Australian midwives knowledge, attitude and perceived learning needs around perinatal mental health

Contribution of the abbreviated CAVE-st questionnaire in Spanish: the attitudes toward childbirth experiences

There are several factors that influence women's childbirth experience, and personal interactions with health professionals are of particular significance. The main objective of this study was to present the validation of an abbreviated form of an existing questionnaire on attitudes about childbirth in medical and nursing students. We used a sample of 512 perinatal medicine and nursing students who received the original 52-item CAVE-st questionnaire to obtain a shorter version with proper psychometric properties. We used Cronbach's alpha coefficient to evaluate the new version's internal consistency. The Kaiser- Meyer-Olkin test and the Barlett sphericity test were performed to assess the suitability of exploratory factor analysis (EFA). Subsequently, confirmatory factor analysis (CFA) was performed using structural equation models in a second sample of 139 medical students. We obtained a 15-item version with a Cronbach's alpha of 0.82. The EFA revealed a four-dimensional structure, similar to the full 52-item version. In the CFA the adjustment indexes showed good model fitness, RMSEA= 0.046 [CI 0.00-0.07]; CFI = 0.978. We can conclude that the 15-item version is a valid tool for evaluating the attitude of students toward childbirth, pointing out the matters that should be improved in their training to avoid obstetric trauma by the promotion of a positive experience in women during childbirth.

Nurses' and midwives' experiences of managing parental postnatal depression: A scoping review

AIM

To describe the current state of the literature on nurses' and midwives' knowledge, perceptions and experiences of managing parental postnatal depression (PPND).

DESIGN

The Joanna Briggs Institute scoping review method and the PRISMA extension for Scoping Reviews guided the work.

DATA SOURCES

A systematic search of PubMed, CINAHL, Embase, MEDLINE, PsycINFO and Scopus databases was conducted in January and February 2023.

REVIEW METHODS

Peer-reviewed primary research articles published in English between 2012 and 2023 that involved nurses or midwives managing PPND were included. Rayyan was used to screen titles, abstracts and full-text articles. A spreadsheet was used to organize extracted data and synthesize results.

RESULTS

Twenty-nine articles met the inclusion criteria. Most study samples were of mothers, and few were from middle- and lower-income countries. Nurses and midwives lacked knowledge about PPND, yet they felt responsible for its management. Nurses and midwives faced significant organizational and systems-level challenges in managing PPND. However, nurses and midwives facilitated PPND care in collaboration with other healthcare providers.

CONCLUSION

The review highlights significant gaps in the nurses' and midwives' care of PPND. Educational programmes are necessary to increase nurse and midwife knowledge of PPND and strategies for its management, including facilitating collaboration across the healthcare system and eliminating organizational and systemic-related barriers. Additional focused research is needed on nurses' and midwives' knowledge, perception of and experience with PPND beyond mothers, such as with fathers, sexually and gender-minoritized parents and surrogate mothers. Finally, additional research is needed in middle- and lower-income countries where nurses and midwives may face a higher burden of and unique cultural considerations in managing PPND.

IMPACT

PPND can affect the parent's mental and physical health and relationship with their child. If left untreated, PPND can lead to long-term consequences, including child developmental delays, behavioural problems and difficulties with parental-child attachment.

REPORTING METHOD

This scoping review adheres to PRISMA Extension for Scoping Review guidelines and the Joanna Briggs Institute scoping review method.

PATIENT OR PUBLIC CONTRIBUTION

This research is a scoping review of published peer-reviewed studies.

Knowledge, attitudes, and support needs of obstetric and gynecological nurses and midwives toward perinatal mental health disorders screening in Central China: a multicenter cross-sectional survey

Background

The perinatal period is a time of increased vulnerability regarding maternal mental health status. Although guidelines and policies have been published for perinatal mental health disorders (PMHDs) screening in China, the knowledge, attitudes, and support needs of nurses and midwives toward implementing mental health screening programs during pregnancy remain unclear. Thus, this study aimed to investigate the knowledge of PMHDs, attitudes and support needs related to implementing mental health screening during pregnancy among obstetrics and gynecology (OB/GYN) nurses and midwives in the central region of China while identifying the related influencing factors.

Methods

A cross-sectional survey was conducted in 14 cities in Hubei, China, using convenience sampling from July to October 2023. The Chinese version of the Perinatal Mental Health Knowledge Questionnaire, the Chinese version of the Perinatal Mental Health Attitudes Scale, and the Health Care Facilities Support Needs Scale were used to investigate the PMHDs knowledge, attitudes, and support needs of OB/GYN nurses and midwives, respectively. Data were analyzed using SPSS version 27.0. Descriptive and inferential statistics were performed, with a p-value of <0.05 considered statistically significant.

Results

The average scores for knowledge, attitudes, and support needs were 6.09 ± 1.99 (total score: 13), 47.67 ± 8.80 (total score: 80), and 29.35 ± 4.66 (total score: 35), respectively. After adjusting for years of nursing experience and years of obstetrics and gynecology nursing experience, the multivariate logistic regression analysis indicated that having mental health-related education or work experience [adjusted OR (aOR) = 1.43, p = 0.01], being midwives (aOR = 1.78, p < 0.001), and working in specialist maternity hospitals (aOR = 1.55, p < 0.001) were significantly associated with higher knowledge scores; having mental health related education or work experience (aOR = 1.59, p = 0.014) and working in specialist maternity hospitals (aOR = 1.42, p < 0.01) were significantly associated with higher support needs scores.

Conclusion

OB/GYN nurses and midwives demonstrated insufficient knowledge and moderate attitudes toward PMHDs screening, and have great support need for PMHDs screening. To address these issues, medical organizations and relevant government sectors should enhance training for nurses and midwives on PMHDs and provide professional support to promote routine maternal mental health screening programs and improve perinatal mental health outcomes.

Midwives' perspectives and perceptions in relation to perinatal psychotic-like experiences: a qualitative study

BACKGROUND

Psychotic-like experiences (PLEs) refer to subclinical experiences consistent with psychosis that may include hearing, feeling or seeing things that others cannot, or experiencing unusual beliefs. These experiences appear to be more common during the perinatal period. There appear to be barriers which make it difficult for midwives to support mothers with mental health difficulties. However, it is important that midwives can provide support with PLEs.

