Mental health support in pregnancy and childbirth is as important as physical care

Midwives play an important role in health promotion,¹ including the promotion of positive mental health in pregnant women and new mothers. The disruption of mental health has serious consequences for both maternal and foetal well being, while also affecting the partner and family unit.²

Pregnancy, birth and the postnatal-period are times of adaptation, psychologically, physically and socially, as women explore their roles as new mothers.³ A central role of the midwife is to support and facilitate this transition for mothers.

Positive mental health is a key factor in the transition to motherhood. Mental health is a ‘state of wellbeing in which an individual realises their own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to their community’.⁴ With this in mind, it is easy to see how pregnancy and childbirth can disrupt a woman’s ability to cope with stresses of life, particularly when confronted with caring for a newborn baby.

Postnatal depression (PND) is often coupled with feelings of guilt and fear.⁵ Fortunately, there is now greater public awareness that a smooth transition to motherhood, which so many women expect, is not the norm. PND may be preceded by antenatal depression and anxiety. Therefore, addressing the issue in the antenatal period is warranted. Identifying women at risk of mental health problems may lead to a support structure being established prior to the baby’s birth.

‘Salutogenesis’ encourages a focus on the factors that support health and well-being rather than those that cause ill health.⁶ It provides midwives with the necessary holistic approach, knowledge and skills relevant to their health promotion roles.⁷

In taking a salutogenic approach and promoting self-efficacy, the midwife can help women to reduce stress and vulnerability to depression and increase their self esteem and coping skills. Women with strong self-efficacy tend to manage multiple demands and maintain a sense of well being, factors all innately relevant to motherhood.

When a pregnant woman first makes contact with the maternity services, the midwife should ask certain questions to gain an understanding of the woman’s mental health history.² This should be done in a sensitive and systematic manner with the aim of establishing rapport. Most of Ireland’s maternity services are large units⁸ and time constraints may affect the length of these discussions. Nonetheless, women should be offered appropriate support and information, and any treatment or care required should be tailored to the woman’s specific needs and preferences.

Supporting a woman’s emotional health is as important as the physical care of mother and baby. The midwife should link women who feel anxious or depressed to the appropriate support services³ – a referral to the hospital social work team or mental health liaison nurse as per local policy may be necessary.

During labour and birth, the midwife can provide individualised, sensitive care and maintain this ethos of care during the postnatal period. If emotional problems are suspected, there is value in discussing the birth and listening to the woman, encouraging her to share her feelings.

In the postnatal-period it is useful for the midwife to provide an opportunity for talking each day, to present realistic portrayals of motherhood and to speak about the prevalence and symptoms of PND. Providing information empowers women and their families to be aware of their feelings and know what help is available.¹⁰

Midwives should know which online resources are available to women, evaluate them and refer women to websites offering good-quality advice.⁷ PND Ireland (www.pnd.ie) is an Irish resource for mothers with PND. Based in Cork, this service offers telephone, email and ‘by appointment’ support, free of charge. A Facebook page, chat room, forum, and link service (where mothers meet local recovered mothers for support) are also available.

We must recognise the importance of the impact that midwives can have when supporting positive mental health for women in pregnancy, childbirth and the postnatal period.

Katy McGranaghan is a student midwife at UCC/Cork University Maternity Hospital (CUMH)

References

1. RCM. Royal College of Midwives. Vision 2000. RCM, London. Available: http://www.rcm.org.uk/midwives/features/ mapping-new-horizons/
2. NICE. CG45 Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance, 2007
3. RCM. Maternal Emotional Wellbeing and Infant Development – A good practice guide for midwives. RCM, London, 2012
4. WHO. Mental Health: Strengthening our Response Fact sheet No 220 World Health Organization, Geneva, 2010
5. McLoughlin J. Stigma Associated with Postnatal Depression: A Literature Review. British Journal of Midwifery, 2013; 21(11): 784-791
6. Antonovsky A. The salutogenic model as a theory to health promotion. Health Promotion International, 1996; 11(1): 11-18
7. Bowden J, Manning V. Health Promotion in Midwifery – Principles and Practice 2nd ed. Hodder Arnold, London, 2006
8. ERSI (2013) Perinatal Statistics Report 2012. Dublin: ESRI

10. Mauthner NS. Postnatal Depression: How can Midwives Help? Midwifery, 1997; 13: 163-171

Midwifery matters - Dealing with depression