Psychosocial support during childbirth: Development and adaptation of WHO’s Mental Health Gap Action Programme (mhGAP) for maternity care settings

Abstract

Introduction Poor psychosocial support and lack of respectful care for women during childbirth are commonplace in health facilities in low- and middle-income countries. While WHO recommends providing supportive care to pregnant women, there is a scarcity of material for building the capacity of maternity staff to provide systematic and inclusive psychosocial support to women in the intrapartum phase, and prevent work stress and burnout in maternity teams. To address this need we adapted WHO’s mhGAP for maternity staff to provide psychosocial support in labour room settings in Pakistan. Mental Health Gap Action Programme (mhGAP) is an evidence-based guidance which provides psychosocial support in resource-limited health care settings. This paper aims to describe the adaptation of mhGAP to develop psychosocial support capacity building materials for maternity staff to provide support to maternity patients, and also to staff, in the labour room context. Methods Adaptation was conducted within the Human-Centered-Design framework in three phases: inspiration, ideation, and implementation feasibility. In inspiration, a review of national-level maternity service-delivery documents and in-depth interviews of maternity staff were conducted. Ideation involved a multidisciplinary team to develop capacity-building materials by adapting mhGAP. This phase was iterative and included cycles of pretesting, deliberations, and revision of materials. In implementation feasibility, materials were tested via the training of 98 maternity staff and exploring system feasibility via post-training visits to health facilities. Results Inspiration phase identified gaps in policy directives and implementation and formative study identified limited understanding and skills of staff to assess patients’ psychosocial needs and provide appropriate support. Also, it became evident that staff themselves needed psychosocial support. In ideation, team developed capacity-building materials comprising two modules: one dedicated to conceptual understanding, the other to implementing psychosocial support in collaboration with maternity staff. In implementation feasibility, staff found the materials relevant and feasible for the labour room setting. Finally, users and experts endorsed usefulness of the materials. Conclusion Our work in developing psychosocial-support training materials for maternity staff extends the utility of mhGAP to maternity care settings. These materials can be used for capacity-building of maternity staff and their effectiveness can be assessed in diverse maternity care settings.

Understanding the Mechanisms of Change in the Supportive and Respectful Maternity Care Intervention in Sindh, Pakistan: Provider Perspectives

“…The effectiveness of its psychosocial elements is well established across diverse contexts. 31 , 32 Ours was the first research initiative to systematically and rigorously adapt the Mental Health Gap Action Programme, especially its psychosocial components, for the maternity care setting in LMIC health systems. 31 After acquiring psychosocial skills as part of the S-RMC project, maternity staff were able to identify fundamental mechanisms of change.…”

“… 31 , 32 Ours was the first research initiative to systematically and rigorously adapt the Mental Health Gap Action Programme, especially its psychosocial components, for the maternity care setting in LMIC health systems. 31 After acquiring psychosocial skills as part of the S-RMC project, maternity staff were able to identify fundamental mechanisms of change. They felt better equipped—with understanding and skills—to engage effectively with pregnant women and their maternity team colleagues.…”

Promoting Supportive and Respectful Maternity Care in Public Health Facilities in Sindh, Pakistan: A Theory-Informed Health System Intervention

“… 34 We believe our study is the first to use mhGAP in the maternity care setting. 14 As a result of the implementation of S-RMC, the psychosocial support provided by maternity team members to birthing women resulted in a more than 50% reduction in women’s experiences of lack of supportive care, as well as a decrease in maternal postpartum anxiety and depressive symptoms.…”

“…Details are included in earlier studies. 8 , 14 Its broad components included capacity-building of maternity teams and systemic changes for improvements in governance and accountability within public health facilities. Uniquely, we integrated psychosocial support in routine maternity care to address the psychological and social needs of birthing women and their companions.…”

Supportive Care—A Missing Piece in the Current Global Efforts of Promoting Respectful Maternity Care

“…In the context of RMC, supportive care (a.k.a psychosocial support) is “the provision of psychological and social strategies provided by the staff that aims to help a pregnant woman to tackle physical, mental and emotional challenges faced during intrapartum phase” [ 2 ]. The objectives of this commentary are: to highlight the significance of embedding “supportive care” more prominently for pregnant women and their companions in RMC interventions and programmes.…”