Midwives NHS MSWs – Maternity Support Workers Caring For You campaign Caring For You Charter Race matters
Perinatal mental health (PMH) is the principal term for mental ill health during pregnancy and the first postnatal year. It can be defined by either an existing mental health illness or a condition that arises during pregnancy or related to pregnancy.
Perinatal mental health problems can affect up to one in five women during pregnancy and up to one year after birth (Khan 2015). Common perinatal mental illnesses include anxiety disorders, depression, post-traumatic stress disorder (PTSD), eating disorders and stress-related conditions such as adjustment disorder. The effect of mental ill health in the perinatal period does not only impact on the woman or birthing person, but also affects their children, partners, family, and friends (Howard & Khalifeh 2020). Financially this is also felt, with untreated perinatal mental ill health costing over 8 billion pounds (Bauer et al. 201).
Midwives can help to identify and support women with perinatal mental illness by asking everyone, regardless of history, socioeconomic status or religion, how they are feeling at every appointment, not just at booking. As midwives we have opportunity to break down the barriers to accessing mental health support by linking women and birthing people to a wide range of services. Each Trust should have access to a specialist perinatal mental health midwife who can aid in training and signposting to services. Services range from talking therapies (IAPT), specialist perinatal mental health teams, newly created maternal mental health services and thjrd sector charity organisations.
More than any other illness, mental health disorders are subject to stigmatisation, resulting in social exclusion and prejudices (Mental Health Foundation 2021). Stigma leads to isolation, discrimination, stereotyping and results in a delay of treatment or support that could improve the quality of life for the families that we care for (Kingston et al. 2015).
Being a part of a group normalises conversations to tackle stigma now and for future generations. As the investment in mental health services increases and access improves, women and families will be encouraged to talk openly about their mental health. In time it is hoped that education and awareness of mental health conditions during pregnancy will increase and in turn stigma will become less of a societal issue.
In 2020 the whole world was thrown into chaos with the appearance of Covid-19. We endured many restrictions including lockdowns, families were unable to be together, support each other in the way they needed and connecting with others became distanced or virtual. For healthcare including maternity, this resulted in some reduced face to face contact with women, birthing people and families during the antenatal period (Bridle et al. 2022). The result was a decline in mental wellbeing which had a detrimental effect on women and the whole family.
In the UK, minority ethnic groups have a higher burden of common perinatal mental health disorders when compared to the majority white population (Watson et al. 2019). Factors that impact on minority ethnic women’s ability to receive adequate perinatal mental health support include; a lack of awareness about mental ill health, cultural expectations, ongoing stigma, culturally insensitive and fragmented health services and interactions with dismissive health providers.
When considering the concept of reflection, it brings the role midwives play in supporting women and birthing people to reflect on all of their options when it comes to birth and advocating for them to make informed decisions. Considering mode of birth and choices around birth care can be even more challenging for women and birthing people who are facing mental health challenges; particularly when it comes to severe anxiety around childbirth. Tokophobia – a fear of childbirth – is a relatively common although less talked about condition, affecting around 14% of women (Mycroft, R and Taha, S, 2018).
Providing a supportive space for women and birthing people to reflect on their anxieties and worries around birth and discussing ways in which they can feel a sense of control over their body and their choices, can make a fundamental difference to women’s experiences of pregnancy, birth and early motherhood.
Maternal Mental Health Awareness Week is a week-long campaign devoted to talking about mental illness during the perinatal period. It focuses on promoting public and professional awareness of perinatal mental health difficulties, advocating for women and birthing people affected by it, tackling stigma and assisting families to have access the information, care and support they need to recover.
The week is organised and led by the Perinatal Mental Health Partnership UK, who launched the first-ever UK Maternal Mental Health Awareness Week in 2014. The group includes women with lived experience, who came together to raise awareness of maternal mental health.