AIM

This study aimed to explore UK midwives' perspectives and perceptions relating to mothers' psychotic-like experiences in the perinatal period.

METHODS

A qualitative study using semi-structured interviews with ten midwives recruited online was conducted. Transcripts were analysed using thematic analysis.

RESULTS

Four themes were developed: (1) Identifying psychotic-like experiences would be complicated; (2) Psychotic-like experiences can feel overwhelming for women and midwives; (3) This is my responsibility: I'll do what I can to support women even if it's hard; and (4) The system feels unsafe and insecure which makes the anticipated role in supporting psychotic-like experiences harder.

CONCLUSION

Midwives described their motivation to support mothers with PLEs but articulated many factors that made this difficult. The results emphasise the importance of training and guidance for midwives to support them being able to offer support and information to mothers. The findings also highlight the importance of systemic safety for midwives alongside support through supervision and reflective practice.

Evaluation of the effectiveness of a video-based educational intervention on perinatal mental health related stigma reduction strategies for healthcare professionals: A single group pre-test-post-test pilot study

BACKGROUND

Healthcare professionals have a role to play in reducing perinatal mental health related stigma.

AIM

To assess the effectiveness of a video-based educational intervention developed to provide guidance to healthcare professionals on perinatal mental health related stigma reduction strategies.

DESIGN

A single group pre-test-post-test pilot study with no control group.

SETTING(S)

A university affiliated maternity hospital in Ireland PARTICIPANTS: A convenience sample of registered midwives, nurses and doctors (n = 60) recruited from October 2020-January 2021.

INTERVENTION

A twenty-minute video-based educational intervention.

METHODS

Respondents (n = 60) completed a pre-test (time point one) and post-test (time point-two) questionnaire, and a three-month follow-up post-test questionnaire (time point-three) (n = 39). The questionnaire included the Mental Illness Clinicians' Attitudes Scale, Reported and Intended Behaviour Scale, Reynolds Empathy Scale and open-ended questions. Wilcoxon Signed Rank Test was selected to evaluate the pre-test post-test scores.

RESULTS

The difference in mean Mental Illness: Clinicians' Attitudes-4 scores were statistically significant between time points one and three (z = 3.27, df=36, P = 0.0007) suggesting more positive attitudes towards people with mental health conditions after the intervention. The mean total score for the Reported and Intended Behaviour Scale increased from 18.7 (SD 1.87) at time point one to 19.2 (SD 1.60) at time point two (z= -3.368, df=59, P = 0.0004) suggesting an increase in positive intended behaviours towards those with mental health issues immediately following the intervention. These findings were also corroborated by responses to open-ended survey questions.

CONCLUSIONS

Further research with a larger sample of healthcare professionals evaluated over a longer period would provide further evidence for the sustainability of the intervention.

TWEETABLEABSTRACT

A video-based intervention can increase healthcare professionals' knowledge of perinatal #mentalhealth related stigma reduction strategies @Journal. Link to article.

Identifying psychosocial vulnerabilities in pregnancy: A mixed-method systematic review of the knowledge base of antenatal conversational psychosocial assessment tools

BACKGROUND

Early identification of psychosocial vulnerability among expectant parents through psychosocial assessment is increasingly recommended within maternity care. For routine antenatal assessment, a strong recognition exists regarding conversational assessment tools. However, the knowledge base of conversational tools is limited, inhibiting their clinical use.

OBJECTIVE

Synthesising existing knowledge pertaining to antenatal conversational psychosocial assessment tools, including identifying characteristics, acceptability, performance, effectiveness and unintended consequences.

DESIGN

Mixed-method systematic review based on searches in CINAHL, PubMed, Embase, PsycINFO, Cochrane and Scopus. 20 out of 5394 studies were included and synthesised with a convergent integrated approach using a thematic analysis strategy.

FINDINGS

We identified seven antenatal psychosocial assessment tools that partially or completely utilised a conversational approach. Women's acceptability was high, and tools were generally found to support person-centred communication and the parent-health care professional relationship. Evidence regarding effectiveness and performance of conversational tools was limited. Unintended consequences were found, including some women having negative experiences related to assessment of intimate partner violence, lack of preparation and lack of relevance. High acceptability was reported by health care professionals who considered the tools as valuable and enhancing of identification of vulnerability. Unintended consequences, including lack of time and competencies as well as discomfort when assessment is very sensitive, were reported.

CONCLUSIONS

Evidence regarding conversational tools' effectiveness and performance is limited. More is known about the acceptability of conversational tools, which is generally highly acceptable among women and health care professionals. Some unintended consequences of the use of included conversational tools were identified.

Clinical teaching practices in maternal mental health care: An integrated review

WHAT IS KNOWN ABOUT THE TOPIC?: Mental health-related problems in pregnancy are now becoming a global health concern. However, most studies have reported that midwives are unable to assess and support maternal mothers due to poor preservice education. The findings of these studies needed to be explored further from the available literature to address the gap. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The paper has identified maternal mental health core competencies and innovative clinical teaching strategies that nurse educators can utilize when supporting students theoretically and during clinical practice so that students should be adequately prepared for maternal mental health practice. Challenges and recommendations for clinical teaching were also identified. However, there are still gaps in the literature related to the effectiveness of teaching strategies to promote competence acquisition in maternal mental health. WHAT ARE THE IMPLICATIONS FOR EDUCATION?: The study results can be used by nurse educators to develop effective clinical teaching practices in maternal mental health care. The findings can be used in the development of best clinical teaching guidelines for maternal or perinatal mental health to be used by nurse educators for the undergraduate midwifery training programmes. ABSTRACT: Introduction Maternal mental health problems are commonly experienced by women; however, they are usually not adequately recognized and treated by midwives in Malawi. Evidence suggests poor preservice education by nursing colleges which affects the development of essential maternal mental health competencies. Aim The aim of the study was to review existing evidence on clinical teaching practices by nurse educators in teaching student midwives maternal mental health care. Method Integrative review method was used, and various databases were searched. Out of 1768 articles, 27 research articles met the inclusion criteria. The critical appraisal skills programme checklist tools were used to assess data quality. Thematic analysis was done by comparing, grouping and integrating data. Results Six themes emerged, namely: core maternal mental health competencies, professional regulation, interactive teaching strategies, collaborative partnerships, capacity building and shortage of resources. Discussion Clinical teaching is an important aspect of midwifery education. Utilizing student-centred teaching approaches helps students acquire competencies in maternal mental health care. Further research is required to identify the effectiveness of the clinical teaching methods. The Implication to Practice The study results can assist nurse educators to provide comprehensive clinical teaching practices in maternal mental health care which will aid in the development of maternal mental health competencies among student midwives.

