stories of women involved in a postpartum depression peer support group

Feature Article_828 1..9

Stories of women involved in a postpartumdepression peer support group

Phyllis Montgomery, Sharolyn Mossey, Sara Adams and Patricia H. BaileySchool of Nursing, Laurentian University, Sudbury, Ontario, Canada

ABSTRACT: Living through postpartum depression (PPD) might lead women to seek a variety ofsupport to re-establish their well-being, including a hybrid of traditional and non-traditional services.Within this mix, some women participate in peer groups; however, there is a paucity of researchregarding their subjective experiences of engaging in this type of support. The purpose of this studywas to describe how women talked about living through PPD in the context of a peer support group.This focused ethnography was a component of a larger participatory action study in northern Ontario,Canada. The seven members of a 5-week peer support group described their postpartum experiencesthrough written, visual, and spoken stories. Using structural narrative analysis, stories about recoverywere identified across the data. Three groups of recovery stories were labelled as illness, motheringwisdom, and mobilizing. The findings suggested that women actively sought and established a thera-peutic space for PPD recovery with peers. As such, health-care providers are encouraged to acknowl-edge the merits and advocate for the multiple and diverse alliances women might require to actualizerecovery.

KEY WORDS: community mental health, women, postpartum depression.

INTRODUCTION

Motherhood is a natural part of many women’s lives.Although largely celebrated and romanticized in manysocieties, it is fraught with initial vulnerabilities thatwarrant internal resilience, external support, and pur-poseful agency for self and family health. During thefirst year following childbirth, an imbalance betweenresources and demands renders mothers at a heightenedrisk for health challenges. In particular, postpartumdepression (PPD) is the most common mental healthchallenge, often undiagnosed, following childbirth(Sword et al. 2008). The reported incidence rates rangefrom 10% to 15% of women in economically-developed

countries (Canadian Psychological Association 2008;O’Hara et al. 1990). Without intervention, PPD is associ-ated with multiple negative outcomes for women, chil-dren, and family health (Dennis 2003; McCarthy &McMahon 2008; Paulson & Bazemore 2010).

Traditionally, PPD research has examined bio–psycho–social causal factors to determine women’s riskand appropriate level of intervention (Dennis & Hodnett2007). Beck (1993) presents an alternative perspectivethat involves women’s subjective experiences of invasiveemotions, negative cognitions, and social withdrawalthat ultimately impede selfhood and result in unfulfilledexpectations as new mothers. In a later metasynthesis of18 studies about women’s experience of PPD illness, thepresence of PPD creates a ‘downward spiral’ away fromtheir perception of agency in mothering (Beck 2002).Further, the trauma of the spiral intensifies withoutmeaningful support.

Even though 30% of women self-diagnose with PPD,the majority do not divulge their concerns to health-careproviders (Whitton et al. 1996). Often their silence or

Correspondence: Phyllis Montgomery, School of Nursing, Lauren-tian University, Ramsey Lake Road, Sudbury, ON P3E 2C6 Canada.Email: [email protected]

Phyllis Montgomery, RN, MScN, PhD.Sharolyn Mossey, RN, MScN.Sara Adams, RN, MScN.Patricia H. Bailey, RN, MSc, PhD.Accepted March 2012.

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International Journal of Mental Health Nursing (2012) ••, ••–•• doi: 10.1111/j.1447-0349.2012.00828.x

© 2012 The AuthorsInternational Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

indirect communication is attributed to fear of childremoval by child protection agencies, admission to apsychiatric facility, being labelled as a ‘bad mother’, andcriticism by others (Beck 1993; Hall 2006; Holopainen2002; McCarthy & McMahon 2008; Sword et al. 2008).Research suggests that silence is preferred over beingmisunderstood by health-care providers (Holopainen2002) or being judged as unable to meet societal expec-tations of motherhood (Berggren-Clive 1998). For thosewomen who seek professional care, services focus pre-dominantly on symptom management. Thereby, somewomen seek peer support to complement their recovery,a resource often not fully understood by health-careproviders (Coatsworth-Puspoky et al. 2006; Raymond2009).

