Guidance calls for better mental health support through pregnancy

Women at risk of mental health problems should receive more support at every stage of pregnancy, healthcare professionals are to be told.

Doctors, nurses, health visitors and midwives will be given updated guidelines on how to safely treat women before, during and after pregnancy.

The guidelines, tackling a wide range of issues concerning antenatal and postnatal mental health, have been issued by the National Institute for Health and Care Excellence (Nice).

Parents who experience a stillbirth should be given the option of seeing a photograph of their baby, seeing and holding the baby and having mementos of him or her.

Such parents, and those who suffer a miscarriage, should also be offered a follow-up appointment in primary or secondary care.

Discussions should take place before and, if needed, after delivery, when it is known that a baby has died in the womb.

Pregnant women experiencing tokophobia – an extreme fear of childbirth – should be given the opportunity to discuss their fears and requests for planned caesarean sections should be respected.

Extra support and advice should be offered for women who have experienced a traumatic birth, with the impact on the partners also taken into account.

Potential mothers-to-be with new, existing or past mental health problems should be advised on contraception and how pregnancy and childbirth could lead to a risk of relapse.

The effects of a mental health problem on the woman, foetus or baby as well as how it may affect parenting should also be discussed as part of Nice’s guidelines.

Mental health professionals should provide detailed advice on benefits, risks or harms to a woman, foetus or baby associated with drug treatments at each stage of pregnancy.

Nice’s updated guidelines come two weeks after Charlotte Bevan, 30, went missing from a maternity hospital in Bristol with her four-day-old daughter, Zaani Tiana.

The bodies of Ms Bevan, who is believed to have suffered depression, schizophrenia and severe sleep deprivation after giving birth, and Zaani were found in the Avon Gorge.

Professor Mark Baker, Nice Centre for Clinical Practice director, said: “Mental health problems during and after pregnancy are common.

“More than one in 10 women will experience depression at some point during their pregnancy. This increases to one in five women during the first year after giving birth.

“During pregnancy and the postnatal period, women may also experience other mental health problems. Giving women the right treatment at the right time can have a profound effect – not just for the mother, but her family too. The effect of getting this right can last for years.

“The guidance makes a number of new and updated recommendations, covering not only treatments, but also in providing women who are newly diagnosed or with a history of mental health problems with the information and support they need before they become pregnant.”

Around 12% of women experience depression and 13% suffer anxiety at some point during and after pregnancy, with many experiencing both.

One in five women is affected in the first year after childbirth, while there is an increased risk of psychosis in the weeks after the birth.

The update comes thanks to more information becoming available on using drugs to treat mental health problems during pregnancy, and on stopping medication.

More is now known about detecting mental health problems in mothers and pregnant women, with help in the guidelines to assist doctors, nurses, health visitors and midwives.

Charities, organisations and experts have welcomed Nice’s updated guidelines, saying they could help awareness of mental health problems around pregnancy.

Mother-of-two Maria Bavette, co-founder of Maternal OCD, experienced postpartum obsessive compulsive disorder and helped to develop the new Nice recommendations.

“I believe this guideline will help to de-stigmatise mental health problems during the perinatal period and encourage all healthcare professionals at every point of contact with a mum to talk about their mental health as well as their physical health,” she said.

“Mothers especially need looking after so they can in turn care for themselves and their baby – this guideline sets out which treatments are recommended for mild, moderate to severe maternal mental health problems and needs to be utilised by all healthcare professionals.”

Clare Murphy, director of external affairs at the British Pregnancy Advisory Service (bpas) said the guideline would help address issues such as tokophobia and traumatic birth.

“It is deeply troubling when we see women who feel they cannot continue with a pregnancy because they suffer from tokophobia or because of a traumatic experience of childbirth in the past,” she said.

“Access to specialist support will of course be important in addressing the needs of women suffering from tokophobia or birth trauma, but we know it is also vital that women are offered support and choice around how they give birth, whether that is deciding to give birth at home, ensuring they have access to effective pain relief or planning an elective caesarean section.”

Dr Patrick O’Brien, spokesman for the Royal College of Obstetricians and Gynaecologists, said it was important to recognise what was “not normal” around pregnancy.

“Many women experience low mood following childbirth; however, this is normal and should pass,” Dr O’Brien said.

“However, women who have pre-existing mental health conditions, or who develop a more serious mental health condition antenatally or postnatally, need specialist attention and care. Mental illness makes a significant contribution to maternal deaths and therefore it is vital these women receive the right support at the right time by the right professional.”

The guidelines are available on the Nice website.

Elizabeth Duff, senior policy advisor at parenting charity NCT, questioned how the guidelines could be put into practice.

“The Government and NHS need to take immediate action to broaden service provision and ensure it is consistent,” she said.

“It is often difficult for new parents to talk openly about their mental health and this can be damaging for families. In extreme cases, this can lead to the loss of life.

“We urgently need to see an increase in specialist services, such as mothers and baby units, and better training for health practitioners to make sure no new parent suffers alone.”

Health Minister Dr Dan Poulter said the guideline would help healthcare professionals give the “very best support”.

“It is vital that pregnant women and new mothers with mental health problems get the specialist care they need,” he said.

“This is why we have employed 1,600 more midwives and an extra 2,000 health visitors since 2010 to provide personalised care and support to women during pregnancy and the perinatal period.

“This guideline will help our NHS staff to provide the very best support for pregnant women and new mothers.”

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