Are midwives trained to recognise perinatal depression symptoms? Results of MAMA (MAternal Mood Assessment) cross-sectional survey in Italy

PURPOSE

To assess the knowledge, clinical experience, and attitudes of Italian midwives toward perinatal depression (PND) and to explore how these factors impact the quality of care.

METHODS

We conducted a cross-sectional online survey among 152 midwives employed in public hospitals across Italy. The questionnaire covered a range of topics, including demographic data, professional experience, knowledge of PND symptoms, risk factors, and clinical management, as well as communication skills and personal experiences with PND cases.

RESULTS

A concerning 76.3% of midwives displayed inadequate knowledge of PND based on current scientific literature. Those with a more comprehensive understanding were notably more confident in their practice, expressing significantly fewer apprehensions about communicating with mothers (25.8% vs 74.2%) and lesser concerns about the mothers' future well-being (38.9% vs 62.95%). The survey results also emphasised the midwives' call for specialised guidelines and formal training in PND management and underscored the value of communication skills, continuity of care, and family engagement in supporting affected mothers.

CONCLUSION

This inaugural study sheds light on the current state of knowledge and attitudes among Italian midwives regarding PND. It pinpoints crucial areas for educational enhancement and practice improvement, suggesting that elevated levels of midwife expertise in PND could significantly elevate the standard of care and expedite early diagnosis and treatment.

A systematic review of midwives' training needs in perinatal mental health and related interventions

Background

Midwives may be key stakeholders to improve perinatal mental healthcare (PMHC). Three systematic reviews considered midwives' educational needs in perinatal mental health (PMH) or related interventions with a focus on depression or anxiety. This systematic review aims to review: 1) midwives' educational/training needs in PMH; 2) the training programs in PMH and their effectiveness in improving PMHC.

Methods

We searched six electronic databases using a search strategy designed by a biomedical information specialist. Inclusion criteria were: (1) focus on midwives; (2) reporting on training needs in PMH, perinatal mental health problems or related conditions or training programs; (3) using quantitative, qualitative or mixed-methods design. We used the Mixed Methods Appraisal Tool for study quality.

Results

Of 4969 articles screened, 66 papers met eligibility criteria (47 on knowledge, skills or attitudes and 19 on training programs). Study quality was low to moderate in most studies. We found that midwives' understanding of their role in PMHC (e.g. finding meaning in opening discussions about PMH; perception that screening, referral and support is part of their routine clinical duties) is determinant. Training programs had positive effects on proximal outcomes (e.g. knowledge) and contrasted effects on distal outcomes (e.g. number of referrals).

Conclusions

This review generated novel insights to inform initial and continuous education curriculums on PMH (e.g. focus on midwives' understanding on their role in PMHC or content on person-centered care).

Registration details

The protocol is registered on PROSPERO (CRD42021285926).

Evaluation of a pilot online education program to develop midwives' knowledge, skill and confidence in perinatal mental health in rural South Australia

One in five women will experience perinatal anxiety and/or depression. In South Australia, a rural health service identified a high proportion of women with risk of perinatal mental health challenges and sought additional education for midwives. In response, a six-week facilitated, online perinatal mental health education program (e-PMHEP) was piloted.

AIM

The aim of this study was to evaluate the effectiveness of the (e-PMHEP) for rural midwives, nurses and Aboriginal maternal infant care practitioners.

METHOD

Program evaluation incorporated a validated online pre/post survey to assess self-reported knowledge, skill and confidence regarding perinatal mental healthcare. Additional questions sought feedback on satisfaction and feasibility.

FINDINGS

Sixteen participants from rural South Australia engaged in the project from June to August 2022. Twelve participants completed the online pre/post survey. The overall pre/post knowledge scores were statistically significant (t = 2.73, 8df, p = 0.025) with improvement from the pre to post-test. Pre/post data also showed a measurable increase in confidence and skills. All respondents agreed that the content addressed their learning needs and would recommend this program to other practitioners.

DISCUSSION

The e-PMHEP appeared beneficial in developing knowledge, skills and confidence regarding perinatal mental healthcare in rural midwives and practitioners. Only a third of practitioners routinely developed a mental health care plan with women. Key strengths of the program included the accessible content, and the combination of an experienced mental health clinician and a facilitator with lived experience.

CONCLUSION

Providing an accessible, facilitated online perinatal mental health education program could be beneficial for rural midwives.

The perceptions and attitudes of obstetric staff and midwives towards perinatal mental health disorders screening: a qualitative exploratory study in Shenzhen, China

BACKGROUND

The perinatal period is a crucial time for women, as they experience various biological, psychological, and social stressors. Due to the complexity of this vulnerable time, there is a high prevalence of depressive and anxiety disorders among pregnant women. In 2019, the Health Commission of Shenzhen initiated perinatal mental health screening programme in China. However, attitudes and perceptions of medical staff towards implementing mental health screening programme during pregnancy remain unclear. The aim of this study was to explore the perceptions and attitudes of obstetric staff and midwives towards screening for perinatal mental disorders in pregnant women, and identify their perceived needs and motivations for undertaking this task.

METHODS

This is a qualitative exploratory study. Data were collected through in-depth, semi-structured, face-to-face interviews. The dataset was analysed using inductive content analysis. Purposive sampling method was used to recruit 13 participants at a tertiary maternal hospital in Shenzhen from September to November, 2019.

