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Featured Leader Q&A: Astrid Tiefholz, National PIMH Connect and Care Navigator for ForWhen

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New parenthood is often framed as the perfect scenario, but the realities of it are rarely so. National PIMH Connect and Care Navigator (Tasmania) for ForWhen. Astrid Tiefholz, talks to the Healthcare Channel to clear up misconceptions surrounding new parenthood, and how to help. Read on for her insights.

HCC: There’s often the stigma that transitioning to parenthood comes naturally to people, when it really isn’t so. Why do you think that’s the general mindset of people regarding this transition? 

Astrid: As children, we are socialised to believe that parenthood is an easy process. Magazines and social media reinforce this with airbrushed pictures of beautiful, smiling celebrities holding their perfect babies, underscored by headlines that use words like bliss, joy, and miracle. 

In this idealised world, everyone is dressed in white, the furniture is white, and the laundry is folded in neat piles. There’s no vomit, no explosive nappies, no sore breasts, and no stitches. 

It’s no wonder that when the reality of pregnancy, birth, and new parenthood arrives that people can feel overwhelmed, even in the most optimal of circumstances – and circumstances are rarely optimal! So many people are living with the complex realities of financial stress, existing mental health issues, and relationship challenges, not to mention the social isolation caused by the pandemic over the last two years, it’s little wonder that modern Australian parents might be struggling. 

Astrid: For many families, pregnancy and birth can be fraught with unexpected complications, such as fertility issues, pregnancy loss, premature birth, traumatic birth events, injuries, haemorrhages, feeding challenges, babies with serious health conditions, and multiple births. The psychological effects of these events can be enormous and ongoing. As a midwife, I have so often heard women being told that “at least the baby is okay” after a deeply traumatic birth experience. These attitudes are absolutely invalidating to new mums who are trying to deal with their physical recovery as well as integrating their emotions while trying to care for a baby, and maybe older children, too. 

When teenagers are going through hormonal changes, rapid growth, and transitioning from childhood to adulthood, we expect them to have some bumps along the road. Sleep patterns become disrupted, and the difficulty of dealing with emotional fluctuations are considered to be a normal part of growth and change. New mums go through a lot of similar changes, known as matrescence. Pregnancy and birth is a time of profound physical, social, and emotional change. Women can feel like their bodies are out of their control, they are beset by hormonal changes, they are undergoing a role transition from being an individual or part of a couple, to being a mother and forging a family identity.

As for regular sleep – forget about it! We accept that adolescence will be challenging, but as a culture, we expect the opposite of women during matrescence – that they should take on these changes in a state of blissful serenity. Women often feel like they are failing, when actually they are doing amazing, loving work in exhausting circumstances.

HCC: The mental health struggles of new parents, especially the dads, are less talked about. Do new fathers go through the same struggles as the new mums? Or is it quite different? 

Astrid: Dads and non-birth parents experience perinatal anxiety and depression at the rate of about one in ten. Like birth mothers, other parents take on a new role as the family changes formation. There is emerging research on how fathers and non-birth parents also experience hormonal changes when a new baby arrives. Partners may feel overwhelmed by the responsibility of suddenly being the sole breadwinner, as well as functioning on reduced sleep. Most partners care deeply about supporting the birthing mother, but often have very little idea of how best to do that. The relationship can become a source of friction. This sense of helplessness can be stigmatising. Men are also less likely than women to seek help from friends, family, and professionals when experiencing mental health problems.

As clinicians, we have a long way to go to change how we approach the care of non-birth parents during pregnancy, birth, and the postnatal period. A generation ago, men weren’t even allowed into the birthing suite. While it is now expected that they will be there, little attention is paid to partners during antenatal care. They are invited to appointments and classes, but the manner of the midwife or obstetrician has a massive effect on how welcome they feel.

Astrid: Many partners feel like the focus is completely on the wellbeing of the mother and baby, and they are scarcely acknowledged. When partners feel included and embraced as part of the family unit, they are more likely to step up and make positive contributions to the emotional and practical wellbeing of the family. I believe it is crucial that midwives and obstetricians address partners by their name, ask how they are going – and listen to the answer!

We need to use inclusive, non-stigmatising language.

Astrid: We can normalise this with phrases such as “It’s really common at this time for dads/partners to feel anxious and overwhelmed. We are here to support you as a whole family. Do you have any concerns that you would like to discuss?” And we need to refer appropriately. As clinicians, we’ve made big strides in referring mothers for mental health support, but we have a long way to go with referring fathers and non-birth parents. Psychologists, counsellors, and supportive GPs can make a huge difference in the lives of dads, but it’s often midwives and child health nurses who are the first to recognise that those referrals need to happen. This is why we need to focus on the whole family, not just mum and bub.

HCC: ForWhen is a good initiative. What is its history, and why was it brought up in the first place? 

Astrid: ForWhen is a webchat and phone service for expectant and new parents, family members, and clinicians. It is a national project funded by the Commonwealth Government to connect families with the mental health services that they need, when they need them.  It is run by Karitane, a NSW-based child and family health program that has focussed on promoting resiliency and mental health in Australia for nearly a century. Karitane recognised that there were huge service gaps in different parts of Australia, so ForWhen was established with Clinical Care Navigators in every state and territory. State-based care allows families to connect with a Navigator who knows the local services and social contexts.

ForWhen aims to provide a no-wrong-door approach to accessing services.   ForWhen’s 1300 phone service directs callers to their local Navigator, who triages and assesses the level of care required, provide support, and coordinate service access. The program aims to reduce wait times and service duplication, and ensure that the care provided is appropriate to the level of need. The ForWhen Helpline is free of charge to clients and clinicians.

It’s a very exciting project, and we are proud to be connect families to private, public, NGO, and community services when they need it most. As well as providing local service guidance, we have partnerships with telepsychology providers in national networks, enabling women to access to bulkbilled services with short wait times. We are also able to provide clinicians with resources for their clients, as well as curated updates in professional development in perinatal and infant mental health.

HCC: For the people keen on supporting new parents, what signs of struggle do we look out for? How can we help ease them into the transition better?

Astrid: Mental health struggles can manifest in different ways. Mothers may experience anxiety, worry, or fear about the pregnancy, the baby, or their own wellbeing. They might worry that they are not coping, or enjoying pregnancy or the baby in the way they were expecting. There may be feelings of ambivalence or negativity towards the pregnancy or baby. Some parents may feel isolated or start withdrawing from friends, family, and community. They may be overwhelmed by the responsibility of parenting, and unable to cope with each day, even feeling hopeless about the future. Some parents may find it difficult to process their feelings after a difficult birth, experiencing trauma, flashbacks, ruminating thoughts, and disrupted sleep. Some parents may experience profound changes in their normal patterns of appetite and energy. Insomnia, beyond attending to the baby’s needs, may occur. Parents may become hypervigilant about the baby’s safety, or maintaining excessive standards of hygiene.

Seeking help is extremely important.

Partners, family, and friends can help in practical ways, like attending to domestic tasks, caring for other children in the family, and tending to the baby so mum can get some uninterrupted rest. If you have concerns that a new parent is struggling with mental health, approach the topic calmly, non-judgmentally, and compassionately. Acknowledge that parenting can be hard, and you are concerned that your loved one seems down or anxious. Reassure the family that you want them to feel safe and supported. Provide simple information about services such as ForWhen. Don’t overwhelm the parent with too many options.

ForWhen is staffed by health professionals who are able to provide real time support, assessment, and referral to culturally appropriate services for the family. This includes providing care pathways for dads and non-birth parents who are facing their own mental health challenges.

Note: Content has been edited for style and length.

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