There is increasing awareness of perinatal mental health as a public health issue. The Government is keen for midwives to further develop their role in public health. Midwives need to be adequately prepared to take on a more developed role in perinatal mental health if practice improvements are to be made. The aim of this study was to identify any barriers to successful implementation by midwives of the recommendations from the Confidential Enquiries into Maternal Deaths aimed at reducing maternal deaths from suicide. This article describes a survey of midwives’ attitudes, knowledge and confidence in relation to perinatal mental health. The study used a quantitative survey method. A 29 item questionnaire was completed by 187 midwives working with one inner London Trust prior to attending a one day study day on perinatal mental health. Statistical analysis of the data was carried out using the SPSS (Statistical Package for the Social Sciences) software package. The study found that midwives are willing to take on a more developed role in relation to mental health but that they often lack training, knowledge and confidence in this area.

Two studies were undertaken to evaluate a programme to encourage midwives to detect and refer women with mental health problems. In the first study, 187 midwives completed questionnaires before and one month after a study day. There was a significant improvement in answers to knowledge questions and in self-reported confidence and attitudes. In the second study, the handheld maternity notes carried by pregnant patients were examined after discharge. Significantly more records showed mental health problems entered and more had explanatory information added beside the diagnosis.

The importance of identifying pregnant women at high risk of postpartum psychotic illness has been highlighted by recent enquiries and guidelines. It has been recommended that these women are referred to perinatal mental health services, and that individualised care plans are made prior to delivery. This audit describes a cohort of 45 women, referred to a new perinatal mental health service, with a history of psychotic illness or at risk of developing a postpartum psychotic episode. It describes the characteristics of this group, and the outcomes in terms of relapse and whether their children remained in their care. Thirty-nine women (87%) were seen for assessment. Sixty-seven per cent were under the care of a community mental health team. Twenty-one (53.8%) were well at the time of referral. Planned pregnancies were uncommon (15%). All women seen antenatally had care plans written to address the high risk of postpartum relapse. Ten (26%) women had psychiatric admissions during pregnancy. Fifteen (38%) relapsed or had admissions during the first postpartum year. At 1 year postpartum, 74% women had care of their children; 18% children had been adopted or were in foster care; and the outcome was unknown for 8%.