RESULTS

A total of 13 obstetric staff was interviewed, including two obstetricians, three midwives, and eight nurses. Four themes were identified from this study: views on perinatal mental health disorders screening, competency in identifying and supporting high-risk groups, barriers to dealing with psychological problems during pregnancy, and the support needs of medical staff in undertaking the tasks of mental health disorders screening.

CONCLUSION

Medical staff lacked sufficient knowledge and skills in perinatal psychological health and were not well prepared for the task of screening pregnant women for mental health disorders. To address this issue, medical organisations and relevant government sectors should provide training to medical staff on perinatal mental health disorders, enhance public awareness of perinatal mental health disorders, establish a model of multidisciplinary collaboration for the screening of women's perinatal mental disorders, and provide continuous and holistic care for pregnant women.

A mixed methods study to understand perinatal mental healthcare referral decisions among midwives and health visitors in the UK

Background

In the UK approximately half of women requiring perinatal mental health (PNMH) care do not receive treatment despite having routine contact with midwives (MWs) and health visitors (HVs). Limited research has been undertaken regarding MWs'/HVs' decision-making around referring women for secondary PNMH care. In particular, the impact that the level of local secondary PNMH services may have on MWs'/HVs' referral decisions is unexplored.

Aim

To understand MWs'/HVs' decision-making in relation to referring women with identified PNMH problems, to identify barriers and facilitators to effective and timely referrals including any impact of the local secondary PNMH service provision.

Methods

Participants were recruited from four National Health Service (NHS) Trusts in England, located across two geographical areas, that provided different types of PNMH services. One area had PNMH services that met National Institute for Health and Care Excellence (NICE) guidelines; the other area had no secondary PNMH services. A sequential mixed methods design was used: In-depth semi-structured interviews with practising MWs/HVs (n = 24) to explore their approach to PNMH referral decision-making, analysed using thematic analysis; Questionnaire offered to all practising MWs/HVs in the two geographical areas to measure factors that may impact on PNMH referral decision-making allowing for statistical comparisons to be made between the professional groups/geographical areas.

Findings

Three themes were identified from the interviews that impacted on MWs'/HVs' PNMH referral decision-making: identifying need; education, skills and experience; and referral pathways.Questionnaire response rate 13.1% (n = 99). The most reported facilitators to referral decision-making were a trusted relationship between MWs/HVs and women and routine enquiry about women's mental health; the most reported barriers were stigma associated with mental ill-health and women's perceived fear of child removal.

Conclusion

Fundamental to MWs'/HVs' decision-making was their perceived relationship between themselves and women. Although PNMH service provision is important for women to ensure they receive appropriate PNMH care, service provision appeared less important to MWs'/HVs' referral decision-making than how maternity/health visiting services were delivered. Further important factors to MWs/HVs were to the ability to provide continuity of carer with women allowing MWs/HVs to identify women who would benefit from referral for secondary PNMH care.

Evaluation of a manual-based training program in changing auxiliary nurse midwives (ANMs) knowledge, attitudes, and skills related to maternal mental health

Background

Globally, maternal mental health has been recognized as a priority public health issue. While it is crucial to integrate maternal mental health into mother and child health services, research on strengthening the knowledge and skills of primary healthcare providers on maternal mental health is limited in India.

Aim

To evaluate the effectiveness of a manual-based training program in improving auxiliary nurse midwives (ANMs) knowledge, attitudes, and skills related to maternal mental health.

Methods

The present study adopted an experimental design among ANMs (N = 110) working at primary health centers, Karnataka, India. The participants were randomly assigned to either experimental group (n = 53) or control group (n = 57). The training program delivered interactive sessions based on a facilitator's manual developed specifically for ANMs in India. The assessments were done in both groups at baseline, after the intervention, at three months and at six months using self-rated questionnaires and a case vignette. The descriptive and inferential statistics were used to analyze the data.

Results

After the training program the mean knowledge, attitudes and skills scores were significantly increased in the experimental group (P < 0.001) and significant differences were found between the mean scores of the groups at 3 months and 6 months follow-up (P < 0.05).

Conclusion

The training program was found to have a positive impact in enhancing ANMs' knowledge, attitudes, and skills related to maternal mental health in India as there is dearth for mental health professionals in primary care settings.

Healthcare professionals' experiences and perceptions of providing support for mental health during the period from pregnancy to two years postpartum

OBJECTIVE

Mental health issues in the perinatal period are common, and can have negative consequences for maternal and child health. Healthcare professionals (HCPs) who provide women with perinatal care are well-placed to detect mental health issues and provide support. This study therefore examines HCPs' experiences and perceptions of providing mental health support during the perinatal period, including during the COVID-19 pandemic.

DESIGN

An exploratory realist qualitative study was conducted.

SETTING

Republic of Ireland PARTICIPANTS: A purposive sampling strategy was employed to recruit HCPs (e.g., general practitioners, midwives, public health nurses, practice nurses, doulas, and breastfeeding counsellors), via professional bodies in Ireland. An invitation to participate was also circulated via Twitter. A total of 18 HCPs participated in semi-structured interviews conducted between 18/8/2020 and 24/5/2021.

MEASUREMENTS AND FINDINGS

Semi-structured interviews were conducted according to a topic guide designed by a multidisciplinary team. Data were analysed using thematic analysis. Four themes were developed: 'Supporting women in healthcare settings,' 'Skills and capacity to provide adequate care,' 'Structural barriers to care provision,' and 'The impact of the COVID-19 pandemic on stress support.'

KEY CONCLUSIONS

HCPs reported providing emotional support and advocacy, but highlighted challenges, including limited capacity to address women's concerns, clinical culture and hierarchy, insufficient organisational investment, and social inequities in support access. Some HCPs felt these barriers could lead to additional psychological harm. HCPs also reported that the pandemic had introduced novel stressors and changed the nature of the mental health support they provided.

IMPLICATIONS FOR PRACTICE

Interventions incorporating education and physical resources for HCPs, increased investment in specialist perinatal mental health services, increased investment in holistic supports, and changes to address cultural challenges in care environments, may facilitate - or enhance - support for women.

