Monthly Archives: November 2012

On Being a Dementia Nurse Newbie

The #dementia hashtag has been showing-up on Twitter a fair bit lately. This is due in no small part to British Nurses hosting an online chat and gathering resources under the #WeNurses social media portal: see their chat info and transcript here.

It’s had me thinking back to my first experiences of nursing the person with dementia, of being a dementia nurse newbie.

Since those early days as a nurse I’ve come across dementia in a number of roles, most frequently when working as a Consultation Liaison (CL) Clinical Nurse Consultant (CNC). CL CNC is a role where mental health assessment, support and education is provided in the general hospital setting in partnership with the clinical staff working there. Dementia isn’t usually part of a mental health nurse’s day-to-day work, but it is a frequent trigger for referral to a CL mental health nurse. In a 2005 survey of Australian CL nurses the “Four Ds” of common CL presentations were identified: Delirium, Dementia, Depression and Deliberate self-harm (Bryant et al, 2007, p 34). These four conditions aren’t mutually exclusive, of course. In fact, somebody with dementia (even very early stage) is much more prone to developing delirium and/or depression. Additionally, there are very clear links between dementia, depression and deliberate self harm.

Anyway, back to the subject. The prevalence of the dementia hashtag on Twitter reminded me of the clinical placement where I first encountered dementia amongst the residents of a large nursing home. Being new to nursing and new to dementia I felt pretty baffled at first. Luckily there are some secret weapons to feeling baffled: they’re often found in literature, art and music.

In 1989 Elvis Costello released a song he co-wrote with Paul McCartney called Veronica. The story I’ve heard is that the song was about Elvis Costello’s Grandmother who had dementia. As we know, dementia is a progressive, irreversible brain condition that results in cognitive and physical decline with some fluctuations in alertness and lucidity. Dementia can leave many long-term memories fairly intact, but makes laying-down new memories very difficult. The song Veronica captured the fluctuations in mood and memory beautifully, and was a timely, poignant accompaniment to my clinical placement.

Veronica by Elvis Costello helped me a lot when I was a newbie to nursing the person with dementia; maybe the song will help other dementia nurse newbies too.

Veronica video [via www.youtube.com]

Veronica lyrics [via www.sing365.com]

Is it all in that pretty little head of yours?
What goes on in that place in the dark?
Well I used to know a girl and I would have
sworn that her name was Veronica
Well she used to have a carefree mind of her
own and a delicate look in her eye
These days I’m afraid she’s not even sure if her
name is Veronica

[Refrain:]
Do you suppose, that waiting hands on eyes,
Veronica has gone to hide?
And all the time she laughs at those who shout
her name and steal her clothes
Veronica
Veronica

Did the days drag by? Did the favours wane?
Did he roam down the town all the time?
Will you wake from your dream, with a wolf at
the door, reaching out for Veronica
Well it was all of sixty-five years ago
When the world was the street where she lived
And a young man sailed on a ship in the sea
With a picture of Veronica

On the “Empress of India”
And as she closed her eyes upon the world and
picked upon the bones of last week’s news
She spoke his name outloud again

[Refrain]

Veronica sits in her favourite chair and she sits
very quiet and still
And they call her a name that they never get
right and if they don’t then nobody else will
But she used to have a carefree mind of her
own, with devilish look in her eye
Saying “You can call me anything you like, but
my name is Veronica”

[Refrain]

Veronica mp3 [via iTunes]

In Closing

Nurses (#wenurses) are referred to in the lyrics: “And they call her a name that they never get right, and if they don’t then nobody else will.” It’s especially important for we, the nurses, to be fully present when dementia has made the person’s own presence tenuous, brittle.

We Nurses are fortunate to have art, literature and music to inform our empathy and build our emotional intelligence. Neither empathy or emotional intelligence are exclusive to nursing, of course, but both are core nursing qualities. I found those qualities, as they relate to nursing the person with dementia, in Elvis Costello’s song in 1989, and again by following the #wenurses and #dementia hashtags on Twitter in 2012.

Reference

Bryant, J., Forster, J., McNamara, P. & Sharrock, J. (2007) You are not alone: Results of the 2005 Australian consultation liaison nurses survey, Australian College of Mental Health Nurses. Available online here http://eprints.jcu.edu.au/2013/1/ACMHN2007.pdf or here http://www.acmhn.org/images/stories/Media/CLSIG_survey_report.pdf 

Paul McNamara, 30th November 2012

#bePNDaware: Looking Back at Postnatal Depression Awareness Week through a Social Media Lens

Postnatal Depression Awareness Week 2012 in Australia ran from Sunday 18th November to Saturday 24th November. I’m not entirely sure of the history of Postnatal Depression (PND) Awareness Week; my understanding is that it was initiated by beyondblue in the early 2000s, but am quite possibly completely wrong about that. If you know the history please let us all know via the comments section at the bottom of the page.