Generally, peer support groups in mental health aredescribed as a therapeutic space for sharing struggles andinformation to help one another effectively address indi-vidual circumstances (Mohr 2003; Ralph 2005). Suchgroups are characterized by one or more of the follow-ing five foci: education, stress management, behaviouralchange, social development, and engagement in tasks(Gitterman & Shulman 2005). Some individuals, how-ever, are reluctant to initiate peer support involvementdue to unfamiliarity with its processes and uncertaintyabout its merits. Despite such apprehensions, situations,such as limited supports and escalating unmet needs,might precipitate initial peer support involvement (Prattet al. 2009; Ralph 2005). With the giving and receivingof mutual aid, a camaraderie and unique bond might beactualized (Coatsworth-Puspoky et al. 2006; Mead et al.2001). The degree of involvement is influenced by thepresence of a trusting milieu that evolves as commonalitiesbecome apparent and group belonging is fostered (Meadet al. 2001). This bond is solidified by shared attributes,such as hope, mutuality, self-acceptance, group validation,and empowerment (Pratt et al. 2009; Resnick & Rosen-heck 2008). A possible outcome of peer support is recov-ery; a process of living with the impact of one’s mentalhealth circumstances (Moll et al. 2009).

Research specific to PPD peer support includes fourqualitative studies (Letourneau et al. 2007; McCarthy &McMahon 2008; Raymond 2009; Scrandis 2005), fivequantitative studies (Dennis 2003; 2009; 2010; Denniset al. 2009; Fleming et al. 1992), two systematic reviews(Dennis & Chung-Lee 2006; Dennis & Kingston 2008),one keynote address (Scott 2008), and one non-researchpublication (Wroblewski & Tallon 2004). This bodyof literature is replete with variability in the structure,format, and approach of PPD peer support. Overall, PPDpeer support interactions generally engage mothers

through a common purpose, providing collective stability.Safe interactions with peers are valued by women, as theyengender compassion and mutuality among ‘mums likeme’, and ultimately lessen women’s sense of marginaliza-tion (Scott 2008). Other researchers report that followingchildbirth, being among like others decreases women’sisolation, secondary to symptomatology (Berggren-Clive1998), and has the potential to heighten hope throughthe building of supportive communities (Beck 1993).Alstveit et al.’s (2010) explorative study involving primi-parous women report that development of trust in parent-ing skills was attributed to the affirmational supportprovided by other mothers.

Some researchers identify a positive associationbetween PPD peer support and recovery. A limitednumber of primary studies specifically explored theuniqueness of peer support in presenting structures andprocesses for women to share their experiential knowl-edge of PPD (Chen et al. 2000; Di Mascio et al. 2008;Mauthner 1995; Raymond 2009). This sharing promotesself-recovery through the validation of like illness experi-ences and identification of mediating resources andstrategies (Letourneau et al. 2007; Wroblewski & Tallon2004). Further, this sharing, which includes the telling ofnarratives, reinforces, expands upon, refines, supports,and positions each woman as a valuable other. In part, thismight constitute what Raymond (2009) introduces asmothers’ ‘safety net’, a network of like women who sharesimilar common understandings about postpartum chal-lenges. In Di Mascio and et al.’s (2008) Delphi study,women describe professional and non-professional inter-ventions essential for PPD recovery. Diagnosis and timelyassessments comprise the professional interventions.The other six factors represent the importance of securingdifferent types of support from partner, family, andfriends for recovery.

