Analyzing Information on the Web: The Best Postnatal Mental Health Websites

Later this month, Science & Sensibility contributors will share their hopes for the year 2012: what we would like to see accomplished in the ensuing months on behalf of mothers, babies and families, and the maternity care industry as a whole.  One of my hopes for the coming year(s) is that childbirth education organizations like Lamaze will increase their attention to issues revolving around maternal mental health; training birth professionals to screen, recognize, support and appropriately refer women with whom they work who may be suffering from one of the myriad perinatal mood disorders (PMDs)we now understand exists.

To that end, I’d like to share with you a study that recently crossed my desk (thank you, Walker Karraa) which assessed online resources pertaining to PMDs.  Donna Moore and Susan Ayers published their findings from A Review of Postnatal Mental Health Websites: Help for Healthcare Professionals and Patients in the Archives of Women’s Mental Health in November of last year.  The aim of the study was to conduct a systematic review on any and all current websites that maintain a primary purpose of discussing postnatal health with particular interest in the depth, breadth, quality and technological excellence of sites that specifically discuss postnatal mental health. 

Studies show that 10–15% of new mothers are diagnosed with postnatal mental illnesses, and potentially one in four women may have significant distress without meeting criteria for a disorder.” (Baker et al. 2009a, b;Czarnoka and Slade 2000)… However, there is now increasing evidence that anxiety disorders are also prevalent in between 3% and 43% of women in the postpartum period (Glasheen et al. 2009).”

The four major search engines were employed (Google, Bing, Ask Jeeves and Yahoo) and the top 25 results for each key word entered were then analyzed.

Disappointingly, the publication of results does not list all sites scrutinized (I would like to see what their search results generated) but the authors did list the top five websites, according to their criteria for excellence which included accuracy of information, available resources for mothers, and website (technical) quality:

Table 1

table 1 PMD websites

*Table 1 re-purposed directly from publication

The websites were examined for their quality of information and navigability based on the basic criteria list above, as well as by the following sub-categories:

  1. Accuracy of Information
    a. symptoms (of postnatal mood disorders…not only PPD but anxiety, psychosis and PTSD
    b. risk factors (psychosocial, medical history and additional factors)
    c. impact (of postnatal mood disorders upon the mother, infant and her partner/family)
  2. Available Resources
    a. self-help
    b. tools for mothers
    c.  support for mothers
    d.  additional resources.
  3. Website Quality
    a. authority
    b. contact ability
    c. up-to-date
    d. navigation
    e. presentation
    f. advertisements (appropriateness or lack there-of, distracting, misleading…)
    g. accessibility

As concluded by the authors:

Information was often incomplete and tended to be about symptoms, predominantly depressive symptoms, such as tearfulness. Coverage of other symptoms of anxiety, puerperal psychosis or PTSD was minimal. This could reinforce the misconception that postnatal mental illness is solely depression or simply an extension of the ‘baby blues’.”

What type of information, as certifying organizations, are we providing our educators?  What kind of information are we, as childbirth educators, providing our clients?  Are we providing information that is accessible (understandable), readily available (are we not shying away from difficult-to-discuss topics) and high quality (evidence-based)?  Are we acknowledging that somewhere between ten and forty-three percent of the women we teach will end up suffering a postnatal mood disorder?  Are we discussing risk factors and approaches to late pregnancy and birth that might help them avoid this outcome?

Invitation for reader feedback:  How are YOU implementing postnatal (or perinatal) mood disorders into your curriculum?

Posted by: Kimmelin Hull, PA, LCCE, FACCE


Analyzing Information on the Web: The Best Postnatal Mental Health Websites

January 10, 2012 07:00 AM by Judi Calhoun, LCCE
I always speak about baby blues and PPD in my prenatal classes where we discuss the need for good supports. Thanks for the websites...this is tremendous. We are hoping to start a PPD support group here and this will be a great resource. In my discussions, we always discuss supports and attachment. We talk about birth as a continuum, not an event. And I am trauma informed, so my work reflects that--which I think cannot be over estimated!

Analyzing Information on the Web: The Best Postnatal Mental Health Websites

January 12, 2012 07:00 AM by Joni Nichols
There is PLENTY of room for improvement in my curriculum since I hardly acknowlege the possibility of postpartum depression prenatally except when discussing placenta encapsulation (which I do not personally offer). Talking about placentophagy with couples these past few years has been a way to discuss the hormonal changes and energy needs of new mothers and to reflect with them about the needs of some mamas for additional "nourishment" (emotionally, physically and spiritually) in the postpartum period. I think this has been my indirect way to approaching the subject and I'll look forward to reading contributions from those of you who do this more directly! One aspect I do treat with more diligence (and may contribute overall to less problems for mamas)is what I call "who does what". We review with detail who walks the dog, services the car, makes the appointments, takes out the trash, picks up the drycleaning, shops for food/housewares/gifts, and all the other gotta do's of life NOW and then we anticipate that with the new baby there is going to be a redistribution of getting them done! A nice practical conversation begun during class with me then becomes their homework. Obviously this isn't a panacea for the myriad reasons a women may feel overwhelmed or sad but it definitely reflects my reality as a mother whose husband traveled over half the time. I suppose we teach what we have lived no? Also, like most experienced educators I have my "go to" list of local professionals if a family asks for help. I suppose my strength lies in "being there" for families in the days and weeks after the birth via visits, phone calls and emails. Mothers-to-be whose births I will be attending, come to my home in the final two months of pregnancy to form community with the other women who have already birthed. These mother baby gatherings occur every month and there is always time before and after the multi hour visit for a mama to approach me privately with a concern.If someone doesn't attend then I call to find out why! I may not have the training of a psychologist but she has the confidence of knowing a very loving, experienced and interested person is listening. Finally, I can't help but wonder if having experienced safe and respectful birth hasn't gone a loooonng way in reducing the incidence of PPD in the women I have worked with over the years. Certainly I have never in 800 births had anyone who suffered post traumatic stress syndrome! That alone has to have reduced the number of PPD. Even as I write this short contribution I am reminded of the woman with whom I have nearly daily contact (since late November) whose baby died at 2 months. I was the doula for her first baby but was not available to accompany her for the recent birth. When her daughter died though, she wrote me immediately and called. Perhaps "mental health" wasn't listed on the curriculum guide but the discussions, anectodal stories, and underlying belief are important, you're baby needs you whole, you may need additional support to meet this new lifestyle....contribute to forming a safety net what mother's will seek when they need it. Certainly a baby's death put her at risk of becoming seriously depressed and despondent and so far she is coping in healthy ways.

Analyzing Information on the Web: The Best Postnatal Mental Health Websites

January 12, 2012 07:00 AM by Kimmelin Hull, PA, LCCE
Joni, I really value your input, with your lengthy experience attending births, as a mother, and a birth professional working in a different setting (Mexico) than many readers of this blog site. The personal contact you describe both before and after a woman's birth is HUGE in supporting her emotionally--and creates a bridge that is easier to walk across if/when she needs extra support. Your discussion in class of the "who does what" is an excellent suggestion, and likely one that many first time expectant couples don't recognize the need for. It is hard to explain to expectant parents all the ways life will change following baby's arrival--implementing these types of conversations is so fruitful and hopefully just a starting point for couples to springboard off of. Thank you for sharing!

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