Reprising an idea I’ve used previously, this post will review PND Awareness Week through a social media lens. Why? Well, until June 2013 I’m in a role funded by the National Perinatal Depression Initiative (NPDI). One of the goals of the NPDI is to raise community awareness about depression and anxiety in the perinatal period. Promoting community awareness is something that I endeavour to do every week, but in PND Awareness Week we trot out a few extra posters and brochures in antenatal clinics and community health waiting rooms, and try out other ways to engage members of the media/community in the conversation. Social media lends itself very well to raising community awareness too, so that’s where I threw a fair bit of effort this year.

Looking back at PND Awareness Week 2011 (13th-19th November) on my now-mothballed @PiMHnurse Twitter account, I see that I used a #PND hashtag, and interacted with only two other Twitter users on the subject. In 2011 I sent twenty-five PND-specific tweets in PND Awareness Week, 18 of them starting with “For Postnatal Depression Awareness Week let’s focus on the positives…” In short, PND Awareness Week 2011 was pretty lonely on Twitter.

By contrast, Twitter was a much more lively, engaging place to be during Postnatal Depression Awareness Week 2012… just have a look at all the participants:

All #bePNDaware Participants 8th November 2012-25th November 2012, courtesy of www.symplur.com

All #bePNDaware Participants 8th November 2012-25th November 2012, courtesy of http://www.symplur.com

PANDA’s Social Media Strategy

For Postnatal Depression Awareness Week 2012 PANDA (Post and Antenatal Depression Awareness Association) released suggestions on how to get involved using social media via a page titled Join the Conversation #bePNDaware. PANDA encouraged use of Facebook, Blogs, Instagram and Twitter as avenues for people to get involved: the primary target group for this is pregnant women and new mums, especially those who have experienced or are experiencing anxiety and/or depression.

Facebook content is difficult to collate, so let’s skip past it here. BTW: if somebody knows an easy way, please let me know.

Fifty (50) blogs were submitted here – there are some very articulate, generous and gutsy stories of the lived experience of perinatal mental health problems on that page. Recommended reading for expecting couples, new parents and health professionals.

Instagram had over 500 photos tagged using the #bePNDaware hashtag. With Instagram installed you’ll be able to view the photos on your smartphone, or alternatively you can browse them online here.

For those interested, there’s an abbreviated compilation of #bePNDaware content from Twitter, Instagram and Facebook (very limited) available here via Storify,

twitter.com/meta4RNTwitter is Not a Toy

Twitter is a great tool for sharing information, which makes it a very good fit for awareness raising campaigns such as Postnatal Depression Awareness Week. PANDA had the wisdom to publicise the #bePNDaware Twitter hashtag a few weeks before Postnatal Depression Awareness Week, which gave me an opportunity to register it as a healthcare social media hashtag with Symplur. As discussed on a previous post Symplur offer an excellent way to track healthcare hashtags; have a look at their analytics here.

So, let’s summarise some of that data. From midnight beginning Thursday 8th November 2012 to midnight ending Sunday 25th November 2012 (Cairns time) there were:

  • 250 Twitter participants using the #bePNDaware hashtag
  • 928 tweets using the #bePNDaware hashtag
  • amongst these tweets, @PANDA_NATIONAL was mentioned more than any other individual or organisation
  • amongst these tweets @beyondblueorg was equal 4th number of mentions with Mamamia
  • @Mamamia, with its very large Twitter following, had the greatest amount of “Tweet Reach” of all those who used the #bePNDaware hashtag . In fact, Mamamia accounted for nearly half of the #bePNDaware impressions as calculated by Symplur (explanatory note here).
  • Overall, the potential Tweet Reach/Impressions topped one and a half million (no – not a typo: one and a half million!). It is an impressive number, but as touched-on in a previous post we should be a little cautious in our interpretation of this.

As a Mental Health Nurse, I’m very pleased that three of the ten most prolific Twitter accounts using #bePNDaware over the period were from my profession: @ACMHN, @nursewhitebeard and @meta4RN (my account). Also in the top ten of most prolific Tweeters were the Australian Multiple Birth Association (@AMBAconvention), PANDA and the social media agency account @BrandMeetsBlog and two of the agency’s members. Two women who shared their lived experience of postnatal depression made up the remaining spots in the top ten. The complete lists are here.

