While awareness of the mental health struggles faced by many new mums is increasing, new research shows that one quarter of pregnant women will experience some form of mental health challenge.

The UK study from King’s College London revealed that of the one in four women, 11 per cent had depression, 15 per cent had anxiety, 2 per cent had eating disorders and 2 per cent had obsessive-compulsive disorders.

Many women experienced a combination two or more issues.

Australian Nursing and Midwifery Federation (Vic Branch) Maternity Services Officer Julianne Barclay says she isn’t surprised by the findings.

“Australian studies have found similar figures when both anxiety and depression are taken into account across the whole span of  pregnancy, and when co-morbidities - such as intimate partner violence - are factored in,” says Ms Barclay.
“Time constraints, sleep deprivation, lack of community or family support, isolation, adjustment to leaving the workforce, transitioning roles and relationships - all heighten awareness and anxiety and can provide a tipping point for mental illness to occur.”

Ms Barclay says there are a number of processes in place to help midwives identify mental health issues in both pregnant women and new mothers, however multiple limitations and barriers contribute to increased pressure on maternity staff, reducing their ability to effectively support the women who need it.

During pregnancy, universal screening - generally the Edinburgh Postnatal Depression Score (EPDS), is offered to all women on booking in. 

At this visit issues such as intimate partner violence and a range of other psychosocial issues, for example, housing, are raised by the midwife. 

“If a woman requires mental health follow-up due to a raised EPDS, appropriate referral is made by the midwife,” says Ms Barclay.

“Conversations will be held relating to supports at home, the woman’s thoughts and fears about the pregnancy and birth etc.”

The EDPS is generally repeated at 20 weeks gestation.

“Midwives will observe, assess and monitor a woman’s mood during all visits during the antenatal period and will offer advice and appropriate solutions when required.

“This includes helping a pregnant woman to access a support group or counselling as required or organising referral to a specialist mental health practitioner if this is warranted.

“Midwives continually assess, reassure and educate pregnant women during antenatal visits and this places them in a unique position to identify symptoms of mood disorder or mental illness.”

A similar process takes place post birth.

“Midwives continuously and unobtrusively assess mothers during labour and birth and in particular attachment and interaction with the baby after birth.

“During the postnatal stay in hospital this work continues along with providing opportunities for women to discuss their concerns.”

Unfortunately, lack of time can result in these important processes being rushed, or in some instances, not taking place at all.

“Midwives in antenatal clinics and postnatal wards do not have sufficient time to perform all of the above all of the time,” says Ms Barclay.

“If a woman discloses information that requires further follow-up all the rest of the clinic is running late. 

“This is a great pressure on midwives.”

Furthermore, if a midwife appears rushed, a woman is less likely to disclose her concerns. 

“In the postnatal space, midwives make 1 to 3 home visits.

“Again, the higher acuity of mothers and babies at discharge means that often midwives are running very late by the end of the day if they provide appropriate time for women to express their concerns or disclose issues that require follow-up.”

Due to the specialised and highly fraught nature of mental health issues, Ms Barclay says midwives should be more actively supported in upskilling in relation to assessment and treatment of less complex issues.

“Midwives should be supported in gaining mental health qualifications and - informally - they should be involved in local policy and protocol development.”

Ms Barclay says midwives should also be actively guided and educated by mental health nurses.

“Mental health nurses should be employed alongside midwives to provide a point of immediate referral as well as to capacity build the midwifery workforce,” says Ms Barclay.

She also called for properly resourced antenatal care to allow full mainstreaming of mental health and psychosocial screening and assessment throughout pregnancy.