Let’s break the silence around maternal injury and mental health

Perinatal mental illness affects up to 20% of women, and covers a wide range of conditions. If left untreated it can have a significant and long-lasting effect on women and their families.

Royal College of Obstetricians and Gynaecologists, on their twitter page, have recently highlighted the 2015 “Mothers and Babies, Reducing Risk Through Audits and Confidential Enquiries” (MBRRACE) Report, which states that deaths from psychiatric disorders is now one of the leading causes of maternal death, surpassing haemorrhage, pre-eclampsia and genital tract sepsis.

Have you ever struggled with poor maternal mental health? Read our TOG article on seeking help during pregnancy or after birth https://t.co/8txvtbQhwV #MaternalMHMatters #NoShame pic.twitter.com/9jkzMYZA0L

— RoyalCollegeObsGyn (@RCObsGyn) April 30, 2018

These statistics are alarming to read and highlight the need to raise awareness for maternal mental health matters, to ensure women are getting the right support from an early stage.

The MBRRACE report also highlights that perinatal mental health is stigmatising to women and professionals alike, leading to reluctance to discuss the topic and under or misdiagnosis. Sadly, it is often found that clinicians may feel apprehensive in approaching the subject for fear of asking questions insensitively.

So, what is being done to address the problem of mums’ mental health?

The MBRRACE report highlights key objectives which include;

• assisting clinicians to understand “how to ask” women about mental health by normalising and raising awareness of perinatal mental health, providing examples of open screening questions, recapping psychiatric history and mental state examination, and performing a risk assessment; and
• understanding “how to help” women with their mental health with guideline driven advice at first contact for mild anxiety and low mood, decided on level of risk and the direction and urgency of referral.

In addition, NHS England have committed to fulfilling the ambition in their “Five Year Forward View for Mental Health” that by 2020/21 there will be increased access to specialist perinatal mental health support in all areas of England, allowing at least an additional 30,000 women each year to receive evidence-based treatment, closer to home, when they need it. This includes the right range of specialist community and inpatient care. NHS England is undertaking a phased five year transformation programme, backed by £365 million in funding, to build capacity and capability in specialist perinatal mental health services, focused on improving access to and experience of care, early diagnosis and intervention, and greater transparency and openness.

Is what the Government has planned enough?

It is reassuring to see that practical steps being taken to address the problem of maternal mental health. However, it is clear we need to work together to create a culture where mums feel more able to talk about how they are feeling and obtain the necessary help and support required.

Mums often find it difficult to talk about how they are feeling, but obtaining the necessary help at an early stage can make a significant difference to women who are suffering. For those who are struggling, help should be available from their GP or midwife and organisations aimed at providing support such as MIND, PANDAS and APNI (Associate for Postnatal Illness).

As a clinical negligence solicitor, I represent a number of clients who have sadly suffered life-changing injuries at the time of the birth of their baby. For example, perineal tears can lead to mums suffering with faecal incontinence.

Mums often struggle to talk about how injuries such as these impact upon them, and feel embarrassed by their symptoms which have a significant impact upon all aspects of their lives. Some mums avoid going out for fear of an “accident”, live with pain on a daily basis or experience difficulty with sexual relationships.

Mums often (understandably) put the needs of their baby first and just try to ‘get on with things’, as far as they are concerned. However, it’s important that they sometimes think of themselves too – although, as a mum myself, I can understand how difficult even this simple statement sounds.

I believe we need to encourage a culture where mums recognise that they matter too and where they feel able to talk about any physical or emotional problems they are experiencing following childbirth without feeling any sense of judgement or embarrassment. I welcome the changes being implemented following the MBRRACE report and by NHS England’s Five Year Forward View for Mental Health. In order to ensure women access these services available it is important that we make sure mums know that they matter too and that they do not have to suffer in silence. #maternalmhmatters