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09.12.15

Quarter of maternal deaths linked to mental health problems

Every woman must have access to coordinated care between maternity wards, her GP and a specialist mental health midwife, royal colleges have said, after a glaring report revealed that almost one-quarter of all maternal deaths up to a year after birth are related to mental health problems.

The stark report, published by the MMBRACE-UK team at the National Perinatal Epidemiology Unit at the University of Oxford, revealed serious failings in mental healthcare for pregnant women.

While the overall maternal mortality rate in the UK continues to fall, this is largely due to a reduction in deaths from ‘direct’ pregnancy causes. The rate of deaths from ‘indirect’ causes, however, has not reduced significantly. This represents deaths from conditions not directly due to pregnancy, but to existing conditions that are exacerbated by pregnancy – such as heart problems and mental ill-health.

The researchers looked into the care of more than 100 women who died by suicide during pregnancy, or in the year after giving birth, between 2009 and 2013. One in 11 women who died during pregnancy, or up to six weeks after, did so from mental health-related causes.

This grew to nearly one-quarter of women when considering all deaths between six week and a year after birth, with one in seven of these caused by suicide.

The research team argued that while severe mental illness is common after birth, women and mainstream mental health services often fail to recognise this or take action quickly enough. Junior medical or nursing staff are also often tasked with assessing new mothers, despite not necessarily having the “breadth of experience to recognise herald symptoms, such as mounting anxiety”.

Figures were even worse when considering marginalised women, such as those with socially complex lives and substance misuse problems, which MMBRACE-UK said emphasised the need for integrated care to “ensure that these women do not fall through the cracks between services”.

The Royal College of Midwives said this highlighted the need for maternity services arranging follow-up appointments for women instead of leaving this up to GPs.

Its director for midwifery, Louise Silverton, said: “We acknowledge that this is vitally important in ensuring vulnerable women and those most in need of additional mental health care are not missed. To achieve this, we need more specialist mental health midwives to provide continuity of care for these women.

“We know that suicide is a leading cause of death in new mothers in the UK. Despite this, provision of perinatal mental health services in the UK is at best patchy, and in some areas, non-existent.”

Silverton recognised that these deaths occur more often in women from economic and socially deprived backgrounds and in women from certain ethnic groups – many of which are already known to social services.

“We must do everything we can to make sure that they do not fall through the system,” she said, in agreement with the report. “We owe these women and their families bespoke services and additional support from a dedicated midwifery team trained in mental health.”

The Royal College of Nursing’s response was no different, with its professional lead for midwifery & women’s health, Carmel Bagness, saying there is clearly more work left to be done to enhance the mental wellbeing of new mothers.

“All healthcare professionals needs to be aware of the signs which might indicate a mental health issue, and should regularly ask parents about their mental health,” she said.

“Midwives and nurses know how important openness and understanding is when it comes to mental health. Their employers should now ensure they have the training, and the time, to support better mental health of mothers.”

Hitting a slightly different note, the Royal College of Paediatrics and Child Health’s president, Professor Neena Modi, said it is vital that planned £200m cuts to public health budgets are stopped.

“If this goes ahead, health visiting will be placed under immense strain, adding to the current crisis facing public health and the NHS’ financial burden in the long term,” Modi added.

(Top image c. David Jones/PA)

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