Launching its new roadmap, the Royal College of Midwives (RCM) has warned that ‘vital perinatal mental health support’ is currently in a precarious position – and is still often considered secondary to physical health needs in pregnancy.

The RCM says its new report, Strengthening perinatal mental health, makes for ‘sobering reading’ as it calls for the UK government to extend support for perinatal mental health and counselling.

One in five women will experience mental health issues during pregnancy and up to a year after giving birth.

Yet, the RCM estimates that over half of perinatal anxiety and depression cases are going undiagnosed as it calls for mental health care during and following pregnancy to be given equal parity by the healthcare professionals.

The midwifery professional body also says every health board has at least one whole-time equivalent band 7 or 8 perinatal specialist midwife.

The RCM believes that midwives are only part of the solution, with a fundamental shift in how mental ill-health is viewed also required.

Suicide also remains one of the leading causes of death among new mothers within the first year after giving birth – with barriers to access or availability of mental health services often compounded by stigma.

Last year’s Scottish parliament committee inquiry into perinatal mental health revealed “significant inconsistencies” in access to specialist units which support new mothers with complex needs.

Holyrood’s Health, Social Care and Sport Committee found that many women had been left unsupported during the pandemic despite cases of post-traumatic stress disorder after childbirth having risen sharply.  

Midwife and the RCM’s Executive Director, Birte Harlev-Lam OBE, says current resources do not meet the clear needs for mental health support.

Ms Harlev-Lam explains that to help address this, more specialist perinatal mental health midwives are needed:

“Quite simply midwives need time to care and there needs to be more midwives to share the workload.

“We are not asking for the moon; we estimate that fewer than 350 additional specialist perinatal mental health midwives could bring about the results that we all want to see – and that women deserve.

“Mental ill-health ranks with physical factors as one of the leading causes of maternal deaths in the UK, and yet this is not reflected in the resources allocated to it, whether in terms of staffing or other support. We urge the government to support the provisions around perinatal mental health and counselling recommended in the recent independent pregnancy loss review.”

The new report from RCM highlights that barriers to care have been exacerbated by the pandemic, with the most vulnerable communities hardest hit.

Public Health Scotland (PHS)-supported research shows that health inequalities begin as early as halfway through pregnancy. The study authors call for more financial support throughout early pregnancy.

In February, the Scottish government announced £1m additional investment in perinatal and infant mental health, following Holyrood’s health and social care committee’s earlier criticism of the lack of support across Scotland.

The committee warned that poor perinatal mental health care and support is acute across the north of Scotland and highlighted a lack of clear training routes and a shortage of specialist midwives as particular barriers.

Now, the RCM has detailed how very few post-natal parents who died actually received a formal diagnosis despite reporting symptoms.

Implementing change

The RCM is calling for the provision of trauma-informed training to ensure all professionals working with new and expectant parents have necessary perinatal mental health knowledge.

The RCM is calling for greater investment towards training of more perinatal mental health midwives.

Additionally, the representative body for midwives says its roadmap demonstrates the ‘irrefutable economic and social case’ for more mental health resources.

Undiagnosed or untreated poor mental health impacts women and families but also creates a financial burden for the state, estimated to be an additional £8.1bn a year across the UK.

The RCM says investing in perinatal mental health would be ‘a fraction’ of the estimated cost of untreated mental ill health, adding that NHS leaders should commission a midwifery workforce framework looking at the future planning of women’s perinatal mental health needs.

Professor Asma Khalil, consultant obstetrician and Vice President of Royal College of Obstetricians and Gynaecologists welcomed the call for change towards more equitable access to mental health services, adding:

“This roadmap paves the way for positive changes at all levels, advocating for every maternity unit to be equipped with staff who can recognise women who may benefit from specialist care, and allowing specialist healthcare professionals the time to care for them.”

Read more: Perinatal and infant mental health funding extended; ‘Weaknesses' found in Scotland's cervical screening; Transatlantic mental health partnership strengthened; Health poverty hits children halfway through pregnancy; Nursing report spotlights burnout and discrimination

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