Knowledge, attitude, and practices of healthcare providers about perinatal depression in Himachal Pradesh-A cross-sectional study

Introduction

Perinatal depression is defined as depression occurring in a woman during pregnancy or within 12 months of delivery. It has been associated with many poor outcomes, including maternal, child, and family unit challenges. This study aimed to assess the knowledge, attitude, and practices of obstetricians and primary healthcare professionals so that the knowledge gap could be assessed and they could be educated regarding the screening and treatment/referral of patients with peripartum depression.

Methods

The study used a cross-sectional study design with convenience sampling. The data were collected through an online survey among healthcare providers using the Google Forms application. Submission of filled questionnaire implied consent for participation. Ethical approval for the study was obtained from the institutional ethics committee. The results were reported as mean and percentages. All data were analysed using Excel software 2019.

Results

A total of 53 doctors responded to participate in the study. More than 98% of them were aware of an entity called perinatal depression. Around 89% of the participants do not screen patients for the perinatal period routinely using a screening questionnaire. About 90% of participants agreed with the need for screening for perinatal depression. Less than 50% of participants had heard about the screening questionnaire for the same. Around 89% agreed that all health professionals should have skills in recognising and managing depression.

Conclusion

There is a need to educate healthcare workers including obstetricians about screening for perinatal depression, thus improving the quality of life of perinatal women and preventing complications due to untreated depression.

Perinatal mental healthcare: Developing skills in midwifery students

Midwives have a pivotal role in screening for risk factors for mental illness and psychosocial vulnerabilities in women during the perinatal period. They also have a key responsibility to provide women with the appropriate resources to support their mental wellbeing. Midwives can lack confidence and/or feelings of competence regarding these skills. Care of women in the context of their perinatal mental health is a core midwifery skill that deserves practical learning during pre-registration education, just as the more 'hands on' skills such as abdominal palpation, labour and birth support or newborn examination. However, there is limited opportunity for students to gain clinical placement experiences that are specific to perinatal mental health (PMH). This discussion paper describes an innovative teaching and learning project that aimed to improve confidence in students' ability to conduct screening, support, and referral of women experiencing mental ill health. The project involved the development of an Objective Structured Clinical Examination (OSCE) and audio visual resources to support learning and teaching and clinical placement. Feedback was collected to inform the refinement of the first OSCE, and to assist in the design of the audio visual resources that are now displayed publicly on the Australian College of Midwives website at https://www.midwives.org.au/Web/Web/Professional-Development/Resources.aspx?hkey=12c2360e-d8b9-4286-8d0a-50aeaeca9702.

Barriers to perinatal mental health care experiences by midwives and obstetricians and their patients: A rapid review

INTRODUCTION

While perinatal mental health concerns are common, little attention is paid to noticing or addressing these concerns. Midwives and obstetricians are uniquely positioned to universally screen their patients for mental health conditions during the perinatal period, and provide referrals for additional mental health supports if relevant. Previous studies on perinatal mental health care have focused primarily on midwifery care, excluding perinatal healthcare providers such as obstetricians. This rapid review aims to examine the barriers to accessing mental health care during the perinatal period as experienced by obstetricians, midwives, and their patients.

METHODS

A rapid review of literature was conducted on barriers to perinatal mental health care as experienced by patients, midwives, and obstetricians. The search strategy included published literature from PubMed, CINAHL, PsycINFO, and Web of Science published between 2000 and 2020. All documents were screened by two researchers and disagreements were resolved through consensus with a third reviewer. After data from all included articles were extracted, thematic analysis was conducted, and findings were compared with related reviews that focused on mental health access for individuals who accessed midwifery care.

RESULTS

Of the 539 references and documents that were screened, 31 articles met the inclusion criteria. In the extraction phase, country, study objective(s), study design, perspective(s), barriers, and the dimension(s) impacted along the pathway to accessing care were retrieved from the 31 included articles. After all barriers were classified using the Supply-Side Dimensions of Access, we developed a classification framework to further examine stigma at the societal, institutional, and individual levels.

DISCUSSION

While midwives utilize a more holistic approach to care as compared with obstetricians, the barriers identified through this rapid review indicate that obstetricians and their patients face similar struggles to accessing and providing mental health care. Moreover, stigma plays a large role in the barriers experienced by patients, midwives, and obstetricians - at individual and institutional levels.

CONCLUSION

Obstetricians encounter similar stigma-related barriers as midwives in detecting mental health concerns, as well as connecting clients to available mental health resources and supports. Therefore, to effectively eliminate barriers to accessing perinatal mental health care, a systemic change must be enacted throughout all three layers to address the deep-rooted stigma associated with accessing mental health care during the perinatal period.

Psychosocial interprofessional perinatal education: Design and evaluation of an interprofessional learning experience to improve students' collaboration skills in perinatal mental health

BACKGROUND

Perinatal mental health disorders are one of the leading causes of maternal illness and suffering and care and services need to be well coordinated by an interprofessional team who are skilled in working collaboratively.

AIM

The aim of this paper is to describe the design and evaluation of an innovative interprofessional education initiative to increase midwives and other health professional students' knowledge and skills in caring collaboratively for women with psychosocial issues in the perinatal period, including women experiencing domestic and family violence.

METHODS

The Psychosocial Interprofessional Perinatal Education workshop was designed for midwifery, psychology, social work and medical students. It provided a simulated learning experience with case studies based on real life situations. Students undertook pre and post surveys to measure changes in students' perceptions of interprofessional collaboration and their experiences of participating in the interprofessional simulation-based learning activity. Quantitative survey data were analysed using paired t-tests and a qualitative content analysis was undertaken on the open-ended questions in the survey.

FINDINGS

Comparison of pre and post surveys found students from all disciplines reported feeling more confident working interprofessionally following the workshop. The following categories were generated from analysis of the open ended survey data: Greater understanding of each others' roles; Recognising benefits of interprofessional collaboration; Building on sense of professional identity; Respecting each other and creating a level playing field; and Filling a pedagogical gap.

CONCLUSION

Through this innovative, simulated interprofessional education workshop students developed skills essential for future collaborative practice to support women and families experiencing psychosocial distress.

