Post-natal depression is on the rise and midwives are not trained enough to help detect it, according to a professional with 27 years experience in the field.
Mothers should be screened for the condition during midwives’ visits after birth, says Carmen Bugeja from the Malta Memorial District Nursing Association, which works in the community.
Her experience visiting about 11 mothers in their homes every day has made her realise the frequency of post-natal depression and she is calling for midwives to equip themselves to be able to pinpoint any problems earlier.
“Mothers do not realise it themselves, and if they do not open up their feelings, it could be detrimental to their health,” she said.
She pointed to a recent visit in which a woman, whom she had already taken care of in the past, told her she had been depressed after her first baby.
“I did not realise it, so something must be missing,” Ms Bugeja said, speaking in the wake of International Midwives’ Day last Saturday.
One tool not yet being used is a special questionnaire that would help midwives identify how mothers feel through their answers. If a problem is detected, it could be referred to the relevant channels.
The condition is probably becoming more common due to emerging social patterns, such as mothers not having enough support from extended family or the increasing number of single mothers, who would be more predisposed to the condition.
Working mothers are often tired during their pregnancy and could fall into a depression after birth, Ms Bugeja said.
The University’s midwifery course includes a unit on the subject, but in Ms Bugeja’s day it was not stressed on as much.
Arrangements between the University and MMDNA are in hand for this generation of midwives to undergo the specialisation unit, while the others could do with refreshing their skills.
The “upgrading” of midwives’ education is being recommended also to help them lobby to take midwifery back into the community, including ante-natal care and homebirths.
Today, the MMDNA midwives’ role has been “reduced” to post-natal visits only.
Upgrading education, professionalism and skills is one of the strategies of the MMDNA’s 10-year plan to gain more recognition and be able to fight for their cause: taking care of the whole pregnancy from conception to breast-feeding.
“We need to revolutionise the way the system works. In the old days, we used to handle the deliveries too, but care was then centralised to hospital… We want that to change,” she said, citing “professional issues” as the hindrance to their goal.
“We aspire to have birth centres and midwifery-led clinics, which could be located close to hospital, as is the case overseas.”
“In the old days, it is true the mortality rate in pregnancy was high and it dropped when it was centralised. But a trial of the previous system in the 1990s did well and resulted in high satisfaction levels,” Ms Bugeja said.
Moreover, midwives have now specialised and furthered their studies, she continued.
Despite almost three decades in the field, Ms Bugeja is back at school, doing a B.Sc in community nursing and midwifery in the hope of not remaining restrained to the post-pregnancy phase.
Making her case, she said midwives were generally closer to mothers than doctors.
The importance of primary health care should not be underestimated, she insisted, adding that when delivered properly, it should reduce hospital admissions.
“Going into the core of society, we can make a difference.”
The MMDNA also tries to send the same midwife on three visits over three weeks to new mothers, building more interpersonal relations.
Its resources are “quite stretched”, with seven midwives for all of Malta and Gozo, who carry out about 11 visits a day, Ms Bugeja said, before calling for more staff to be employed.
As things stand, the midwives are allocated 30 minutes to the first visit and 20 for the other two.
But first-time mothers can ask many questions and if they have breast-feeding problems, they could easily spend an hour, ending up working longer, despite driving like “Speedy Gonzales” around the island.