Perinatal mental health training in Norway
Theme: Perinatal mental health
Working with perinatal mental health requires specialized knowledge about both adults and babies, as well as the interaction between them in the perinatal period. Such knowledge is traditionally not covered in traditional specialist education within the health care sector. To remedy this, we have since 2011 offered the training program "Mental health in pregnancy and childbirth" to midwives, nurses, psychologists, psychiatrists, and GPs in Norway.
"In order for a mother to be able to give her child space, it is necessary for her at certain moments to lose herself, give up control and allow anxiety and pleasure to come". I read this quote from the French psychoanalyst Michelle Montelray many years ago. In a sense, it has become a mantra for me in my work, both when working in clinical practice with pregnant and new mothers, but also when I teach and supervise health personnel working within the field of perinatal mental health.
Becoming a parent is a transition. The nine months of pregnancy are designed for the mother and father to adjust and meet the child the best way possible. Neurobiological and hormonal changes help both the mother and the father/co-mother during this process. The mothers' transition state is called their constructive fragility. Constructive because we are made for this, reproducing ourselves. This while the fragility during this period helps us meet the unborn and newborn baby’s needs.
Perinatal mental health (PMH) problems occur during pregnancy or in the first year following the birth of a child. We know from research that if left untreated, such mental health problems could affect both mother, child, father and the whole family for years.
Perinatal mental health issues can be understood as a spectrum, ranging from baby blues, through depression, anxiety, severe mental illness, bipolar disorder, obsessive thoughts, psychosis, intoxication, grief and loss, trauma and retraumatization, PTSD and eating disorders.
The Norwegian guideline for pregnancy care recommends that health services identify women with perinatal mental health problems, but there is no directive for how this should be done or what kind of help those identified should receive. Healthcare personnel also often lack expertise in perinatal mental health (Høvik et al, 2021).
Working with perinatal mental health requires specialized knowledge about adults, about unborn/newborn babies and about the interaction between them all. The dyad or triad is centerstage. This requires expertise about each of the participants, as well as about the interaction between them.
This is somewhat different from many other types of mental health care, where specialists are trained to care for either children or adults (Brockington et al 2015). It may look like the family as such, or «the new patient», falls between two chairs.
With this background, we at RBUP in 2011 created the training program "Mental health in pregnancy and childbirth". The desire was to deliver better care to women and families struggling during the perinatal period. RBUP is a competence network, a public service for the services, providing day courses and education programs, among other services.
The training program is designed for midwives, nurses, psychologists, psychiatrists, and GPs. It lasts for 1,5 years and consists of 9 sessions of 2 days each. The sessions alternate between theory, exercises, reflection, and guidance/supervision. Each session follows the same pattern: One day of theory, followed by one day of self-compassion, exercises and supervision. The interdisciplinarity of the program covers relevant aspects, and this facilitates necessary interdisciplinary and interagency reflections and collaboration. The perinatal period is emotionally demanding also for the helpers. This is both because of the actual vulnerability of the unborn/newborn child, and because of the feelings this arouses in the helper him- or herself. Knowledge of one's own vulnerability is important in order to create change in others, and also provides help for one's own development and well-being.
Introduction to perinatal psychology
The neurobiology of the perinatal period
Mental disorders related to the perinatal period
Normal and abnormal development in the young child
The therapeutic meeting
Practical tools in the meeting with the other
Affect regulation for the therapist, the mother, the father/co-mother and child)
Helping the helper to cope with vulnerability in the other and in him/herself.
Reflections on the helper's own vulnerability
Reflections on compassion and self-compassion
A total of about 250 midwives, health nurses, psychologists, and physicians from all over Norway have participated. The training program is not formally evaluated. But participants who have completed the course consistently report gaining a higher level of professional self-confidence in their clinical encounters with vulnerable pregnant women and their families. Many also report that after completing the program they have initiated and developed much more interdisciplinarity in their daily work, broadening the cooperation with other professionals, and thus being able to meet "the new patient" better. □
References on request
Høivik, M. S., Eberhard-Gran, M., Wang, C. E. A. & Dørheim, S. K. (2021). Perinatal mental health around the world: priorities for research and service development in Norway. BJPsych International, 18(4), 102-105. (link)
Brockington I, Butterworth R, Glangeaud-Freudenthal N. An international position paper on mother-infant (perinatal) mental health, with guidelines for clinical practice. Arch Womens Ment Health. 2017 Feb;20(1):113-120. doi: 10.1007/s00737-016-0684-7. Epub 2016 Nov 8. Erratum in: Arch Womens Ment Health. 2017 Feb;20(1):121. PMID: 27826750; PMCID: PMC5237446.