Palladino (2010) describes the subjective experienceof PPD recovery as a three-stage process involvinga prelude, igniting, and recounting of recovery. Theimpetus for recovery occurs as women become aware ofhow illness effects their significant others. To address thisneed, they seek support from others, both familiar andunfamiliar, as being a key aspect of recovery. Recountingrecovery is described as a victory, during which womenrealize recovery is possible. Several researchers haveidentified the need for the explication of peer support asa resource for PPD recovery (Coatsworth-Puspoky et al.2006; Holopainen 2002; Sword et al. 2008). Palladino(2010) suggests that an awareness of the discourse amongwomen with PPD in a peer support group by health-careproviders allows them to better attend to women’s

2 P. MONTGOMERY ET AL.


descriptive experiential language and informationalneeds and behaviours. Further, this awareness can informhealth-care providers’ actions to advocate in collaborationwith consumers for comprehensive postpartum servicesbeyond clinical recovery (Mead et al. 2001; Piat et al.2009).

Based on a review of the literature relative to PPD andpeer support, there is a paucity of research regardingwomen’s subjective experiences of engaging in this typeof support. The purpose of this study, therefore, was todescribe how women talked about living through postpar-tum depression in the context of a peer support group ledby a PPD survivor with a respected history of helpingother women with PPD. This study is a component of alarger ongoing community-based participatory action ini-tiative to translate the stories and experiences of womenwith PPD into supportive action. In the parent study, anadvisory committee was created to inform the exploration,planning, implementation, and evaluation of a PPD peersupport programme ‘from the ground up’. The committeewas composed of northern and rural PPD survivors andrepresentatives from national community mental healthassociations, post-secondary educational institutions,psychiatric outpatient clinics, and primary health-careagencies. A deliverable outcome of their efforts was thedevelopment of a Peer Support for Women with Postpar-tum Depression: Meeting Guide (Canadian MentalHealth Association (CMHA) 2009). The creation of thisresource was intended to prepare peer support groupleaders to initiate and facilitate mutual aid throughthe respectful exchange of experiential knowledge, theaffirmation of self-efficacy, and recognition of peer groupmembers’ strengths. The meeting guide included weeklyfoci for the five sequential sessions within the peersupport programme. Suggested topics of discussionincluded establishing expectations of participation, illnessexperiences, parenting in the midst of illness, identifyingand accessing pragmatic supports, and identification andappraisal of their goal achievements.

METHODS

DesignFocused ethnography, a form of traditional ethnography,was used to elicit an understanding of the shared experi-ences situated within a particular naturalistic context(Richards & Morse 2007). Specific to this study, the expe-rience of living with PPD for members of a peer supportgroup was illustrated through the stories told withinthis narrative environment. A description of how women

talked about, and lived through, postpartum depression inthis peer support group was enhanced through participantobservation. This method is particularly suitable, as itoffers a means to strengthen understanding of women’sconstructed realities through description and interpreta-tion of behaviours and social interactions in a naturalsetting bound by time (Hammersley & Atkinson 2007;LeCompte & Schensul 2010). This study received ethicalapproval.

SettingThe setting for the peer support group was selected bythe primary study’s advisory group, based on the availabil-ity of childcare and accessibility to transportation. Thissetting was affiliated with a formal community mentalhealth agency known for its commitment to implementingpeer-based network expansions.

ParticipantsThe seven members of this inaugural peer supportgroup comprised the convenience sample in this study. Inresponse to posters and word-of-mouth recruitment strat-egies, five women attended all peer support group meet-ings, while two women joined for the last group session.The women all spoke English, had self-identified ashaving PPD, were between the ages of 18 and 30 years,had a minimum of high school education, lived with anadult partner and at least one child, and actively soughtpeer PPD support. In their interactions, they sharedinformation inferring current socioeconomic conditionsranging from family financial poverty to both partners of afamily having professional careers.