Implementation of the ‘Kimberley Mum’s Mood Scale’ across primary health care services in the Kimberley region of Western Australia: A mixed methods assessment

The Kimberley Mum’s Mood Scale (KMMS) was co-designed with Aboriginal women and healthcare professionals to improve culturally appropriate screening practices for perinatal depression and anxiety. This paper describes the implementation of the KMMS across the remote Kimberley region of Western Australia from January 2018 to December 2021. We used the Dynamic Sustainability Framework to progress the implementation and assess at the intervention, practice setting and ecological system level using a mixed methods approach to analyse implementation. Rates of administration and results of screening were described using a retrospective audit of electronic medical records. Analyses of KMMS training registry, stakeholder engagement and sustainability initiatives were descriptive. KMMS acceptability was assessed using qualitative descriptive approaches to analyse patient feedback forms (n = 39), healthcare professional surveys (n = 15) and qualitative interviews with healthcare professionals (n = 6). We found a significant increase in overall recorded perinatal screening (pre-implementation: 30.4% v Year 3: 46.5%, P < 0.001) and use of the KMMS (pre-implementation: 16.4% v Year 3: 46.4%, P < 0.001). There was improved fidelity in completing the KMMS (from 2.3% to 61.8%, P < 0.001), with 23.6% of women screened recorded as being at increased risk of depression and anxiety. Most healthcare professionals noted the high levels of perinatal mental health concerns, stress, and trauma that their patients experienced, and identified the KMMS as the most appropriate perinatal screening tool. Aboriginal women reported that it was important for clinics to ask about mood and feelings during the perinatal period, and that the KMMS was appropriate. Aboriginal women consistently reported that it was good to have someone to talk to. This study demonstrates that innovation in perinatal depression and anxiety screening for Aboriginal women is possible and can be implemented into routine clinical care with the support of a sustained multi-year investment and strong partnerships.

Developing a training programme for midwives and maternity support workers facilitating a novel intervention to support women with anxiety in pregnancy

BACKGROUND

The RAPID-2 intervention has been developed to support women with symptoms of mild-to-moderate anxiety in pregnancy. The intervention consists of supportive discussions with midwives, facilitated discussion groups and access to self-management materials. This paper reports the development of a training programme to prepare midwives and maternity support workers to facilitate the intervention.

METHODS

Kern's six-step approach for curriculum development was used to identify midwives and maternity support workers training needs to help support pregnant women with anxiety and facilitate a supportive intervention. The stages of development included feedback from a preliminary study, stakeholder engagement, a review of the literature surrounding midwives' learning and support needs and identifying and supporting the essential process and functions of the RAPID intervention.

RESULTS

Midwives' reported training needs were mapped against perinatal mental health competency frameworks to identify areas of skills and training needed to facilitate specific intervention mechanisms and components. A training plan was developed which considered the need to provide training with minimal additional resources and within midwives' scope of practice. The training plan consists of two workshop teaching sessions and a training manual.

CONCLUSION

Future implementation is planned to include a post-training evaluation of the skills and competencies required to fully evaluate the comprehensive programme and deliver the RAPID-2 intervention as planned. In addition, the RAPID-2 study protocol includes a qualitative evaluation of facilitators' views of the usefulness of the training programme.

Disparities in postnatal depression and anxiety screening: Results from a cross sectional survey of Maternal and Child health nurses in Victoria, Australia

OBJECTIVES

To describe Maternal and Child Health nurses' self-reported knowledge of, and attitude toward screening for postnatal depression and anxiety, and identify factors which impact screening in line with recommended guidelines.

METHODS

A population-based, cross-sectional study of all Maternal and Child Health nurses in Victoria, Australia. Data were collected in 2019 through an online survey designed to fit a Knowledge, Attitude and Practice framework. Descriptive analyses were conducted to describe participant characteristics, self-reported knowledge, attitude, and practices. Bivariate and multivariate regression analysis were performed to evaluate associations between screening practices and nurses' attitude toward screening and a range of sociodemographic variables.

RESULTS

Two hundred and eighteen Maternal and Child Health nurses participated in the study. Participants viewed screening as an important part of their role and screened all mothers at least once in the first 12 month postpartum. <35% routinely did so more than once in the first 12 months postpartum, and 31% were able to adhere to the recommended use of psychosocial assessments as part of their screening practice. After adjusting for confounding factors, nurses practicing in communities with greater socio-economic advantage were significantly more likely to conduct psychosocial assessments (aOR 3.93, 95% CI 1.47-10.49) and screen more than once (aOR 2.91, 95% CI 1.18-7.13), compared to nurses who worked in disadvantaged communities.

CONCLUSION

Place-based inequities in nurses' screening practices serve to widen the gap in health outcomes between advantaged and disadvantages mothers. Policy and practice strategies must consider the systematic challenges that contribute to this phenomenon and embed place-based strategies which address them.

[Preventive staff meetings in maternity ward for women at high medico-psycho-social risk: Qualitative study between 2012 and 2018]

OBJECTIVE

To assess the effectiveness of a multidisciplinary consultation meeting created in collaboration between a perinatal psychiatry team and professionals from a level 3 maternity hospital, whose purpose is to prepare the delivery and postpartum of pregnant women at high medico-psycho-social risk. I) Study the functioning of these multidisciplinary meetings. II) Assess the concordance between the decisions made in antenatal care and the actual management of the delivery and postpartum care.

METHODS

This is a retrospective study of 140 files for which the opinion of the multidisciplinary meeting was requested in the years 2012, 2014, 2016 and 2018. We looked at the psychiatric files of the patients, as well as the summary sheets written after staff meetings.

RESULTS

The selection of files is compliant in 98% of cases and the traceability of information in the summary sheet is over 80% for half of the process indicators. The overall compliance rate between the decisions taken at meetings and their implementation in the post-partum period is 68%. Acute psychiatric episode and reporting could be anticipated.

CONCLUSION

This multidisciplinary consultation meeting is efficient in the early detection of risk situations. The decisions taken during the multidisciplinary meetings in antenatal care are mostly applied postpartum in the Maternity Ward. In cases where they are not applied, the system offers great reactivity to postpartum professionals.

