Dr Finbar Hopkins awarded PhD for research into maternal & child mental health

Earlier this year, CPN Nursing lecturer Dr Finbar Hopkins was awarded her doctorate for a PhD thesis titled From woman to mother: exploring maternal representations from pre-pregnancy to early motherhood.

Drawing on the work of psychoanalytic theorist Daniel Stern, the study explored the ‘maternal representations’ in a group of 15 first-time pregnant women attending a Midwives Clinic in metropolitan Melbourne for routine antenatal care. The study’s working definition of ‘maternal representations’ was the “fantasies, hopes, fears and dreams memories from own childhood, models of parents, and prophesies for the infant’s future” that were held by participants (Stern 1995, p85).

The study identified the concept of maternal representations as “playing an important facilitating role in how a woman becomes a mother, by helping her to prepare a ‘new’ mindset that supports her to transition from woman to mother”, says Dr Hopkins. “Exploring maternal representations helps facilitate the creation of ‘new’ imaginings, peopled with images of the pregnant woman as a mother – as well as of her unborn infant, her partner and significant others - that will support her to achieve her goals of motherhood.”

In November 2017, Dr Hopkins presentation at the Australian Association for Infant Mental Health Conference on the topic of Maternal Representation and Midwifery Ethics. The presentation drew on the results of this PhD research, and further proposed an ethical and educational framework for introducing the concept of maternal representations into midwifery practice in routine antenatal care settings in an Australian context. Of particular focus was the ethics of informed consent and the mother’s right to privacy; a consideration “sparked”, says Dr Hopkins, by a UK a Guideline for Midwives  Maternal Emotional Well Being and Infant Development (2012). These guidelines specifically direct midwives to encouraged mothers-to-be explore maternal representations, but they also “recommend that a woman is referred to a clinical psychologist if she shares very negative images of her unborn child, or if the midwife believes the woman is disengaged from her unborn child”, she said.

Dr Hopkins makes the case that “most critical” to an ethical and educational framework for introducing maternal representations into Australian midwifery practice, “is that [these frameworks] are contextualized by the ethic of informed consent”.

Informed consent “allows the mother to consent to exploring her maternal representations in a safe and reflective space. It also means that midwives have clearly defined outcomes for maternal emotional and psychological wellbeing, as well as understanding the impact and importance of maternal representations on the mother-infant relationship”, says Dr Hopkins. She believes that any guidelines in the Australian context “should also include a defined pathway for when to refer and whom to refer to, in instances where midwives identify maternal representations as a risk to maternal emotional wellbeing”.