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Mental health and pregnancy - no one should suffer in silence

Following the recent study by Imperial College London which shows women who suffer a miscarriage are at risk of developing PTSD, Gemma Castrofilippo discusses mental health care during and after pregnancy

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Gemma is an experienced clinical negligence solicitor who has specialised in this area since qualifying in 2008.  Gemma handles a wide range of cases, with a particular interest in obstetric cases, brain injury cases, mental health issues and cytogenetic work. You can follow Gemma on Twitter on @LD_Gemma
We’re often told that pregnancy is one of the happiest times in a woman’s life, but sadly this isn’t always the case.  When a pregnancy doesn’t proceed as expected or difficulties are experienced after birth, some women can subsequently suffer psychological trauma for which they require treatment. Unfortunately, a large number of women do not receive the support they need, resulting in lifelong effects.

One in 10 women develop a mental health illness during pregnancy or during the first year after giving birth, yet the lack of mental health care during and after pregnancy is a growing issue.

The recent study by Imperial College London, the first to focus only on early pregnancy loss, shows that following a miscarriage or ectopic pregnancy women may be at risk of post-traumatic stress disorder (PTSD).  Of the 113 women who participated in the research, 45% of those who suffered a miscarriage reported symptoms of PTSD three months after the pregnancy loss, compared to 18% who suffered an ectopic pregnancy. Considering these figures, it is surprising that there is no routine screening in place following pregnancy loss to identify those displaying symptoms of PTSD and to ensure psychological support is provided.  Those affected are essentially left to carry on as though nothing has happened, when in reality the pregnancy they had been planning has come to an unexpected end and they must now grieve for their loss. 

A woman’s life can be profoundly affected by such a loss; it can affect her work, her relationships with family and friends, and her everyday life in general. It is deeply saddening that women affected are essentially ignored. Women should not accept this lack of support as the norm.  I hope that one of the outcomes of this recent study will be that women affected will be offered the support they need to grieve and come to terms with the loss they have suffered. 

In comparison to early pregnancy loss, there are checks in place for postnatal depression. At the six week postnatal check, new mothers are reviewed, usually by their GP, and specifically asked about their mental wellbeing. Despite this, women who develop postnatal depression, which is thought to affect 10,000 new mothers a year, are also faced with an unacceptable level of input from mental health professionals.

Concerns have been raised by the Maternal Mental Health Alliance that mothers are not receiving an acceptable level of care due to a lack of Mother and Baby Units (MBU) and specialist community health provisions nationwide.  MBUs provide specialist family-centred treatment and support to mothers who experience mental health issues during and after pregnancy.  MBUs differ to adult wards in that they ensure mothers remain with their new babies while receiving treatment.  There are 17 MBUs nationwide, but none in Wales, Northern Ireland or parts of the North East, South and East of England. This means those mothers without the option of a MBU, are admitted frequently to adult wards and separated from their babies. At a time when the relationship between a baby and its mother should be protected and nurtured, it is completely illogical that the proposed course of action to “help” mothers in half the country is to separate them from her babies. 

Shockingly, the NHS’s recently published ‘Five year forward view for mental health’ shows “fewer than 15 per cent of localities provide effective specialist community perinatal services for women with severe or complex conditions, and more than 40 per cent provide no service at all”.

To ensure the best outcomes for women more needs to be done to ensure that as well as being offered the treatment they need, it is tailored to their individual needs.  Different women at different stages of pregnancy will require different treatment; a one size fits all approach simply will not work.

A recent opportunity was missed by the National Institute for Health and Care Excellence (NICE) to include clear updated recommendations in its new guidelines to ensure health professionals diagnose and treat promptly mothers affected by postnatal depression.  Instead, NICE recommends mothers should be treated in line with the general guidance on PTSD that is currently being updated.  This has been criticised by both the Birth Trauma Association and the Royal College of GPs, who wanted mothers to be considered separately to other groups, such as military personnel, whose treatment would not be suitable for mothers. 

Encouragingly, the Department of Health has confirmed an additional £290m will be spent on perinatal mental health. It aims by 2020/21 the NHS will support at least 30,000 more women each year to access evidence-based specialist mental health care during the perinatal period; to include access to psychological therapies and specialist community or inpatient care.

It is clear that improvement is needed in the mental health care available to women during and after pregnancy.  It is of paramount importance that women have access to the psychological support they need, no matter the stage of pregnancy.  Women who suffer pregnancy related mental health issues need to know that there are professionals willing to talk through what has happened and explore suitable treatments with them. The onus must be on the professionals to follow-up and ensure women’s psychological wellbeing, by tailoring treatment to individual circumstances; be that early pregnancy loss, stillbirth or postnatal depression. 

No woman should suffer in silence.

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