Extracting the #bePNDaware data from www.symplur.com day by day (and adjusting for time zone differences), we can see that Wednesday of Postnatal Depression Awareness Week was by far the busiest in terms of both traffic (312 Tweets) and participation on Twitter (120 participants). I assume that this is because Wednesday coincided with two events: [1] the planned “it’s not always black and white” Instagram event; and [2], this was the time when @Mamamia became involved in using the #bePNDaware hashtag. This needs to be understood in context: at time of writing the two most prolific accounts using the #bePNDaware hashtag were @PANDA_NATIONAL with 260 Twitter followers and @meta4RN with 234 followers. @Mamamia has over 65,000 followers – that’s significant social media clout in the right demographic.

Curious as to what was said on Twitter during the week? Browse through the transcript here: www.symplur.com

So what?

Let’s start with an assumption:

Raising community awareness regarding perinatal mental health = reduced fear/stigma = reduced barriers to support = improved uptake of information and services = reduced impact of anxiety/depression for pregnant women, new mums and their significant others.

I guess that’s the whole idea behind the NPDI citing improved community awareness as one of their key performance indicators. Social media has become another tool (not the only tool) for health promotion. Although I would caution against taking the one and half million impressions too literally, there is no doubt perinatal mental health became part of the thoughts and conversations for many hundreds, probably many, many thousands of people using social media during the week.

What does it cost?

Time. Using HootSuite, I scheduled most of my #bePNDaware Tweets for the week last Saturday morning while watching Rage and drinking coffee (who said blokes can’t multitask?). That allowed me to maintain a presence in the Twitter stream while I went about my paid work. Before and after work and during breaks I could check-in on the hashtag and see what else was going on, then interact and respond as time allowed.

What lessons have we learnt?

PANDA’s multi-channel strategy was certainly instrumental in the success of Postnatal Depression Awareness Week on social media. Pre-announcing the hashtags primed a core group of social media enthusiasts to get the conversation started, to get #bePNDaware off the ground. It was a very sophisticated idea to not just organise a place for relevent blogs to be compiled, but also to provide resources and tips to assist bloggers frame their information in a helpful manner. PANDA and the people supporting their social media strategy deserve to be congratulated. Apart from keeping an eye out for changes in social media fashions (eg: farewell MySpace, hello Pinterest), I don’t think PANDA will need to change their strategy much.

PANDA took the leadership role in this year’s social media campaign; I hope they do so again in 2013.

Next year, it would be great to see the other big-hitters in online info/support/funding re perinatal mental health get more involved in using the same hashtag: @HealthAgeingAU, the state and territory health departments, @beyondblueorg, @beyondbabyblues@blackdoginst, @headspace_aus could each contribute to a #bePNDaware hashtag blitzkrieg. Health professionals and the organisations that unite them could also plan to join in and amplify the social media buzz – I’m proud that the Australian College of Mental Health Nurses @ACMHN is so active in this space. I’m also pleased that NGOs, clinicians, private enterprise, interest groups and those who have “been there, done that” with perinatal depression/anxiety were all able to share their insights into the same subject. Exposure to a range of perspectives is the antidote to tunnel vision.

In 2013, let’s go out of our way to include the non-health sector people in the conversation too. The extra “Tweet Reach” that one social media enterprise - @Mamamia - bought along this year was fantastic. It would be great to have them, and other organisations that interact with the target demographic, onboard in time for the launch of PND Awareness Week 2013.

Now that the #bePNDaware hashtag has been established and has some recognition, let’s try to use it for all tweets that relate to the subject of perinatal mental health: we can use the hashtag all the time, not just for one week a year. The data/analytics/transcripts on www.symplur.com are available to us all.

Never Tweeted before?

If not, a lot of this might be a bit baffling. Like most things, Twitter is odd until you’ve spent a little bit of time with it. When it clicks-in with you you’ll love it.

I’ve covered getting started on Twitter in a previous post (scroll down to about 3/4 mark).

One last thing.

A 12 month old Tweet; the question still remains.

The language around postnatal depression week gets clumsy, because we’re trying to include anxiety and the antenatal period as well, and we don’t want to leave men out of the equation. Should we bite the bullet in 2013 and call it Perinatal Depression Awareness Week? Why not? It would be in keeping with the terminology used in the National Perinatal Depression Initiative. #bePNDaware

As always, your thoughts/comments are welcomed.