Assessment of the attitude towards childbirth in health sciences students - development and validation of the questionnaire Cave-St

The purpose of this study is to report on the validation process of a questionnaire that explores health science students’ attitudes towards women’s childbirth experiences. This questionnaire can help inform education programs to enhance the quality of woman-professional interactions, and to improve women’s experiences of childbirth. A standardized procedure for the development and validation of the questionnaire included: item development and psychometric pre-validation, Cronbach’s Alpha coefficient calculation, test–retest and item-total correlation for the reliability analysis. Content validity was undertaken by Delphi method with sixteen panelists over two rounds. We determined the factor structure and refined and validated the questionnaire according to the responses of a cohort of 560 students using principal components factor analysis with varimax rotation. Confirmatory factor analysis was undertaken. A 52-items questionnaire CAVE-st: (acronym for cuestionario de actitudes sobre vivencias y experiencias en el parto) was developed and validated. The results of the factor analysis finally revealed four latent dimensions. The questionnaire CAVE-st is a valid and reliable tool to assess health science students’ attitude towards women’s childbirth experiences. Further work to translate and adapt the instrument in other cultures and languages will be undertaken.

Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth

OBJECTIVES

The main objective of the present study was to evaluate what educational needs were being neglected in current perinatal educational program in the University of Malaga.

METHODS

We performed a cross-sectional study using the Students' questionnaire on attitudes towards childbirth (CAVE-st) in a sample of 378 students who were finishing their undergraduate or postgraduate academic perinatal program, including medical and nursing students.

RESULTS

The Cronbach's alpha reliability coefficient was 0.895. The mean score of CAVE-st in the sample was 200.34 (DT 21.0). The scores were below the median value in more than 53% of the students, especially in medical students. Female students scored systematically higher in the overall scale and its subscales, even after adjusting for study groups. On the other hand, the students with children scored significantly lower in the subscale that explored their attitudes towards unexpected results. A huge margin for improvement was recognizable in those subscales related with childbirth medicalization, respect to women decisions, and health-care prioritization.

CONCLUSIONS

Students' attitude towards childbirth need to be improved as a means to improve women's childbirth experience and prevent birth-related trauma. The current undergraduate and postgraduate training in perinatal care lacks a comprehensive and biopsychosocial perspective that would improve the quality of clinical practice during childbirth.

Midwives' experiences of caring for women's emotional and mental well-being during pregnancy

AIMS AND OBJECTIVES

To explore midwives' experiences of caring for women's emotional and mental well-being during pregnancy.

BACKGROUND

Transitioning to motherhood is a major life event for any woman and while it is a joyful experience for the majority, 15%-25% of women will experience a perinatal mental health problem. Providing psychological support to mothers by midwives is acknowledged internationally. The 2016 Irish National Maternity Strategy identifies midwives as being ideally placed to assess women's emotional needs. The research revealed a paucity of qualitative research from an Irish context in this area; therefore, this study addressed this gap in the literature.

DESIGN

Qualitative descriptive design.

METHODS

Semi-structured interviews were conducted with a purposive sample of 10 midwives recruited from the Irish midwifery e-group. Data were analysed using Burnard (Nurse Educ. Today, 11, 1991, 461) thematic content analysis. Transcripts were coded, and meanings were formulated to reflect significant statements, which were categorised. Categories were then evolved into subthemes, and eventually, three themes were emerged using the COREQ checklist.

RESULTS

Three salient themes emerged from the data are as follows: 'awareness of Perinatal Mental Health', 'discussing emotional well-being' and 'the woman has something to divulge'. The themes convey the midwife's awareness, recognition and perceptions of mental well-being during pregnancy. How midwives discuss and assess emotional well-being, the observational skills they use, and what they perceive as the barriers and facilitators to discussing mental well-being were all identified.

CONCLUSIONS

Midwives reported an awareness and acceptance that women's emotional health was as important as their physical health. Midwives used every antenatal opportunity to raise awareness about perinatal mental health, whilst also identifying key challenges in getting women to talk.

RELEVANCE TO CLINICAL PRACTICE

Care pathways for assessing and identifying Perinatal Mental Health issues should be available in all maternity services. More support for midwives is required to debrief, which would assist them in supporting women's emotional well-being.

Barriers to addressing mental health issues in childbearing women in Ghana

Aim

The aim of the study is to investigate factors hampering the provision of mental health services by nurses and midwives to childbearing women to assist in the prioritization and distribution of limited mental health resources.

Design

This is a cross‐sectional self‐report study.

Methods

Data collected from 309 nurses and midwives were analysed using descriptive and inferential statistic, namely chi‐square and analysis of variance (ANOVA).

Results

The barriers reported by the participants include unavailability of mental health services (77%), lack of knowledge of mental health in women from different tribes (75.7%), lack of a clear mental healthcare pathway (75.1%), heavy workload (74.1%) and lack of knowledge of mental health issue (74.1%). These barriers are less likely to be reported by participants who are males, old and who have practiced for a long time.

Conclusions

Systematic effort to restructure the healthcare delivery system, including equipping healthcare professionals with requisite knowledge, skills and competencies in maternal mental health, is highly recommended.

Mental Health Literacy of Maternal and Paternal Postnatal Depression in a Community Sample of Romanian Adults

Postnatal depression affects a large proportion of Romanian parents, but no existing research has examined knowledge of postnatal depression in Romanian adults. To rectify this, we examined the ability of Romanian adults to correctly identify cases of maternal and paternal postnatal depression, as well as attitudes toward cases of postnatal depression. A total of 1,248 Romanian adults were presented with vignettes describing cases of maternal or paternal postnatal depression. Based on the vignettes, participants were asked to report if they thought anything was wrong with the targets and, if so, to describe what they thought was wrong. Participants also rated the targets on several attitudinal dimensions. Participants were more likely to indicate that something was wrong when the target was female (67.9%) compared with male (46.4%). Of those who believed something was wrong, 57.7% of participants correctly described the female target as experiencing postnatal depression, but only 37.1% did so for the male target. Women held significantly more positive attitudes toward the targets than men, particularly when the target was female. Mental health literacy of postnatal depression appears to be poor in Romanian adults compared with other national groups, especially in the case of paternal postnatal depression.

