Making the parenthood transition in a small town

Families across Australia live in busy cities, small towns and large remote properties. Pregnancy and new parenthood can provide challenges no matter where you live but those living in regional, rural and remote areas face unique situations.

Adelaide's story

Adelaide Williams moved from Tasmania to Bendigo in regional Victoria not long before becoming pregnant. She didn’t have any friends or family in Bendigo, other than her husband.

In the beginning Adelaide found the pregnancy exciting but unfortunately, she soon began to experience debilitating hyperemesis which impacted on her mental health.

Adelaide was classified as higher risk of postnatal depression by the hospital which meant that she saw an obstetrician for each of her antenatal visits rather than a midwife. However, due to a breakdown in communication, her history wasn’t recorded properly in her notes and she was regularly questioned by doctors as to what she was doing there.

Eventually in her third trimester, one of the nurses at the hospital investigated further and realised Adelaide was at high risk due to her mental health, yet nobody had been properly monitoring her.

Adelaide’s GP who had been managing her mental health prior to her pregnancy wanted her to stop all her medications, despite her mental health challenges.

Adelaide remembers the worst point was when she went to see someone through the mental health triage service at the hospital and was asked why she was depressed when she had planned her pregnancy.

I said, ‘Well, I don’t know why I’m depressed. I’m here for help, I’m not here to be told that my thoughts are not valid’. 

Adelaide was told that when the baby came she would be happy and, in the meantime, she needed to stop all her medication.

She reflects that at that point there weren’t any other services easily available.

Later in her pregnancy she managed to see a perinatal psychologist in Bendigo who was fantastic.

‘She validated all my feelings and she put me back on my medication’, said Adelaide.

Things got better for a while but towards the end of her pregnancy Adelaide tried to make an appointment to see her perinatal psychologist again but she had left the area.

This lack of continuity of care can be a big issue in regional, rural and remote areas.

Adelaide said that her biggest fear was being isolated. She had no family around, she had to give up work and none of her friends had children.

What helped Adelaide was to maintain connections with her family via video calls and to continue to maintain her work relationships by visiting her work colleagues during their lunch breaks.

She went on to have a second pregnancy and coped much differently with proper support in place.

Post pregnancy, Adelaide continued to foster the behaviours that worked for her including seeing her psychologist, taking her medication, doing mindfulness exercises using the Headspace app, video calls to her family and practicing acceptance of what she couldn’t change such as not fighting her body (in regard to the pain she experienced from pelvic girdle issues).

Barriers to support in regional areas

Dr Rochelle Hine, a social worker and mental health professional, reiterates that there is a lot of isolation for women outside the city, particularly for those who have mental health challenges, as they may not conform to the expectations and normal culture roles that are expected of women in these communities.

‘I really encourage people who have mental health challenges (and everyone really) to talk about the difficult times and to share your struggles and ask for help’. 

As well as the lack of available services, one of the other barriers in regional areas are attitudes and an underlying ‘she’ll be right’ culture.

Help seeking, particularly amongst men, is not so common in regional, rural and remote areas but initiatives, such as Mental Health Mondays, are popping up in the community to encourage people to start a conversation.

Dr Hine says, ‘What we need to do everywhere is have those brave conversations about things that are difficult and challenging in life. If we don’t talk about it, individuals can think that they’re the only ones experiencing these challenges’. 

Some of the other barriers in regional, rural and remote areas can be lack of anonymity. People you know may be the ones working at your local mental health service (if you have one).

For First Nations people these issues compound even further because the communities can be much smaller and more intimate.

Finances are also another barrier to seeking support. While some public mental health services may be available, many services require out of pocket funding and that is just not an option for many people.

Travel is another barrier for people living in regional/remote/rural areas because public transport can be very limited and services such as taxis or Uber either don’t exist or are prohibitively expensive.

Often people in remote areas will delay seeking help because of the subsequent burden placed on their family, for example being away from home for many hours or significant petrol costs.

So, what are the best ways to seek support for those in regional, rural and remote areas?

Finding connections online can be a great opportunity to share your thoughts with communities both near and far. Online parenting groups can offer a lifeline when you don’t have anyone nearby to turn to.

If online isn’t for you, try reaching out to your local GP or maternal child health nurse and tell them how you’re feeling. They may be able to recommend other services for you.