Paul McNamara, 25th November 2012

Using the Edinburgh Postnatal Depression Scale

A core component of Australia’s National Perinatal Depression Initiative (NPDI) is universal screening of all pregnant women and new mums using the Edinburgh Postnatal Depression Scale. The Commonwealth Department of Health and Ageing (DoHA) suggests using it twice – once antenatally, and again a month or so postpartum [reference here]. In Queensland’s public health service, the aim is to use it four times: twice in the antenatal period (usually around 20 weeks, and again midway through the third trimester), and twice postpartum (at 6-8 weeks, and again at 12-16 weeks).

There’s a heap of academic papers about the Edinburgh Postnatal Depression Scale (EPDS), as this simple internet search reveals. This post won’t attempt to replicate such highfalutin work, but just give a few practical tips for clinicians using it.

Tip One: Don’t Believe The Hype

Meaning no disrespect to the authors of the EPDS or those who decided to build Australia’s universal perinatal mental health screening around it, but let’s clearly call the EPDS exactly what it is: a quick and dirty screening tool. Yes it’s been validated in about eleventy-seven different studies, but like all screening tools the EPDS doesn’t pretend to replicate or replace clinical judgement and it certainly doesn’t masquerade as a diagnostic tool. All it does it measure some signs and symptoms of depression and, to a lesser extent, anxiety (more about that in a moment).

The EPDS intentionally limits the screening questions to one week in time. So we need to keep in mind that it’s only takes a snapshot of what’s happening – it doesn’t show us the whole movie. It’s up to the Midwife/General Practitioner/Indigenous Health Worker/Child Health Nurse/whoever to chat with the woman* about whether the snapshot that the EPDS reveals is an accurate glimpse of the big picture. If the woman has had a particularly good or bad week prior to screening the EPDS result will reflect this.

So, when we’re using the EPDS let’s always remind ourselves, and the woman/family we’re working with, that the EPDS isn’t a measure of someone’s psychological strengths or vulnerabilities, nor is it a psychiatric diagnosis. It’s just a reminder, an aide-mémoire, that anxiety and depression are pretty common in the perinatal period**, and that we should keep an eye out for some of the common early warning signs.

Tip Two: There’s More Than One Score

Casually (and irreverently) stated, the usual way EPDS results are interpreted goes a bit like this:

  • zero = this person does not trust this service at this time
  • single digits = about what’s expected
  • between ten and twelve = dodgy mood: we had better check-up on the supports in place and arrange to do the EPDS again in a fortnight or so
  • over thirteen = nudge the woman to chat with someone she loves and trusts and/or accept referral for follow-up

That’s pretty good, but we can, and probably should, get a bit smarter about using the results.

Let’s think of the EPDS as four scales.

Yep: four.

The first (most crude) scale is the overall EPDS result [range = 0 to 30]. Interpret as above.

The second (most important) scale is the self-harm/suicide ideation scale: question 10 on the EPDS [range = 0 to 3]. Question 10 asks for a response to the statement, “The thought of harming myself has occurred to me [in the last week]“. If the result is zero that means one of two things: this person hasn’t had thoughts of self-harm recently or this person doen’t trust this service at this time. The response to a score of zero could be something like, “Cool. Just so you know for when you’re chatting to other Mums: it’s not unusual for somebody to feel so overwhelmed that they have uninvited thoughts about hurting themselves. It doesn’t always mean they’re going to do anything silly, of course, but we do like to make sure that they know there are supports available.” Any result on question ten other than zero will require your sensitive, authentic care and some follow-up questions to check on the woman’s safety. Check on whether these thoughts have ever become actions, whether the thoughts are about suicide or non-suicidal self harm, whether there are protective factors in place, and whether this person is safe to go home today (Have you thought about what you would do? When would you would act on those plans?). In my experience people are usually pleased to have an opportunity to speak openly about thoughts of self harm to someone who is caring, not-freaked-out, and non-judgemental. All you’re doing is sensibly, calmly, professionally following-up on a question about depression/risk with the goal of greater understanding.

The third (most ignored) scale is the seven-question depression sub-scale. Questions one and two are fishing around for anhedonia***. Question six seeks to find out whether the woman is feeling overwhelmed, question eight intends to measure mood. Questions seven and nine look to measure for uncharacteristic tearfulness and sleep disturbance. Question ten may be an indicator of feelings of worthlessness. Together, these seven questions measure some of the common neurovegetative symptoms of depression. So, the EPDS depression sub-scale can be expressed as a result out of twenty-one.

