes as described by Neuman (2000). Coding and analytic memo writing were done. The relationships between concepts were examined and linked to each other and interweaved into theoretical statements. The researcher argues that not enough is done to enhance the relationship between a mother and her foetus, and later her baby. The concept of maternal representations is the only approach that opens the possibility to start working at the earliest point of prevention, because intervention can start during pregnancy. Intervention during pregnancy is ideal because defence mechanisms are less rigid during pregnancy and women are more in touch with their entire life cycle and the whole system is more open for change. The ghosts can be chased out of the nursery by helping the mother to see the repetition of the past in the present. The affective link, recognising and remembering the feelings help a parent not to repeat the past in the present - “…it is the parent who cannot remember his childhood feelings of pain and anxiety who will need to inflict his pain upon his child” (Fraiberg, Adelson&Shapiro, 1980, p. 182).
Thesis (PhD (Psychotherapy))--University of Pretoria, 2006.
Psychology
unrestricted

The aim of this research was to support new mothers in groups, so that they can function optimally as educators. During the research mothers with babies up to three months of age were used by means of a support group. This research project was done after it became evident from a literature study that new mothers suffered with unique problems during this adaption phase. In the empirical survey the researcher gave attention to the new mothers' specific needs and problems during this trimester. The researcher aimed to explore the experiences of the new mother as educator through weekly group sessions. From the results it was clear that there was a need of support from other mothers that is going through the same experiences. In this way new mothers could receive emotional support and obtain knowledge regarding relevant issues experienced during this unique life phase.
Educational Studies
M. Ed. (Guidance and Counselling)