Table 2.

Quotation supporting the themes “Toward deep changes in the socio-cultural conception of the peripartum” and “challenging stigma”

Toward deep changes in the socio-cultural conception of the peripartum
Increasing social support during the peripartum
Mother 4: “It would need a longer follow-up by midwives during the postpartum. […] In our society, you’re much more isolated, the mum is sometimes all alone all day long, that’s all, that’s it. […] that’s the worst, I think, to stay alone. Because if you’re supported, […] well, it would change a lot of things […] You would less worry on things that occur on a loop like that” C&A Psychiatrist 3: “Last weekend, she had all her family at home […] She had the impression to be the only one to care about what her 5-month little girl was living […] She spent the whole weekend being worried about her. And her husband was there, […] but he did not share at all the same concern, the same worry. At the end she felt totally left alone, abandoned”
Switching from a focus on individual level to community level factors
Pediatrician 3: “Maybe we could change how we look at the peripartum. Why that’s women who bear this” Midwife 14: “That’s something cultural in France. Political women who come back working after one week… So women believe that’s the real life”
Switching from infant-centered care to family centered care in the peripartum
Midwife 25: “Childcare nurses do a great job but, still, they’re focused on the baby. […] That’s not always easy to withdraw a little from the baby to take more interest in the mum. And, I think that us the midwives, we’re more on the mother’s side, and the job isn’t the same […] these depressions can stay unnoticed if the babies are going well” Autistic woman 5: “During pregnancy monitoring, I’d like that the mother would not be considered only as an uterus. Meaning child’s health, and also maternal health that would be taken into account” Mother 3: “That childcare nurse comes […], weights the babies. The babies are well, and I tell myself ‘well, once again they focused on them.’ […] And she asks, ‘how are you feeling?,’ I answer, ‘well, he doesn’t sleep, they are always in pain.’ And she says, ‘no, how you’re feeling?’ and actually, I have the impression that it’s been ages that no one asked me that question”
Toward parent-friendly vocational organizations
Psychiatrist 2: “A specific part on basically work environments, and what company leaders should know about perinatal psychiatry and consequently what vigilance they should apply in their company, etc” Psychiatrist 3: “Being parent and working, that’s not incompatible at all, but actually that needs an adaptation. Necessarily. There is inevitably an adaptation just so that you manage to not get burnout or overloaded” Psychiatrist 4: “Finally, the conclusion of all that, that’s it should almost be adaptable to each patient, even to each couple. For instance like in Scandinavian countries where they can share the parental leave, as they prefer, easily” Psychiatrist 2: “That’s not institutionalized. While that’s you who bears this” Midwife 23: “From one hand, maternity leave is very short and for some women it’s too long […] And paternal leave was also very short”
Challenging stigma
Reducing stigma
Mother 1: “To appear as someone weak. And I never liked that, and for me that was a weakness […] that was not my temperament” Midwife 19: “To not feel stigmatized when we want to orient them towards psychological support. That’s still classic to get the response that they’re not crazy” Mother 1: “People associate a lot depression with pills. […] So, well, reducing stigma, yes. […] People think a lot about psychiatry. And this word, ‘depression,’ that means hospital, that means hospitalization, and I think that’s scary” Mother 4: “I observe that it has already improved over 7 years. Anyway, it has evolved. And I see it, a lot of things happen. […] The speech is freed, even…”
Reducing feelings of shame and guilt
Mother 1: “Well, completely [the feeling of shame]! […] What’s funny, however, when speaking again about this, well, I realize that many people hadn’t noticed. […] I believed it could be seen through me and in fact not at all!”
High stigma for mothers who work as health providers or social workers
Mother 1: “I who am a nurse, I could see with my colleagues, if we care for depressive patients, there many who don’t understand it. And who tell, ‘no, but did you see, she doesn’t move during all day,’ or, ‘she doesn’t work, she could motivate herself.’ I who experienced it, now, well in fact that’s something hard. There is something stronger than not going out from your bed” Mother 2: “Yes, I think, of shame and then the fear of being judged by… what that could produce. I’m a social worker, do you realize what that can produce?”