The fourth (most handy) scale is the three-question anxiety sub-scale: a measure obtained from scoring questions 3, 4 and 5 in isolation. I find this score out of nine surprisingly useful in clinical practice. Most weeks I’ll get at least one referral where the EPDS total result isn’t very high: say 6 or 7 out of 30. However, a cursory glance at the EPDS reveals that the entire score was generated over just those three questions exploring anxiety symptoms. This transforms a low score into a high score:  6 or 7 out of 30 on the EPDS usually isn’t a big deal, but 6 or 7 out of 9 on the anxiety sub-scale deserves attention.

Confused? Don’t be. Further down the page we will put the four scales into practice using an example EPDS.

Tip Three: EPDS DIY

A spin-off from the beyondblue and beyondbabyblues web sites is the site justspeakup.com.au. There’s some good info there: a first-time Mum I was meeting with earlier this year found Jessica Rowe’s description of her experience of postnatal depression more recognisable, more poignant, and more helpful than anything I said or did. Empowering for her, humbling for me. Sometimes there’s nothing more powerful than sharing stories of the lived experience.

Another good thing about the Just Speak Up site is the self-scoring online version of the Edinburgh Postnatal Depression Scale here: justspeakup.com.au/epds.

If in a room with a PC and it’s appropriate to check the EPDS, you could bring that site up and ask that it be completed (ten mouse-clicks; takes no time) while you busy yourself with another task. Instant scoring! No mathematical challenges or errors! “Shall I print a copy for you to take home or to give your GP?” 

Why not email the justspeakup.com.au/epds link to the woman as a way to promote self-monitoring of changes in mood? If the partner doesn’t quite get with the whole depression/talking about depression thing, suggest that s/he has a go too (it’s fine to use with blokes). You could suggest to the woman that she puts a reminder in her phone to re-visit the EPDS on the first of every month, “You and your partner can compare and contrast scores, if you like. Also, if you’re not sure how to start a chat with your Midwife/GP/Child Health Nurse about your mood you could just print-off the results page and take it in with you to your next appointment… Hey Doc: what do you make of this?

Tip Four: EPDS? There’s an app for that.

There are three iPhone apps that I know of that include the Edinburgh Postnatal Depression Scale (EPDS). NovoPsych is frightfully expensive for the full version so I havent bought it/tried it. SadScale has the EPDS, but it’s kind of… umm… sad. It’s the least attractive iPhone app I’ve ever seen and has a really dodgy email set-up which I’m reluctant to use (no other app has asked me for my email password). The graphing of the results is laughably bad. It’s cheap to try for yourself if you’d like, but I have another suggestion…

Want the EPDS on your phone?

The best app I’ve found so far for the Edinburgh Postnatal Depression Scale is on Mediquations - it’s available for iPhone/iPod Touch/iPad and Android devices for about AU$5. It’s very easy and intuitive to use, calculates the result instantly, and allows you to quickly and easily email the results, including the answer to each of the variables (see below). At least a couple of times a week I’ll hand over my phone the woman I’m meeting with at the time, so we can both compare/contrast today’s EPDS result with previous results. Then I can email the (unidentified) results to my work email address. Why bother? Well, it’s pretty handy to be able to cut and paste the EPDS results directly into the electronic health record, and/or into the letter to the GP, and/or into the follow-up email to the pregnant woman/new mum.

Here’s a cut and paste example of the emailed EPDS result as served-up by Mediquations (for fun: spot the typo on Q9):

Edinburgh Postnatal Depression Scale

Variables:

Able to laugh and see funny side of things: Not so much now (+1)
Have looked forward with enjoyment to things: Rather less than I used to (+1)
Blamed self unnecessarily when things went wrong: Yes, some of the time (+2)
Been anxious or worried for no good reason: Yes, very often (+3)
Felt scared/panicky for no good reason: Yes, quite a lot (+3)
Things have been getting on top of me: No.  Coping as well as ever (+0)
So unhappy resulting in difficulty sleeping: Not very often (+1)
Felt sad or miserable: No, never (+0)
So unhappy that I’ve been crying: Only occassionaly (+1)
Thoughts of harming self: Never (+0)

Results: Score: 12 Depression: Possible

Sent with Mediquations Medical Calculator for iPhone and iPad.

While we’ve got this example here in front of us let’s revisit the four scales thing and see if we can come up with some info that could guide us in clinical practice:

EPDS = 12/30 [let's repeat it in a fortnight or so]

Q10 = 0/3 [estimate low risk at present]

Depression Sub-Scale = 4/21 [not very indicative of depression, is it?]

