The hot topic for the September 2015 MIDIRS Midwifery Digest issue is “Maternal mental health – everyone’s business”, highlighting crucial statistics of pregnant women’s mental health and a campaign to encourage more women and midwives to talk about it.
According to research, more than 1 in 10 women will experience a mental illness during pregnancy or within the postnatal period. Various campaigns across the UK are now addressing the subject of maternal mental health and offering advice to midwives on how to assist pregnant women regarding the sensitive subject.
Maternal mental health – everyone’s business by Maria Bavetta
The Maternal Mental Health Alliance (MMHA), founded in 2010, is a coalition of nearly 80 national professional and patient-led organisations committed to improving the mental health and well-being of women and their children, in pregnancy and the first postnatal year. Although in the past 20 years there has been increased interest in perinatal mental health research, and individual examples of excellent models of care existed prior to the formation of the MMHA, the availability of perinatal mental health services across the United Kingdom (UK) has not improved for all British women. There exists a ‘postcode lottery’ in which equitable access to services is being denied to many of the women who need it. MMHA members remain committed to collectively attempting to change this, in part through the MMHA’s ‘Everyone’s Business’ campaign.
In the UK, mental illness in pregnant and postnatal women often goes unrecognised, undiagnosed and untreated. When untreated, perinatal illness can have a devastating impact on the affected women and their families. The costs of undiagnosed or untreated perinatal mental illness include:
Avoidable suffering: perinatal mental illness can cause intense, debilitating suffering for women and in severe cases lead to suicide and, although very rarely, infanticide.
Damage to families: perinatal mental illness can have a long-term impact on a woman’s self-esteem and her relationships with her partner and family members.
Impact on children: perinatal mental illness can have an adverse impact on the interaction between a mother and her baby, affecting the child’s emotional, social and cognitive development.
Economic costs: the economic cost to society of not effectively treating perinatal illness far outweighs the cost of providing appropriate services.
Midwives and maternal mental health
The NHS mandate sets an objective to ‘…work with partner organisations to ensure that the NHS reduces the incidence and impact of postnatal depression through earlier diagnosis, and better intervention and support’ (Maternal Mental Health Alliance:17-18); ensuring Specialist Mental Health Midwives in every maternity service, promoting parity between physical and mental health in maternity care, improving midwife knowledge and skills, developing pathways, supporting colleagues and mothers and their families; this will play a valuable part in delivering on this mandate. The MMHA, together with the RCM and NSPCC has developed guidance on Specialist Mental Health Midwives (Maternal Mental Health Alliance 2013).
To support work in this area, the RCM undertook a recent survey of Heads of Midwifery to investigate in more detail midwifery provision across the UK for women experiencing perinatal mental illness, and to gather contact details for midwives who may be interested in joining an online network (RCM 2014). Of the 77 Trusts/Boards which responded to this survey (46% response rate):
- Twenty-three per cent said they had one or more specialist mental health midwives.
- Twenty-nine per cent said they included mental health in a wider specialist midwifery role or caseloading team for vulnerable women.
- Forty-eight per cent said they did not have any specific midwifery post (RCM 2014).
The research revealed that there is little consistency in how perinatal mental health services are being delivered in different Trusts, and that a Specialist Maternal Mental Health Midwife role can be isolating. It was identified that midwives either take on an operational approach, focusing on caseloads etc. or a strategic approach, focusing on ensuring the correct pathways are in place.
The research also acknowledged that midwives are not mental health practitioners and very importantly need to understand when and to whom to refer a mother with perinatal mental health problems. It can be a very frustrating position for a midwife who recognises that a mother needs support, to be forced to deal with this without a clear pathway and access to the services crucial to the mother’s well-being.
The good news is that the latest cohorts of midwives have education and learning sessions on perinatal mental health within their core pre-registration training. However, like other new registrants, they need continuous development and updates. Awareness and understanding of perinatal mental health problems are essential for all midwives and the Everyone’s Business campaign would like to see increased parity of esteem between physical and mental health reflected in such training.
Maria Bavetta is Campaigns Communications Officer for the Maternal Mental Health Alliance.
Keep up to date with the latest research and news from MIDIRS by subscribing to our quarterly academic journal. Subscribe to MIDIRS Midwifery Digest
The full article can be found: MIDIRS Midwifery Digest, vol 25, no 3, September 2015, pp277-282.
Original article. © MIDIRS 2015
Image: Alena Ozerova @Fotolia