Data collectionFor 6 months, as a peripheral participant observer(Savage 2000), the invited researcher collected audio-taped data during the five peer group sessions and fivesemistructured individual follow-up interviews with threewomen. Descriptive field notes were recorded followingthe conventions of Montgomery and Bailey (2007). Theweekly 2-hour peer group sessions followed a contentoutline structured by the participants in the parent study(CMHA 2009). At the onset of the peer support group,women were provided disposal cameras and blank diariesto freely record the unfolding of their individual recoveryin the manner of their choice (Bolger et al. 2003). Duringthe group conversations, the sharing of personal stories,images, and journal entries allowed the group membersand the researcher to look sensitively with, rather than at,each woman’s recovery (Alaszewski 2006; Harper 2002).Their captured photographic images and written text

POSTPARTUM DEPRESSION PEER SUPPORT GROUP 3


initiated discussion during the peer group meetings.In addition, three women consented to sharing their pho-tographs and diary excerpts to elicit supplementary datain one-to-one post-group interviews (Bolger et al. 2003;Johnson & Weller 2001). The common introductory ques-tions in these interviews were: ‘What is the story behindthis picture?’ ‘What did you mean when you wrote . . . ?’.This allowed for a more focused inquiry in relation totheir self-initiated stories. All audiotaped recordings weretranscribed verbatim.

Narrative analysisIn the course of conversation, individuals communicatetheir understandings of life situations through the useof stories (Mishler 1986). Systematic examination ofnaturally-occurring stories allows for the development ofthe meaning of everyday experiences (Riessman 2008).For the purpose of this study, a story or narrative wasdefined as ‘a discrete unit of discourse . . . topically cen-tered and temporally organized’ (Riessman 2008, p. 5);what Labov and Waletzky (1967) understand as ‘oralversion of personal experiences’ (p. 12).

A systematic narrative analysis that combines a struc-tural and coherence approach was used to examine thetranscribed transcripts (Bailey 2001). The first step in thisprocess involved the identification of stories within thetranscriptions. These included first-person event-specificstories that described a specific event (Labov & Waletzky1972); generic stories that presented usual or habitualbehaviour (Riessman 2008); and kernel stories that werebegun, but not told (Connelly & Clandinin 1986). Theprevalence of narratives within the data set was thenrecorded as a numeric value. This quantification is simplydemonstrative of the participants’ patterns of narrationacross the data set (Ford-Gilboe et al. 1995). The identi-fied stories were then parsed into their constituentelements, including abstract, orientation, complicatingaction, resolution, evaluation, and coda (Labov &Waletzky 1972). The story elements from across the data-base were subsequently reviewed by the researchers toelucidate the stories’ meanings and functions.

FINDINGS

The participants told 382 stories (generic = 261, first-person event-specific = 116, kernel = 5) about day-to-dayevents in their lives. Within these stories were 181accounts about their focused efforts to recover, inclusiveof parenting, self-caring, help-seeking, and appraising ofprogress. Their recovery stories were labelled into threegroupings based on shared structure, meaning, and func-

tion: illness (n = 94), mothering wisdom (n = 55), andmobilizing (n = 32). To demonstrate the transparency ofthe analytic process (Bailey 1996) and interpretive cred-ibility (Riessman 2008), each of the three recovery storygroupings are presented sequentially. This presentationdifferentiates the uniqueness of the structure, meaning,and function of each story group. As a collective, however,these stories demonstrate an understanding of howwomen in a peer support group talk about recovery inpostpartum depression. To conclude the findings, a casestudy illustrates the parsing of a story into its constituentelements to make the analytical process overt (Table 1). Inaddition to identifying what women talked about in peergroup conversations, the case study exposes how PPDrecovery experiences are storied (Riessman 2008).

ILLNESS STORIES

StructureThese stories focused on the participants’ illness experi-ences that they shared within the peer support group. Thetwo structural elements, ‘the indescribable’ and ‘theimposed reality’ were common to all of the stories. Withinthe first element, women attempted to translate theirsurreal illness experiences using a variety of linguisticexpressions and literary figures of speech. Across thesestories, illness was consistently referred to or inter-changed with the term ‘it’. Although women identifiedillness as ‘not fully explicable’, they did characterize ‘it’ asan overall ‘heaviness’; an ‘endless abyss’. A comprehensiveunderstanding of illness was perceived as elusive to out-siders, since ‘you really have to be a mom to really know’.The women described illness as leaving them ‘numb’,unable to ‘think clearly’, and ‘hopeless’. Within the secondelement, the imposed reality, women described thepervasive and intrusive nature of illness. The presence ofillness was relentless, as ‘it sucked the energy and joy’from their anticipated experiences as new mothers.