Anxiety Sub-Scale = 8/9 [this person is REALLY anxious]

So, despite being a quick and dirty screening tool, the EPDS can be pretty useful. In the example above we would steer the conversation away from depression and get some information and support with the anxiety instead.

Tip Five: Hate Bagpipes but love Didgeridoo?

From the lofty mountains of science/academia the stone tablets have been handed-down: if you change the questions on a scale it will need to be studied to see if it still has validity and fidelity. In the swampy lowlands of clinical practice we sometimes need to be more pragmatic: if the woman/family we are with don’t understand the wording of a tool written for use in Scotland in the mid-1980s, and/or aren’t all that literate with written English, we need to be adaptive. After all, we’re not doing pure research; we’re doing screening, and we’re doing the best we can with what we’ve got.

One example of how the language of the EPDS can be adapted to be more user-friendly for Aboriginal and Torres Strait Islander women is online courtesy of the Kimberley Aboriginal Medical Services Council; see page 3 of their resource here. I’m not suggesting for a moment that you automatically use this version for every Aboriginal or Torres Strait Islander woman who walks through your door, but it might be a handy reference point for other ways to frame the questions if/when required. There’s probably a lot of non-Indigenous Australians who rather use the style of language of this resource too.

Tip Six: English isn’t for Everyone

Half the fun of travelling overseas is practicing (well, mangling) other languages in pursuit of transport, coffee, toilets, hotel rooms and beer. Using bad translations is fine for that sort of stuff, but it’s pretty dopey to go down that path when looking at something important like emotions or, as per question 10 on the EPDS, about thoughts of self harm.

So, what’s a dude to do? Pull out a translated version: there is a very handy resource with 36 translations into languages other than English. Please note that half of the translations aren’t validated, and have a look at the other tips about working across languages/cultures included on the resource.

Reference: Department of Health, Government of Western Australia. (2006). Edinburgh Postnatal Depression Scale (EPDS): Translated versions – validated. Perth, Western Australia: State Perinatal Mental Health Reference Group.

Tip Seven: You Are A Tool

I mean that it the nicest possible way.

The EPDS is a static screening tool that was written over 25 years ago in place 15000km away from Australia. It relies on the woman’s literacy and your numeracy to make it work, and even then it’s not replacing your clinical judgement. The EPDS certainly has validity and usefulness, but at the end of the day it’s still just a screening tool and an aide-mémoire.

You, however, are an educated, empathetic, responsive and proactive human being. You have emotional intelligence, a desire to be of use/service, and an incredible capacity to use your communication and life skills in a warm, caring manner. The EPDS can’t compete with you. You are a potent screening tool for emotional distress. You are more subtle and more powerful than ten questions on a form could ever hope to be. You’re a really sophisticated screening tool: please don’t let that dumb EPDS make you leave the best tool available sitting around unused.

What About Your Tips?

Thanks for reading this far (oops: I didn’t intend to be so verbose). Please feel free to add your tips/suggestions in comments section below.

Author’s Notes

* Every now and then you’ll see that the term “the woman” is used in this post; there’s an explanation for that. Nomenclature is taken pretty seriously in mental health: years ago the term “patient” was replaced with “client”, which has subsequently been replaced with “consumer” or “service user”. There are other terms that are getting bandied-about and trialled too. Midwives call the pregnant people and new mums they see “women” as a collective noun, or “the woman” if using the de-identified singular. I’m currently working with the same customer group and in the same venues as the Midwives, that’s why I’m speaking their language,

** The definition of “perinatal period” varies quite a bit. For data purposes, the Australian Institute of Health and Welfare defines the perinatal period being from 20 weeks gestation until 4 weeks postpartum. In clinical practice the perinatal period includes all of the antenatal period and (here comes the confusing bit) either up to one, two or three years postpartum. Many clinical services, including the one I’m currently working for, include pre-pregnancy, ie: women preparing for pregnancy.  In everyday use, it’s accurate enough to think of perinatal women as those who are planning pregnancy, pregnant or new mums.

*** Anhedonia is psychobabble jargon for loss of pleasure/joy. Anhedonia is the opposite of being hedonistic. Somebody who is being hedonistic might dance on the tables at nightclubs, shag backpackers, and say “Whoohoo!” a lot. Somebody experiencing anhedonia might still do things that would usually be fun, but just not get much enjoyment from them.

Paul McNamara, 14th November 2012