Is maternal mental health being taken seriously enough?

That historical way of thinking, only working with mothers and babies after the baby has arrived, together with the picture of an ‘insta-perfect’ mum with an ‘insta-perfect’ baby on social media (“oh isn’t he a good baby”) can put pressure on those struggling with their mental health and can often prevent them from seeking help when they need it.

“Maternal suicide is the main cause of death in new mums in the UK in the first year after pregnancy” maternalmentalhealthalliance.org

What an absolutely terrifying statistic. But why? What drives new mothers to do something so drastic and irreversible, and how can these tragic deaths, leaving babies without their mothers, be avoided?

During Maternal Mental Health Week in particular, we are campaigning for better care for mums after birth so that they feel supported, not alone.

Should aftercare be joined by before-care for mums?

The reasons why our mental health may suffer post-birth can be due to various factors, and will be unique to us as individuals. Our experiences of our own labour, our susceptibility to mental health difficulties, on top of social pressures, are just a few of the most obvious factors that could shape our story following the birth of our child or children.

However, I wonder what the impact of mental health pressures would be on us if we were more aware of them prior to labour? What if they actually formed part of our ante-natal care in the same way that our physical health and needs of the baby are considered during our appointments? Would we feel better placed as mothers to deal with the issues we face if we had knowledge of them before they happened to us?

We recently carried out a survey of mums (outside of the last 18 months and the different treatment pregnant women undoubtedly received during the pandemic) which revealed 40% of those completing the survey felt their own mental health care during their pregnancy could have been improved. Now, and perhaps somewhat unsurprisingly, according to the Maternal Mental Health Alliance new mums face increased mental health risks as a result of the pandemic.

In another study it was found that healthcare professionals often missed the opportunity to assess what really mattered to pregnant women during their antenatal care.

The article, jointly written by leading Obstetrician Dimitrios Siassakos, also states:

“Current UK Law requires consent consultations to include explicit effort to gauge a woman’s preferences and values, yet consultations seem to fail to achieve such understanding” and “At the very least, consultations may be improved by the addition of opening questions along the lines of ‘what matters to you most?’”.

The outcome of the study? Women seemingly want more discussion and involvement in their own care throughout their pregnancy. If this can be put into practice, would that give us all more of an opportunity and the confidence to open discussions ourselves over concerns of our physical and mental health, and, perhaps, seek help if we need it?

Perhaps good aftercare actually starts with good ‘before-care’. Listening, acknowledging, understanding and discussing our past experiences, concerns and wishes, to give us (as mums and dads) the power to deal with any adverse consequences of birth should they arise.

What about mums’ mental health?

What trauma can mums suffer as a result of a difficult birth if they are not cared for ante-natally and post-natally?

Whilst baby blues are common and affect up to 8 in 10 mums, depression lasting longer than two weeks and affecting your ability to care for yourself or your baby requires treatment.

Typical symptoms include:

• Flashbacks
• Avoidance
• Difficulty Sleeping
• Anxiety
• Depression
• Lack of Interest in things
• Loneliness
• Suicidal thoughts
• Difficulties bonding with your baby
• Feeling worthless or guilty
• Loss of appetite or eating disorders

All of the above, whether we experience just one or all of them, are difficult to cope with in everyday life, but as a mum with a newborn baby they can be terrifying.

There is support available and mums (and dads) shouldn’t suffer in silence. In fact, symptoms don’t usually go away or disappear on their own just because we ignore them. The sooner help is sought the better the prognosis and recovery.

The brain is such a delicate organ of our body. We must listen to it and take care of it. Talking, discussing and sharing our experiences with each other, good and bad, can help not only ourselves but others also facing the same difficulties and dilemmas we may have faced ourselves. It can even help us overcome them.

An expert’s thoughts on maternal mental healthcare

We spoke with Professor John Morgan, a leading Consultant Psychiatrist who has a great deal of experience with mums’ mental healthcare:

“Postnatal depression is a treatable condition, yet poorly managed and sometimes leaving mothers feeling they are dismissed or disapproved. Most services have systems in place to screen for depression, but other conditions such as birth trauma can go unrecognised and untreated.

Postnatal PTSD commonly occurs after long and painful deliveries, emergency treatment and unplanned surgery during delivery – events that perhaps we are not fully prepared for. Traumatic experiences can negatively impact on relationships, including the relationship with your baby.

Postnatal OCD is also under-identified, including disturbing thoughts about hurting your own baby, or excessively focusing on cleanliness. Postnatal eating disorders are increasingly common.

20 years ago I researched how pregnancy could temporarily alleviate eating disorders such as anorexia nervosa or bulimia, describing pregnancy then as “a socially endorsed licence to feed”. However, increasingly women are under pressure to preserve perfect body image even during pregnancies, and unattainable images of pregnant women in the media and incrementally to the guilt and low self-esteem of many new mothers.

Thus whilst postnatal depression is at least usually screened in healthcare settings, eating disorders, OCD, anxiety and birth trauma are less readily identified, despite treatment ability. This gives rise to avoidable suffering at a time in life that should otherwise be joyous, and can even lead some women to develop a fear of pregnancy itself (tokophobia).”

We hope that all of the campaigning done this week for maternal mental health week, and this month, helps to raise awareness of the issues women face after childbirth. Whilst there is new support being announced by Government, only time will tell whether it has the impact that is so desperately needed.

We’re encouraging medical professionals and the wider public to think “What About Mum?” after childbirth, to help prevent mental health issues and even long-term physical problems, as a survey we conducted demonstrates that a significant proportion of mums don’t get the support they need after birth. Make sure to read our report to find out more.