Meaning and functionWomen told illness stories in an attempt to illustrate thesubjective invisibility of their plight. In the midst of theinescapable illness, women shared their physical, emo-tional, social, and spiritual frailty, as they were at a loss toindependently ‘stop it’. These stories function to demon-strate women’s will to mitigate the potentially destructiveimpact of illness on their daily lives through dialogueabout their illness with their peers, who share a commonsensibility or symbiotic connectedness. These storiessuggest that attending to, and listening for, each woman’s



individual illness experiences and shifting realities offerscompassionate hope for the range of efforts necessary tolive through ‘it’.

MOTHERING WISDOM STORIES

StructureThe mothering wisdom stories described the women’spresent knowledge base concerning mothering practicesand their perceived information needs for the ultimatepreservation of their child and family well-being. The twostructural elements identified in these stories werelabelled as ‘this I need to know’ and ‘this we know’. Withinthe first element, women identified individual motheringchallenges and solicited remediating information con-cerning such topics as healthy eating, setting boundaries,and catching up on sleep. This quest for peer-basedknowledge was typically prefaced by unencumberedphrases, such as ‘I just have a question’ or ‘I was wonder-ing if you guys have any ideas?’. The second element wasan embodiment of the women’s collective experientialknowledge resources. Peers validated that mothering inillness ‘is very difficult’. Mothering wisdom was createdthrough the exposure of personal disappointments andstruggles inherent in trial-and-error efforts to motherwell. Rather than negating expressed knowledge needs,there was deliberation of plausible solutions couched in

situational considerations. This collective knowing wascomprised of a range of perspectives, at times contradic-tory, but nonetheless grounded in the women’s motheringpractices. Through awareness of ‘tried-and-true’ options,these stories offered cognitive respite, or simply ‘peace ofmind’ in knowing that success as a mother is achievable.

Meaning and functionThrough their stories, women affirmed their individualdesire and capacity to mother well in PPD recovery andhelp others by giving ‘them a bit of advice’. The act ofdisclosing individual knowledge needs served to lessenthe burden of unknowing in silence. The group created arepertoire of practical mothering strategies encompassingknowledge, attitudes, and skills that might be individuallyoperationalized to optimize mothering competency.‘Tried-and-true’ strategies serve as testimonies for perse-verance in challenging circumstances. In addition, con-tributing to the creation of peer-based knowledge servedas recovery capital.

These stories function to reveal a culture of mutual aid.Women living with PPD search for plausible solutionsto problems that impede their self-determination. A safeenvironment, where peers come together, offers a venuefor women to seek, and provides recognition and supportfor each other’s growth as capable mothers in challengingcircumstances. The cognitive support provided within

TABLE 1: Amy’s story of mobilizing recovery

Constituentelements Parsed data

Structuralelements

Abstract When you are going through it, you just get tunnel vision/and you don’t see anything else/it was hard for myhusband seeing me when I was at the worst of the worst/that was getting scary for him, because he was like ‘Iwant my wife back’

Emptying

I wasn’t myself anymore and I was just getting worse and worse/it’s hard to see the big picture/and you just reallyget stuck in your head and your mind plays tricks on you

Appraising

Orientation I found out about this group from a friend/I decided I had to be strong ConnectingComplicating

actionI find that, for me, talking about it helped a lot and reduced my anxieties/the more I talked about it, the more

people opened up about what they went through/and what they did/some of it is just stuff I thought aboutbefore

Emptying

Resolution But here and there you get a question/and it’s like/well/ok/that’s food for thought and that’s always good/I’mtaking the time to acknowledge it/I’m not just/you know/brushing it under the rug/and just kinda ignoring it/it’skinda nice to see different perspectives/and sometimes it’s nice to see other women because I get to see myselfyou know/it just kinda normalizes things/it helps me see the progress that I made, you know/it reminds me ofwhat I accomplished