Experienced and anticipated stigma in mothers with serious mental illness or autistic mothers
Woman SMI 9: “Well, I fear being labeled mother who is potentially dangerous for her child. I fear to be told, ‘she is potentially dangerous’” Autistic mother 8: “It will depend on the practitioner. If the fact of knowing I’m autistic, it renders less… they take it less seriously when I tell them there is that thing that isn’t ok, or that I tell symptoms and that’s not taken into account”
Stigma related to lack of knowledge in health providers
Midwife 17: “For me, suicidal risk is either immediately, but the big decompensation, meaning postpartum psychosis, the big thing, either it takes more time, a few months, a few years, and as a private practice midwife, I’ll have tendency to lose them on the follow-up level” Psychologist 3: “I don’t know if you can say postpartum depression in a psychotic patient who has a baby”
Providing clear, accessible and nonstigmatizing information about peripartum mental health and wellbeing to all parents beyond universal routine screening
C&A psychiatrist 3: “General public information too” GP1: “Maybe testimonies related to feelings, saying: ‘I am afraid of hurting my baby’? Well, some questions or ideas that you may have when you’re not well. ‘I’m tired of my baby,’ ‘I don’t like him,’ ‘I’m afraid not to like him,’ ‘I feel sad all the time, I just cry.’ […] the impression that you’re not alone, because in these moments you feel […] completely out of place. […] dads too” Psychologist 6: “I think there is still awareness to conduct […] of these mums too, through childbirth classes. Anyway, midwives talk now more about this. […] to make some pedagogy or training, to be able to say to mums, well, to make difference between baby blues and postpartum depression. […] there is all that prevention work that is interesting” Midwife 26: “During the postpartum care, […] I also tell them the signs” Midwife 19: “Our psychologist intervenes twice a week on half days and sees a large number of mothers in a systematic way. Meaning that we don’t tell the woman, ‘I find you a bit tired, would you like that to see the psychologist?,’ the psychologist just goes see her. Well, not at all intrusively, but rather systematically […] And very, very often that leads to […] real psychological interviews. While initially these mums wouldn’t necessarily saw her if there wasn’t that systematic contact” Psychologist 2: “It removes the taboo and something that is both mental and physical care […] I find that the way they’re seen by midwives too, that’s… […] if indeed they’re at ease like when talk about contraception, if they discuss mental disorders the same way, that’s accessible and that’s not taboo. That doesn’t bring uneasiness to them. But I think that for that they have to be at ease” Mother 2: “You can take the EPDS [Edinburgh Postpartum Depression Scale] on the 1000 days app, I think that’s a very good thing. […] I think that would have opened up some questions for me. It would have already posed something, it would have made what I was experiencing exist. I think that would have made sense” Psychiatrist 2: “Some realize the screening using EPDS during postpartum care, but the midwife who has to administer the questionnaire, she’ll not drop the scale in the patient’s room and leave, she has to contextualize things a bit, so to evoke that the point is to detect depression, so, what’s depression, what is its frequency, what are its symptoms, etc”
Training frontline providers on peripartum mental health disorders (knowledge/attitudes)
Childcare nurse 2: “Training is very important, we still have a lot to learn and see” Psychiatrist 2: “When a patient is pregnant, people who are untrained will tend to say, ‘oh, let’s stop or at least reduce psychotropic drugs in late pregnancy, that will be better for the baby’s arrival,’ whereas, in fact, data rather supports the opposite: there is a volume increase, doses should be increased at this period rather than reduced” Pediatrician 2: “There is a maternal depression scale made by the French Association for Ambulatory Pediatrics […] that is well constructed, that I never use. But anyway, I know that scales exist” Mother 4: “I went to my doctor at that moment who was desperate too, who didn’t know about mother-baby units, who tried to contact a local hospital. […] She managed to tell me, ‘I leave you a message. That’s not a psychologist that you need, that’s a psychiatrist, maybe your treatment should be adjusted,’ well the poor was a bit panicking. She left a message to a psychiatrist who called me back the day after”
Training frontline health providers (skills)
Childcare nurse 1: “That’s often complicated for us to make the mums adhere with the follow-up, or anyway to put in place some support […] that’s sometimes difficult for them to hear because they already feel very guilty about the care they can provide to their baby” GP 1: “That’s in the subtleness of not turning them on us, to avoid breaking the relationship too. And sometimes when we contact the psychiatry, that’s much more complicated” Midwife 17: “I have more difficulties in postpartum than in antenatal. […] in postpartum I really have this, ‘no, that’s not severe, that will pass’” Midwife 24: “That’s not so much that we don’t want to ask it or that we’re afraid to ask that question [suicide ideations], well, for me, that’s my romantic side, a bit naïve, that’s no [laughs]. Unless, […] the woman express it clearly and from that moment, we’ll put all in stage for the care” Midwife 13: “To be confronted to the patient’s distress, I think that puts us in a difficult position” Pediatrician 1: “There is that gap where you’re told, ‘we’d like care at discharge from maternity because this mum will need some support and not to be separated from her child,’ and suddenly, something terrible happens while we did not understand anything. Which renders for instance the concerning information very difficult in some situations because you tell yourself, ‘what will I start?”