World Federation of Occupational Therapists Bulletin

ISSN: 1447-3828 (Print) 2056-6077 (Online) Journal homepage: https://www.tandfonline.com/loi/yotb20

Preparing for motherhood: a role for occupational

therapy

Vinita Acharya

To cite this article: Vinita Acharya (2014) Preparing for motherhood: a role for occupational
therapy, World Federation of Occupational Therapists Bulletin, 70:1, 16-17, DOI: 10.1179/
otb.2014.70.1.005

To link to this article: https://doi.org/10.1179/otb.2014.70.1.005

Published online: 11 Dec 2014.

Submit your article to this journal

Article views: 383

View related articles

View Crossmark data

Citing articles: 2 View citing articles

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=yotb20
Preparing for motherhood: a role for occupational
therapy
Abstract: Parenting as an occupation is significant as it can influence the overall develop-
ment of a child. Clients with mental illness may find it challenging to cope with the demands
of parenting. Occupational therapy can assist women with mental illness in performing their
role as a mother. Preparing for motherhood can ensure that the mother gets the opportunity
to nurture her natural maternal instinct and the child can receive good emotional and physical
environment which would lay the foundation for its future emotional health. Clients with mental
illness and children of parents with mental illness can both benefit through occupational therapy
in preparing for motherhood. Occupational therapy with its unique holistic approach can make
it possible for women with mental illness to have a good self-concept of themselves as mothers
through competency building and skills training.

Mental illness, role development, parenting, caregiving.

Vinita Acharya1
(India) Key words:

Introduction
Parenting as an occupation is significant because of the
contribution it makes to the overall development of a child.
The physical and emotional implications of parenting on
the child’s well-being are well-documented. (Kagan 1999,
Howard et al 2011) Parenting can be quite trying for normal
individuals at times owing to the inherent challenges involved
which require significant amounts of patience, decision
making ability and emotional stability. (Malekpour 2007)
Clients with mental illness can be expected to have more
difficulties in performing their role as parents due to fre-
quent hospitalizations, emotional outbursts, inadequate
coping skills and lack of clarity about their role as parents.
(Nicholson et al 1998)
Reason for new practice
In a country like India, where marriage and children is
the norm more than exception, almost every woman is
expected to get married and have children. It often leads
to women marrying young and into families chosen by
their parents. The decision to have a child is often assumed
and not made consciously by the woman. Pregnancy in
women with mental illness can be an extremely turbulent
time with issues of self-doubt looming large in their minds.
Hence, occupational therapy can play a significant sup-
portive role in helping women assume the role of a mother
and successfully perform it.
1
Assistant Professor (Sr. scale), Manipal College of Allied Health Sciences,
Manipal University, India.
Background
Mrs S was a 29- year old married woman diagnosed with
Emotionally Unstable Personality Disorder and Bipolar
Affective Disorder. She had been married for 4 years and
her husband was not aware of her diagnosis before marriage.
She was seen by an occupational therapist during her hos-
pitalization in an acute in-patient ward of a tertiary hospital.
She had been brought in for anger outbursts and aggressive
behavior towards her husband and family members. Her
husband had taken her to her mother’s home as she had
been increasingly showing aggression towards him and
had frequent mood swings. At the time of admission, she
was 7 months pregnant. This was her second pregnancy
and she had suffered a miscarriage the first time. On inter-
view, she appeared ambivalent about the child, believing that
she would not be able to take care of the child. She planned
to keep the child with her mother till the child was 10 years
of age and then take over care when she thought she could
manage. She said she could not take care of a young child as
she did not have enough patience and she would not be able
to handle the routines of feeding and caring for the baby.
Role of occupational therapy
The Person-Environment-Occupation (P-E-O) (Law et al
1996) model was used to address the concerns expressed
by Mrs S about her abilities to handle the baby.
Person
She attended occupational therapy sessions where she was
engaged in diversional activities to calm her down. She

