Midwives’ perspectives of maternal mental health assessment and screening for risk during pregnancy

Abstract

Background: Increased maternal mental health needs are associated with an increased risk of maternal morbidity and mortality and occur more frequently during pregnancy than during the postnatal period. The implications of this antenatally for the mother, baby and family is increasingly becoming recognised and recommendations are being made for routine antenatal screening. Aim: This qualitative descriptive research study explored midwives' perceptions of maternal mental health antenatally, including screening. Method: Twenty-seven Lead Maternity Carer (LMC) midwives participated in five focus group interviews. These were analysed using thematic analysis to identify the key ways in which midwives perceived and assessed maternal mental health during the antenatal period. Findings: The study identified that these midwives routinely assessed women's mental health during antenatal care in informal and not necessarily explicit ways. Caring for women who were highly anxious was not an infrequent experience and led to the midwives feeling responsible for the woman's mental health needs without a safety-net. Midwives were concerned about the introduction of routine universal antenatal screening without the availability of appropriate maternal mental health services for women who had identified as having mild to moderate mental health issues, such as anxiety. Conclusion: The mental health services that the midwives needed to refer pregnant women experiencing mental health issues to, particularly those women with mild to moderate issues, are lacking. We suggest that the introduction of routine antenatal mental health screening would need to be well supported with accessible and appropriate mental health services to meet the needs of all women, not just those experiencing serious mental ill health.

Antidepressant dispensing before, during, and after pregnancy in New Zealand, 2005‒2014

“…Determining engagement with non-pharmacological interventions in pregnancy would be informative, as there is a mismatch between those taking an antidepressant in pregnancy (<5%) and the reported prevalence of depressive symptoms (12%). 4 Although midwives do assess antenatal mental health informally, 38…”

Strengthening Antenatal Care towards a Salutogenic Approach: A Meta-Ethnography

“…It also means involving women as active partners in their care, e.g., by giving them responsibility for routine aspects of care and letting them participate in decision-making, which also helps care providers when they need to be more directive [ 5 ]. Mellor, Payne and McAra-Couper [ 23 ] found that mental health services were lacking when midwives needed to refer pregnant women with mental health issues, and midwives routinely assessed women’s mental health during antenatal care in informal and not necessarily explicit ways. They were concerned about the introduction of routine universal antenatal screening without the availability of appropriate services for women with mental health issues such as anxiety [ 23 ].…”

“…Mellor, Payne and McAra-Couper [ 23 ] found that mental health services were lacking when midwives needed to refer pregnant women with mental health issues, and midwives routinely assessed women’s mental health during antenatal care in informal and not necessarily explicit ways. They were concerned about the introduction of routine universal antenatal screening without the availability of appropriate services for women with mental health issues such as anxiety [ 23 ]. There is a need for relaxation training during pregnancy that promotes the wellbeing of mother, fetus and baby [ 24 ].…”

Implementation of the ‘Kimberley Mum’s Mood Scale’ across primary health care services in the Kimberley region of Western Australia: A mixed methods assessment

“…A recent review found that midwives are increasingly aware of the impacts of perinatal mental health and are interested in routinely providing mental health care and support [32]. Other research has found that healthcare professionals (including midwives) can be uncomfortable providing mental health screening and psychosocial care [33,34]. Our pre implementation study [11] found Kimberley healthcare professionals were similarly ambivalent about administering a PLOS ONE psychosocial screening tool.…”