Maternal Mental Health: Healthwatch England publishes report asking parents about their experiences
At Baby Lifeline our mission is always to ensure the safety of mother and baby by promoting best practice. As part of this work we undertake a great deal of evidence based research, as well as keep up to date with wider research within the maternity sector. This helps us to understand where best to focus our new course commissioning efforts for Baby Lifeline Training.
Our new Delivering Excellence in Perinatal Mental Health Care training course is available for booking. This course enables non-mental health practitioners to identify and effectively interact with women suffering with their mental health. Find out more and book a place on our course page.
Maternal mental health services in the NHS are gaining more investment – £365 million of funding to support a phased, five-year transformation programme. This programme aims to increase the capacity and capability of staff in specialist perinatal mental health services.
The programme will focus on “improving access to and experience of care, early diagnosis and intervention, and greater transparency and openness” – NHS England.
Research in to Parental Mental Health
In order to shed light on whether parents are getting what they need, Healthwatch England published a report today which looks at the experiences of parents who had a diagnosed or undiagnosed mental health problem before, after, or during pregnancy. They found that while every individual’s experience of having a child is unique, there were also common triggers that could lead to mental ill-health. Baby Lifeline was delighted to be one of the partner organisations that worked with Healthwatch England to expand the project.
What was Healthwatch told?
From their research it emerged that it is never as simple as a single cause. Sickness during pregnancy, difficulties breastfeeding, sleep deprivation, physical illness, a traumatic birth, and a history of mental health challenges are just some of the triggers that can contribute to someone experiencing mental ill-health.
The report found that there was a general stigma surrounding mental health and speaking up about it, and parents felt that there was a distinct lack of information about where to get support. This is a major factor which can prevent people getting the help they need. The general consensus is that people would like more opportunities to discuss their mental well-being.
“I didn’t recognise I was ill, I just thought I had failed, that the boys deserved a better mother, and I thought everything would be better once I was physically well. I was so ashamed to talk about how I was feeling, because we’re told how lucky we are to have a baby.”
The consequences of substandard care
The last review of maternal mortality by MBRRACE-UK (2018) reported that over half of mothers who committed suicide may have had a different outcome if their care had been improved (54%) . It was found that only 15% of those women had “good care”.
In a survey by the Royal College of Obstetricians & Gynaecologists (RCOG), 81% of women reported that they had experienced a maternal mental health problem; however, only 7% were referred to specialist care .
In the same report, women reported that there was no consensus among health professionals about medication for existing mental health conditions during or after pregnancy.
- Maternal suicide is the leading cause of direct deaths occurring within a year after the end of pregnancy, and the third largest cause of direct maternal deaths occurring during or within 42 days of the end of pregnancy .
- For almost one in five women who died in 2016, there was no evidence they had been asked about a history of mental health problems .
- Mental ill-health during pregnancy or in the year after giving birth is not rare – one in five women will experience a mental health problem during pregnancy .
- It has been estimated that maternal mental health problems cost the UK £8.1 billion each year .
- Maternal mental health issues such as depression have been shown to be a factor that could adversely alter pregnancy outcomes; it has been linked to smoking, substance abuse, hypertension, preeclampsia, and gestational diabetes [4-6]. In addition, it has been shown that women with depression during pregnancy are at increased risk for preterm birth and low birth weight .
What can be done on the frontline?
Currently the NHS is focusing on increasing capacity. In 2014 there were only 17 In-Patient Mother and Baby Units in England providing just 122 beds. NHS England estimated that just 3% of the country had good access to services. NHS England has promised a plan for full provision by 2021, with phased implementation ongoing until then.
Now that capacity is increasing nationally in speciality units, all professionals who care for women in pregnancy and postnatal care need to be able to identify, effectively interact with, and appropriately manage women suffering with their mental health.
The RCOG reported that awareness among women and healthcare professionals of the range of mental health conditions and services available is poor , and that there is an unacceptably wide variation of care across the UK.
A recommendation from the RCOG report in 2017 was that “maternal mental health conditions are wide-ranging and all conditions should receive attention”. Training healthcare professionals to help them recognise symptoms and provide accurate, timely information to women is crucial”. 
Insight from the frontline
In 2018 Baby Lifeline conducted research and published the Mind the Gap Report. This study found that in 1 out of 4 trusts perinatal mental health training was not mandatory for any group of staff (2017/18) .
Of the 88% of trusts that provided training perinatal mental health in the last financial year, it was only mandatory for 30% of obstetricians and 35% of maternity support workers. We know from our experience that multi-professional training in this area is imperative. In addition, almost one-third of trusts did not evaluate the training provided. It was recommended by the Mind the Gap Report that the whole maternity team should be equipped to recognise and manage perinatal mental health. 
Get in Touch
If you are interested in Baby Lifeline Training and want to find out more, please visit the Training site where you can browse our catalogue of courses. You can also follow Baby Lifeline Training on Facebook, Twitter, Instagram and LinkedIn.
- M. Knight, K. Bunch, D. Tuffnell, H. Jayakody, J. Shakespeare, R. Kotnis, S. Kenyon and J. Kurinczuk (2018). Saving Lives, Improving Mothers’ Care. Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014–16. National Perinatal Epidemiology Unit, University of Oxford, Oxford.
- Royal College of Obstetricians and Gynaecologists (2017). Maternal Mental Health – Women’s Voices. Royal College of Obstetricians and Gynaecologists, London.
- NHS England. Perinatal. Retrieved from https://www.england.nhs.uk/mental-health/perinatal/.
- Alder J, Fink N, Bitzer J, Hösli I, Holzgreve W (2007). Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? a critical review of the literature. J Matern Fetal Neonatal Med. ;20(3):189–209.
- Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G (2004). Perinatal risks of untreated depression during pregnancy. Can J Psychiatry. 49(11):726–735.
- Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis (1987). Bull World Health Organ. 65(5):663–737.
- Grote N, Bridge J, Gavin A, Melville J, Iyengar S, Katon J (2010). A Meta-analysis of Depression During Pregnancy and the Risk of Preterm Birth, Low Birth Weight, and Intrauterine Growth Restriction. Arch Gen Psychiatry. 67(10): 1012–1024.
- Baby Lifeline: S. Ledger, G. Hindle and T. Smith (2018). Mind the Gap 2018: An Investigation into Maternity Training for Frontline Professionals Across the UK. Baby Lifeline.