16 WFOT Bulletin Volume 70 November 2014

preferred colouring and drawing activities. Gradually she
was encouraged to speak about her expectations and feelings
about the unborn child. She revealed that she would love
to have a child but that she was not confident about handling
the child. She mentioned that her family members had
expressed doubt about her abilities as a mother; hence she
did not want to take a chance. Cognitive Behavioural Therapy
(CBT) (Williams and Garland 2002) techniques were used
by the occupational therapist to help prepare her for the
impending motherhood and look at her limitations as a
problem to be solved rather than as total inability. Her occu-
pational therapist explained the importance of mother-child
bonding in the early years of childhood and how it would
leave a lasting impression on the child. She was encouraged
to visualize herself caring for her child and how happy she
would feel when the baby called out to her. She was assured
that she could learn caring for her baby with her mother’s
assistance and need not completely withdraw herself from
the responsibility of being a mother. She was helped to identify
and challenge her cognitive errors regarding parenting.
Environment
The occupational therapist explained to her mother the
need to reassure Mrs S of her abilities and support from
family members. Her in-laws were involved in a family-
centred approach and learned the need to free her from
her domestic responsibilities enough to let her have more
time with the child. This would ensure that she did not feel
overwhelmed with the responsibilities of caring for the
child and could minimize her mood swings. Since she was
going to be at her mother’s place for the initial months
post-delivery, her mother was asked to supervise and assist
but not do everything for the child. She was asked to make
a conscious effort to let Mrs S be involved in order to gain
confidence through doing.
Occupation
Mrs S was encouraged to learn about mothering and child-
care through simple books and educative materials. She
was made to feel competent by practicing simulated child-
care tasks through holding, handling and carrying a doll.
She was encouraged to sing lullabies or soothing songs
while rocking to calm herself and the ‘baby’. She also made
a collage of baby pictures and wrote motivating affirma-
tions on the poster to remind herself of how much she valued
being a mother and that she could learn to be a loving mother.
In addition, she practiced relaxation techniques like deep
breathing and visual imagery to tide over stressful moments.
Implications and impact
Though Mrs S was seen for a short duration of about two
weeks, the satisfaction and confidence expressed by her by
WFOT Bulletin Volume 70 November 2014
the end of the two-week period was encouraging. She had
changed her view, showed more confidence, and looked
forward to play her role as a mother.
Conclusion
Occupational therapy can play a significant role in helping
a woman to develop competencies for the role of a mother.
In cultures like India, where extended family members are
often available to take care of children, women with mental
illness may not be encouraged to spend time with their
child, leading to weak mother-child bonding or negative
feelings of the child towards the mother and even of the
mother towards herself. Also due to lack of rehabilita-
tion facilities for mental health, women with mental illness
may give up their children or the opportunity to have
children thinking they may not be able to handle these
responsibilities. Their children may be abandoned or left at
orphanages putting the future of these children at risk.
Such incidences may be avoided if these future mothers
are supported and develop confidence about parenting.
Preparing for motherhood can ensure that the mother gets
the opportunity to nurture her natural maternal instinct
and the child can receive a good emotional and physical
environment which would lay the foundation for its future
emotional health.
References
Howard, K., Martin, A., Berlin, L.J., Brooks-Gunn, J. (2011) Early Mother-
Child Separation, parenting, and child well-being in Early Head Start
Families. Attachment & Human Development, 13(1), 5-26.
Kagan, J. (1999) The Role of Parents in Children’s Psychological Development.
Pediatrics, 104, 164-167.
Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., Letts, L. (1996)
The person-environment-occupation model: A transactive approach
to occupational performance. Canadian Journal of Occupational
Therapy, 63, 9-23.
Malekpour, M. (2007) Effects of attachment on early and later development.
The British Journal of Developmental Disabilities, 53,(2), 81-95.
Nicholson, J., Sweeney, E.M., Geller, J.L. (1998) Focus on women: Mothers
with mental illness: I. The competing demands of parenting and living with
mental illness. Psychiatric Services, 49(5), 635-642.
Williams, C., Garland, A. (2002) A cognitive–behavioural therapy assessment
model for use in everyday clinical practice. Advances in psychiatric
treatment, 8, 172-179.
Address for correspondence
Mrs Vinita Acharya, MOTh
Department of Occupational Therapy
1st floor, Manipal College of Allied Health Sciences
Manipal University, Manipal
Dist. Udupi, Karnataka. Pin-576104, India
Email: vinita.acharya@manipal.edu
17