Mental health and wellbeing of pregnant women and mothers

This week heralds the 10^th Maternal Mental Health Awareness Week and with it an opportunity to reflect on how far we have come in our journey to promote the mental health and wellbeing of pregnant women and mothers, but also consider what is yet to be done.

The theme chosen by the Perinatal Mental Health Partnership UK (PMHP UK) for this year is “Together in a changing world” which feels very fitting whilst we continue to make sense of the Brave New World in the wake of the first three years of the COVID-19 pandemic. The world as we know it has changed irreversibly and this has been felt by pregnant women and mothers more than many. We have seen rates of perinatal anxiety and depressive symptoms rise, as well as the impact of isolation on this group[i]. Telemedicine has exploded onto the healthcare scene, but research into the risks and benefits of this in maternal mental healthcare is desperately needed to understand what we gain via improved access but also what we miss. From my own clinical experience, trying to interpret mother-infant interactions across a videocall is very hard and on many occasions we don’t see the baby at all as they are tucked in another corner of the room and this is a huge loss so we need to be cautious.

Through all of these changes though, and despite the impact of COVID-19 on funding, the UK continues to be at the forefront of the maternal mental health journey and it is an exciting place to be. With 22 Mental Health Mother and Baby Units in the UK, we have more places for mothers to regain their health with their babies per capita than anywhere else. Additionally, the growth of community perinatal mental health teams across the UK in the last decade has been inspiring, with multidisciplinary teams passionate about supporting maternal mental health in the community. The NHS Long Term Plan stated a commitment for the NHS in England to develop perinatal mental health support even further with much greater access targets. Some of this has been stymied by the impact of COVID-19 but passionate staff across the country are continuing to push through much of the aims to develop services to meet the needs of families better. Tragic cases of neonatal loss and miscarriage leading to mental health difficulties which have until now fallen in the cracks between services, are increasingly being offered support via maternal mental health clinics. Support is also starting to grow for partners as we continue to develop our understanding of the impact of pregnancy and the postpartum period on other members of the family network. The light shone on the importance of maternal mental health by the Royal Foundation Centre for Early Childhood by the Princess of Wales and Dr Trudi Seneviratne OBE continues to be another driver for change in our field.

There is so much more to do though. A statistic that still sends shock waves through me when I think about it, is that suicide is now the leading direct cause of death for women in the first postnatal year and psychiatric disorders and cardiovascular disorders are now responsible for the same number of maternal deaths in the UK[ii]. This needs to change. The huge disparities in maternal health outcomes (both morbidity and mortality) for women from Black and Asian backgrounds including in mental health in the UK, needs to give everyone in healthcare a wake-up call that we need to work together to support the women who need it most, in the right way. Last week was Black Maternal Health Awareness Week hosted by Five X More. The theme was “Respectful Maternity Care” and one day focussed on mental health highlighting the stark inequalities that exist for mothers in mental health care for women from Black and Asian backgrounds. This also needs to change.

For me, as a passionate medical educator, teaching and training is one of the key parts of the puzzle to bring about change in these areas. I was fortunate as a trainee psychiatrist to work with Maudsley Learning and Dr Seneviratne to develop a perinatal mental health simulation training course that was the first of its kind, and in a time when there were only a couple of formal training courses available in perinatal psychiatry. After seeing many hundreds of participants come through the doors of this course, I witnessed first-hand how multidisciplinary education can profoundly and quickly develop skills and change attitudes and I have so much hope for the future.

Join in the conversation this week on social media with your thoughts on all the topics I’ve raised and more using #mmhaw23 and #maternalMHmatters

[i] Smith, K.A., Howard, L.M., Vigod, S.N., D’Agostino, A. and Cipriani, A., 2022. Perinatal mental health and COVID-19: Navigating a way forward. Australian & New Zealand Journal of Psychiatry, p.00048674221137819.

[ii] Knight, M., Bunch, K., Tuffnell, D., Jayakody, H., Shakespeare, J., Kotnis, R., Kenyon, S. and Kurinczuk, J.J., 2016. MBRRACE-UK. Saving Lives, Improving Mothers’ Care.