Appraising

I know I don’t have as much strength or energy right now/so I really have to listen to myself/or else I could getmyself in to a lot of trouble/I try to take a nap/take time for myself/but it’s hard/because you are thinking aboutthe kids/you know/ok/‘do I go for a walk to do I sleep?’/I try to push myself and just think outside the box

Managing

Evaluation It (the peer group) was good/I find it was better to have someone who has gone through it to talk to/it’s morehelpful to talk to somebody with the knowledge/who actually does have a child/verses someone with a lot ofknowledge who doesn’t have experience with it/it’s not that they don’t listen/it’s just that they don’t understand

Connecting

Coda Some of the other women’s stories really got to me/I see how they struggle/and how I struggled/I know where Iam now so I know there is light at the end of the tunnel/so for me it helps to think about the big picture

Managing



peer support meetings allows mothers to be with othermothers who ‘know what I know’. Through the tellingof wisdom stories, they collectively agreed that ‘this isnot easy, but I can do this, and I am capable’. Further,the mothering wisdom stories emphasize the need to berecognized as ‘mother’, not ‘crazy mother’.

MOBILIZING STORIES

StructureWomen told mobilizing stories about what they believedhelped them initiate and sustain their movement throughillness. These mobilizing recovery stories included fourstructural elements: ‘emptying’, ‘appraising’, ‘managing’,and ‘connecting’. The first structural element waswomen’s internal need to ‘tell someone (their) thoughts’and ‘talk about the hard stuff’ as a way of lessening thepsychological distress that accompanies illness. ‘Empty-ing’ themselves of thoughts, emotions, and experiencesnot only allows them to ‘breathe again’, it hopefully‘deletes them’ and ‘reduces anxieties’. The second struc-tural element involved women’s reflective appraisal oftheir self-recovery in comparison to like others. Womenstated that witnessing others go through the same expe-riences allowed them to ‘reflect back on what (they had)been through and where (they are) now’. As a result,women had a ‘renewed hope’, as they were able to ‘focuson the positives’, even if their progress was ‘trivialized’ byoutsiders. They acknowledged their progressive recoveryin part through the witnessing of their child’s develop-ment, ‘laughing out loud’, or simply ‘smiling’ with plea-sure as their child met milestones, despite illness. Thethird structural element, managing, described tangibleresources that helped them cope with illness. Qualitysleep was cited frequently by all women as ‘critical’ forpositive functioning and mood. In addition, time to carefor self was not only described as replenishing, but ‘life-saving’. The final element, connecting, involved recogni-tion of comparable struggles within illness. Hearing thatothers were ‘experiencing the same thing’ normalizedtheir realities. Being with peers allowed for ‘clicking on adifferent level’ that rendered understanding withoutexplanation. The women found comfort in not ‘trying topretend or put up a front’. They knew that the othermembers could ‘relate to you and just sit and talk aboutnothing . . . knowing that it’s still something’.

Meaning and functionThe meaning of these stories was to communicate recov-ery as a dynamic and strategic process of mobilizing thewomen through illness. The women described purposeful

actions that helped lessen their illness symptoms, even ifonly temporarily. By forging alliances with peers, theybenefited from ‘belonging and acceptance’. As a collec-tive, the peer support group negates ‘isolation’, and allowsfor a mutual focus on ‘health issues other than depres-sion’. These stories function to reveal that the womenwere doing the ‘best they can’ with ‘what was available’.The open dialogue within the peer group allowed thewomen to explore pragmatic strategies that support theirlegitimacy as mothers. Such stories highlight the need forvenues intended to give women voice for articulating andaddressing living with illness.

Case exampleAmy, a second-time mother, told a generic story during anindividual interview. Her story is parsed into its constitu-ent elements, and data are highlighted to indicate thestructural elements of mobilizing recovery (Table 1).

