Recently I have undertaken some research into journals and books on the public health agenda surrounding PNMH in midwifery care for an assignment.
Perinatal Mental Health has been highlighted for some years, as a non-direct and direct cause of maternal morbidity and mortality with the 2015 MBRRACE-UK report highlighting that suicide was the highest direct cause of maternal death.
It really made me focus on how we as midwives influence the reporting of and care for women experiencing mental health issues in pregnancy, labour and postnatally.. and even beyond.

Perinatal mental health has become important to me as I also have depression and anxiety and sometimes worry how this would affect me if I ever had a child.
The stigma surrounding mental health is the main reason why women find it difficult to come forward.
As midwives it is crucially important we are able to create a safe environment where women feel like they can discuss their health, holistically with us in order to make the best maternity care plan. More and more women are booking pregnancy with pre-existing mental health issues, history of mental health issues or current medication for anxiety etc.
However, women are still worried that they will be seen differently, or have to be referred to a specialist, even if they feel in control of their mental health. As midwives we need to use our training and knowledge to be health promoter and supporter for vulnerable women in pregnancy.

Mental health services for pregnancy are severally lacking as outlined in RCOG report 'Women's Voices'. Many women are being referred for appointment and due to the over subscription of the service, they are receiving their appointments well over the 4 week deadline, some even after they have given birth.

Specialist midwives for PNMH are few and far between and constantly find their services over subscribed. More and more demand for midwives with specialist knowledge of mothers with mental health illnesses are needed in maternity care, however the funding doesn't seen to be there - even though the Governments outline mental health as a key health focus in 2017.

So what can we as student midwives, and midwives do for these women in our care?

• Listen, make time in appointments for hearing concerns and worries of mothers. Plan home visits to follow up if the woman needs extra time to discuss her mental health.
• Ask the questions. The booking questions are a quick first line measure to find out the thoughts and feelings of the expectant mother. Remember to repeat these at each appointment and through postnatal period.
• Don't forget the family. Fathers are also known to be effected my PNMH, especially with anxiety in becoming new father, or witnessing birth of child. Have a holistic view.
• Don't judge. If a woman feels she needs to continue a medication or refuses treatment, there will be a reason. Don't judge and care for her just as you would. Use the rapport built to approach the issue if needed.
• Settle fears surrounding referral to specialist midwives. Outline the extra care and support the woman will receive.
• Champion continuity of carer. By having a named midwife and continuity of care it is more likely changes in mood will be seen, noted and responded too. 
• Compassionate care - especially surrounding PNMH and PND.

Have you been taught enough about PNMH in university?
Or approached this subject in regards to training and clinical practice?

Let me know.

Ruth
twitter: @ruth_stmw

Some example leaflets for mothers with mental heath issues.