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Maternal mental health care needs to improve


maternal health care a major issueExperts call for more resources for both aspects of pregnancy – physical and mental health.

A recent Guardian roundtable discussed the glaring gap between physical and mental health care provision for pregnant women.

The focus was on maternal mental health and on what needs to be done to help prevent, diagnose and treat any problems experienced by women during pregnancy and in the first year of their baby’s life.

And to encourage a free and frank discussion, the event was conducted under the Chatham House Rules, so comments are not attributed.

The current disparity in mental health provision is an example of the – until very recently – relatively typical approach to mental health care as an afterthought to physical health.

In maternal care, however, this is particularly dangerous and further amplified because mothers so rarely acknowledge mental illness, either in part or fully.

Many women cover up their real feelings – often because they fear that their child will be taken away.

More than half of all pregnant women experiencing some sort of depression or other mental illness do not discuss their feelings even with their partners.

And the feeling of being unable to discuss their situation with anyone is further exacerbated by the lack of continuity of care within the NHS.

Participants at the roundtable included specialist midwife Katrina Ashton (Medway Maritime Hospital); Steven Dalton, chief executive officer (Mental Health Network); Belinda Phipps, chief executive officer (NCT); Dr Tara Lawn, consultant in perinatal psychiatry (City and Hackney Centre for Mental Health); Sally Russell, managing director (Netmums); and Cathy Warwick MBE, chief executive offer (Royal College of Midwives).

Several of the participants mentioned continuity of care as an important aspect when it comes to improving maternal mental health care provision, particularly as it has become increasingly rare for a pregnant woman to see the same midwife, or midwives, throughout her pregnancy.

Other pressures that appear to play a large part in suppressing the reporting or discussion of maternal mental health appear to stem from the societal archetype of pregnancy and motherhood as an idyllic achievement and point of extreme happiness.

That this is not always the case, is something that inspirational speaker Elaine Hanzak knows well  -the pressure a woman feels to enjoy pregnancy and a new baby.

“I felt I wasnʼt ‘the type’ to get depression.

“Normally, Iʼm an outgoing, optimistic, positive and strong person who thought that as a new mum I ‘had it all.’

“I wanted the baby, I had a lovely home, supportive husband and family and a teaching job that I loved.

“And to add to my own reluctance to admit that I was ill, one colleague said that I should ‘count my blessings and pull myself together,’ while another said that she knew I was putting on this problem because I wanted a longer maternity leave.”

After a difficult pregnancy and birth, Hanzak was eventually admitted to a hospital for two months to help her recover from puerperal psychosis, the most severe form of postnatal depression.

But because there is currently a lack of facilities, many women may find it difficult to get the specialist treatment they need.

One roundtable participant pointed out that ‘there are only 19 mother-and-baby units in England, none in Northern Ireland, two in Scotland and one in Wales.’

Such small numbers mean there is a high probability that a mother needing specialist hospital care could, if she were moved to a such a unit, be separated from her family at a time when she is most in need of extra support.

Even worse is the potential for a new mother to be separated from her baby, which, for a woman already suffering from mental ill-health, may be one of the most difficult things for her to recover from.

With the rising birthrate and understaffing putting midwives under increasing pressure, it is understandable why only 29 per cent have specialist training in mental illness.

Information and campaigning organisations such as the Child and Maternal Health Intelligence Network, the Maternal Mental Health Alliance and the Joe Bingley Memorial Foundation are increasingly drawing attention to the multi-generational impact of maternal mental health.

The Maternal Mental Health Alliance is a coalition of UK organisations committed to improving the mental health and wellbeing of women and their children in pregnancy and the first postnatal year.

‘This acknowledges the extensive evidence that investing in mental health at this early stage can have a dramatic impact on long-term outcomes for mothers, fathers, children, families and society.’

Roundtable participants felt that one relatively simple change could produce rapid and dramatic improvements in maternal mental healthcare – to shift the emphasis of care in the perinatal period (three months before to one month after the birth) from only physical to an equal combination of physical and mental.

While birth is of course a physical event, it is also a dramatic and emotional life change.

The outlook is not bright in terms of additional funding and investment in maternity care, particularly as the government continues to ask the NHS to make savings.

As consultant obstetrician Dr Joanne Topping said, ‘A unit this size [Liverpool Women’s Hospital] should have a consultant present 24/7.

‘At the moment we usually have that for 14 or 15 hours a day.

‘Our aim is 24/7, but that would need us to have four more consultants, which would cost £400,000. Given our £4 million cost-saving target, realistically we aren’t going to get those consultants.’

Much remains to be done in order to provide the level of maternal mental health care that women should have in the UK, making the work of campaigners and health organisations increasingly important.

We need to keep talking about it to make sure it happens.

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