Assessing mental health during pregnancy: An exploratory qualitative study of midwives’ perceptions

Abstract

Background: Mental health disorders are estimated to affect between 10% and 20% of women who access maternity services and can be defined as a public health issue due to the potential consequences for women, children and families. Detecting problems early in pregnancy can significantly improve outcomes for women and their families. However, mental health problems are not being consistently identified in routine midwifery practice and little is known from current literature about midwives' practice in relation to current national guidelines or the impact models of care have on assessing maternal mental health.Objective: To identify midwives' views about barriers and facilitators to screening for mental health in pregnancy using current UK guidelines.Design: Nine community midwives from a single district general hospital in the south of England were recruited to take part in focus groups. Thematic analysis was used to extract key themes from the data. Findings:Three key themes were identified from the focus groups and included system factors, social factors and trust. Barriers and facilitators to screening maternal mental health were associated with the initial 'booking' appointment' and differences in models of care.Barriers to screening were defined as high workload, poor continuity, and a lack of trust between women and midwives. Conclusions:This study highlights key barriers and facilitators associated with mental health screening during pregnancy, including issues of trust and uncertainty about women's willingness to disclose mental health conditions. Further research is required to evaluate the relationship between women and midwives in contemporary practice and the influence this may have on maternal mental health.

Disparities in who is asked about their perinatal mental health: an analysis of cross-sectional data from consecutive national maternity surveys

“…The findings offer a number of explanations for why women may not be asked about their mental health. These include high workload [ 27 ] and time constraints within appointments, particularly the antenatal booking appointment where a lot of information gathering and procedures have to be carried out [ 28 , 29 ]. In addition, some midwives considered the booking appointment too early in pregnancy at a time when they did not know the women well [ 28 ].…”

“…Despite the variation in findings between the different surveys, they all indicate that at least a significant minority of women are not asked about their mental health during the perinatal period. Several qualitative studies have explored midwives' views of mental health screening [27][28][29]. The findings offer a number of explanations for why women may not be asked about their mental health.…”

Mental health service use among pregnant and early postpartum women

“…Qualitative findings in the UK suggest that the level or confidence in basic mental health training and maternal demographics (e.g. level of deprivation or education, and ethnicity) may influence maternity staff’s decision to administer mental health screening assessments during routine antenatal appointments [ 50 , 51 ]. If women with demographics typically underrepresented in mental health services are not screened during their standard perinatal appointments, it may delay or act as a barrier to accessing mental health services.…”

Association between perinatal mental health and reproductive and neonatal complications: a retrospective birth cohort study

“…Mental health disorders, particularly anxiety and depression, are among the most common morbidities in perinatal women, affecting up to 20% of women during and after pregnancy (3, 4). In the United Kingdom, psychiatric issues are the leading cause of death for women in the first 12 months postpartum (3, 4). Mental health disorders are drastically under-diagnosed and under-treated in perinatal women, with just 30% of perinatal women with depression identified in a clinical setting (5, 6).…”

“…One understudied research priority pertains to the influence of maternal mental health as an important precursor to maternal and infant morbidity (1)(2)(3). Mental health disorders, particularly anxiety and depression, are among the most common morbidities in perinatal women, affecting up to 20% of women during and after pregnancy (3,4). In the United Kingdom, psychiatric issues are the leading cause of death for women in the first 12 months postpartum (3,4).…”