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Midwives’ perspectives of maternal mental health assessment and screening for risk during pregnancy

Abstract:

Background: Increased maternal mental health needs are associated with an increased risk of maternal morbidity and mortality and occur more frequently during pregnancy than during the postnatal period. The implications of this antenatally for the mother, baby and family is increasingly becoming recognised and recommendations are being made for routine antenatal screening. Aim: This qualitative descriptive research study explored midwives’ perceptions of maternal mental health antenatally, including screening. Method: Twenty-seven Lead Maternity Carer (LMC) midwives participated in five focus group interviews. These were analysed using thematic analysis to identify the key ways in which midwives perceived and assessed maternal mental health during the antenatal period. Findings: The study identified that these midwives routinely assessed women’s mental health during antenatal care in informal and not necessarily explicit ways. Caring for women who were highly anxious was not an infrequent experience and led to the midwives feeling responsible for the woman’s mental health needs without a safety-net. Midwives were concerned about the introduction of routine universal antenatal screening without the availability of appropriate maternal mental health services for women who had identified as having mild to moderate mental health issues, such as anxiety. Conclusion: The mental health services that the midwives needed to refer pregnant women experiencing mental health issues to, particularly those women with mild to moderate issues, are lacking. We suggest that the introduction of routine antenatal mental health screening would need to be well supported with accessible and appropriate mental health services to meet the needs of all women, not just those experiencing serious mental ill health.

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antenatal anxiety and depression, antenatal assessment and screening, maternal mental health, midwives' perspectives