title: Women's experiences of postnatal distress: a qualitative study.
abstract: BACKGROUND
  Women can experience a range of psychological problems after birth, including anxiety, depression and adjustment disorders. However, research has predominantly focused on depression. Qualitative work on women's experiences of postnatal mental health problems has sampled women within particular diagnostic categories so not looked at the range of potential psychological problems. The aims of this study were to explore how women experienced and made sense of the range of emotional distress states in the first postnatal year.
  
  
  METHODS
  A qualitative study of 17 women who experienced psychological problems in the first year after having a baby. Semi-structured interviews took place in person (n =15) or on the telephone (n =2). Topics included women's experiences of becoming distressed and their recovery. Data were analysed using Interpretative Phenomenological Analysis (IPA). Themes were developed within each interview before identifying similar themes for multiple participants across interviews, in order to retain an idiographic approach.
  
  
  RESULTS
  Psychological processes such as guilt, avoidance and adjustment difficulties were experienced across different types of distress. Women placed these in the context of defining moments of becoming a mother; giving birth and breastfeeding. Four superordinate themes were identified. Two concerned women's unwanted negative emotions and difficulties adjusting to their new role. "Living with an unwelcome beginning" describes the way mothers' new lives with their babies started out with unwelcome emotions, often in the context of birth and breastfeeding difficulties. All women spoke about the importance of their postnatal healthcare experiences in "Relationships in the healthcare system". "The shock of the new" describes women's difficulties adjusting to the demands of motherhood and women emphasised the importance of social support in "Meeting new support needs".
  
  
  CONCLUSIONS
  These findings emphasise the need for exploration of psychological processes such as distancing, guilt and self-blame across different types of emotional difficulties, as these may be viable targets for therapeutic intervention. Breastfeeding and birth trauma were key areas with which women felt they needed support with but which was not easily available.
authors.forename: Rose
authors.initials: R
authors.lastname: Coates
authors.affiliation: Centre for Maternal and Child Health Research, School of Health Sciences, City University London, 1 Myddelton Street, London EC1R 1UW, UK. Susan.Ayers@city.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Ayers
authors.forename: Richard
authors.initials: R
authors.lastname: de Visser
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001942:Breast Feeding / Q000523:psychology; D036861:Delivery, Obstetric / Q000523:psychology; D004644:Emotions; D005260:Female; D006167:Guilt; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology; D008016:Life Change Events; D001523:Mental Disorders / Q000523:psychology*; D009034:Mother-Child Relations / Q000523:psychology; D009035:Mothers / Q000523:psychology*; D011181:Postnatal Care / Q000523:psychology; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D036301:Qualitative Research; D012380:Role; D020377:Self Efficacy; D055815:Young Adult