DISCUSSION

In Canada, it is recognized that recovery in mental health,although complex, is not only desirable, but achievable(Trainor et al. 2004). Through connections with peopleand systems, recovery is a process that empowers indi-viduals to regain a positive sense of self, manage stigma,and resume agency (Ralph 2005). Women living throughPPD mighty implement multiple strategies informed bymedicine, psychology, social services, and colloquial tra-ditions to alleviate their illness experiences during recov-ery (Di Mascio et al. 2008). In the current study, womenwith PPD sought membership in a peer support groupas a complement to traditional treatment. Engagementwith peers fostered a discovery of shared and individualpathways through illness. Consistent with Ralph’s (2005)findings, recovery processes were evident in their dia-logue of hope-filled actions for well-being and efforts tostrengthen their management of life struggles. As mani-fested in the meaning and function of the motheringwisdom and mobilizing stories in this study, a recoveryorientation was a predominant feature of the PPD peersupport group.

The findings of this study are consistent with theconceptualization of mental health recovery as a processthat occurs over time (Mead & MacNeil 2006; Piat et al.2009). In the present study, peer support involvementoffered an opportunity for individual women to guideand be guided through illness. Participation expandedthe women’s options for recovery, and ultimatelystrengthened their self-determination. Through collo-quial exchange about living with illness, the women in the



present study demonstrated agenic engagement, asdescribed by Laws (2009). Their agenic connections wereapparent in their reciprocal subjective disclosures, provi-sion of experiential knowledge, and evaluation of theirindividual and collective progress through illness. Morespecifically, the cohesiveness in their shared illness expe-riences, mothering wisdom, and mobilizing stories facili-tated the creation of a safe space for recovery. This milieu,a non-professional therapeutic landscape (Laws 2009),enabled a culture of mutual aid (Gitterman & Shulman2005).

Within the therapeutic landscape of this peer supportgroup, the women’s stories provided a descriptive profileof illness, and detailed various pathways for recovery.Peer sharing served to diminish the isolation and silentburden of living with illness. More specifically, their dia-logue often focused on the pragmatics of being capablewomen and mothers in illness. The weight of recovery wasshared, as women affirmed their experiential knowing ofPPD with others ‘who know what I know’. By observingthe recovery of others, peer group members acquired aheightened sense of self-understanding; a critical elementfor taking ownership of recovery (Mead et al. 2001;Solomon 2004). As suggested by Bradstreet (2006), recov-ery is not just the absence of symptoms, but rather theability make choices about how to craft a satisfying lifein the presence or absence of symptoms. In the presentstudy, women were validated in their illness experiences,empowered through confirmation of their caring prac-tices, redirected by the acquisition of new strategies, andencouraged by indicators of their success in mobilizingrecovery.

In conclusion, the PPD support group members in thisstudy represented themselves as confronted by illness andcapable of recovery through informational and affectivepeer involvement. The peer support group offered atherapeutic venue for recovery. Women’s discussions oftheir struggles and successes were shared with the intentof helping oneself and others to move through illness. ThePPD support group, as a viable women-centred recoveryresource, allowed for connections to witness and structureindividual recovery pathways. In an effort to optimizePPD recovery, health-care practitioners are positionedto advocate for the recognition and resourcing of peersupport services as an expansion of the continuum ofPPD services. Peer support group participation mightbe recommended by practitioners to women expre-ssing dissatisfaction and/or the desire to complementprofessional-led services. This study’s findings are notintended to be representative of all PPD support groupparticipants, but rather, make an important contribution

in emphasizing women’s need for self-determination inrecovery, intertwined with genuine support in relationalcontexts. Based on the nature of the stories told in thisstudy, women comfortable with self-disclosure, receptiveto sharing experiential knowledge, and capable of makinginformed decisions, seem amenable to peer connectionsfor recovery.

ACKNOWLEDGEMENT

We are thankful to all the women engaged in this com-munity endeavour, and for the generous funding of theOntario Trillium Foundation.

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stories of women involved in a postpartum depression peer support group

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