The Development of the DDads Questionnaire: Awareness, Knowledge and Attitudes of the General Population Towards Paternal Depression

Objectives: Paternal perinatal depression affects ~10% of new fathers and is known to have a negative impact on men's relationship with their partner as well as with their baby. The attitudes of the general population toward paternal depression have received scant attention in the scientific literature. A better understanding of paternal depression might improve the health literacy of the population and also assist professionals and policy makers to adequately address this issue, to ultimately refine the existing health care alternatives for them. This paper describes the Belgian development, face and content validation of the DDads (Depression in Dads) questionnaire. Its focus is to identify the awareness, knowledge and attitudes of the general population toward paternal perinatal depression. Study Design: The DDads was developed using a three-step model with the following phases: (1) identification of the content domain, (2) item generation and (3) construction of the questionnaire. For the DDads validation a (a) Delphi method with content experts (n = 17) and (b) a cognitive debriefing method with lay experts (n = 20) were used to assess the clarity, relevance, wording and layout. Results: The questionnaire consists of three main components comprising: (1) three questions on awareness, (2) three questions on knowledge and (3) one question on attitudes and beliefs. After round one validation, all questions were considered content valid for relevance (I-CVI 0.94-1.00), and six questions for clarity (I-CVI 0.65-1.00). Scale content (S-CVI/Ave 0.93) and face validity (Face Validity Index 1.00) was obtained. One question was revised and split into two questions in a second round. For one of these questions, item content (0.80-0.93), scale content (0.92) and face validity (1.00) was reached. The one question, exploring the causes of paternal perinatal depression, remained inappropriate and was removed from the DDads. One last question was removed after interviews with lay experts. Conclusions: We developed an instrument to establish awareness, knowledge and attitudes of the general population toward paternal perinatal depression in Belgium. The DDads can be valuable in identifying knowledge gaps. It can help to inform policy makers and health professionals to identify gaps and predisposed attitudes in society toward paternal depression which may hinder appropriate management.

[Midwives' feelings about the post-partum care of women with severe mental illness: A qualitative analysis]

BACKGROUND

A significant proportion of women with Severe Mental Illness (SMI) will become mothers during their reproductive life. These pregnancies are, however, more at risk of psychiatric, obstetrical and neonatal complications (increased risks of post-partum depression, relapse, suicide, gestational diabetes, placental abnormalities or low birth weight). Midwives often feel isolated and resourceless when taking care of these women. Specialized units such as mother-infant psychiatric units or the Transversal Unit of Perinatal Care (UTAP) in the Grenoble Alpes University Hospital (CHUGA) enhance the coordination between psychiatric and obstetrical teams and have shown effectiveness in improving maternal and child outcomes.

OBJECTIVES

i) to assess midwives' feelings about the postpartum care of women with SMI; ii) to determine UTAP's impact on this feeling and its determinants; iii) to look for unmet needs.

METHODS

This study is a prospective, exploratory, qualitative analysis. Twenty midwives from Grenoble Alpes University Hospital who took care of one of the selected patients participated in this study. Two women had schizophrenia and one bipolar disorder. Interviews realized with a semi-structured guide were fully transcribed, anonymized and thematically analyzed. Topics have been structured according to the number of occurrences to build a thematic tree.

RESULTS

Midwives felt insecure and resourceless when the postpartum care was unclear, insufficiently anticipated and in case of a danger for the women or the children. They felt uneasy when not feeling able to provide usual care to these patients (due to lack of specific knowledge about SMI and to the impossibility to consider their patient otherwise than through their pathology). Midwives felt at ease and secure when the postpartum care was anticipated. UTAP was identified as a resource for midwives. Specific training and improvements in the organization of the pre and post-natal care could improve midwives' feelings when taking care of women with SMI.

Promoting maternal mental health in Ghana: An examination of the involvement and professional development needs of nurses and midwives

Insight into the involvement and professional development needs (PDNs) of non-mental health nurses and midwives with respect to promoting maternal mental health is necessary to integrate mental health services into primary healthcare delivery. Using a cross-sectional survey and self-report methodology, the study investigates the involvement, PDNs, knowledge and attitudes of 309 nurses and midwives in promoting maternal mental health in Ghana. Data were analyzed using descriptive and inferential statistics, namely Analysis of Variance, bivariate and logistic regression, and cluster analysis. The results showed that the majority of the participants (94%) indicated they were involved in promoting maternal mental health. Knowledge about maternal mental health correlated significantly with involvement in promoting maternal mental health (p < .05), whereas attitude towards maternal mental health did not. An overwhelming proportion of the participants (83%-94%) expressed profound interest in professional development education across a range of maternal mental health areas. Enhancing the mental health knowledge-base of nurses and midwives could contribute significantly to promoting maternal mental health.

Competencies and skill development in maternity care services in Victoria - A qualitative study

In healthcare, continuing professional development is provided to ensure professional standards are maintained and for clinicians to remain fit to practice. The purpose of the study was to identify potential gaps or issues with continuing professional development in maternity services through consultations with key stakeholders and, in addition, to generate possible solutions or recommendations towards the development of a state wide continuing professional development program. The data was collected through semi-structured interviews of a purposive sample between June and August 2018. A thematic analysis was undertaken. Participants included a practicing midwife, allied health practitioner (physiotherapist), manager, healthcare educator, and an outlier service worker (maternal and child health nurse). Following the thematic analysis, four main themes (education, practitioner standards, programme monitoring and resources) were identified along with nine sub-themes. The results suggest organisations need to offer explicit support for staff to access to continuing professional development. In addition, the qualifications of facilitators of continuing professional development and/or consumer education are recommended to go beyond education levels required for registration. In this respect, some organisations credentialed their educators locally in a 'train the trainer' manner however, most participants supported professional preparation for the role of educator.

The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review

Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. Despite a recognition of the significance of this issue, women often do not receive the care they need and fall between the gap of maternity and mental health services. To address this, there is a call for reform in the way in which perinatal mental healthcare is delivered. This paper responds to this by exploring the role and competence of midwives in delivering mental healthcare. Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question 'what is the nature of the evidence relevant to the provision of mental health interventions by midwives?' To identify studies, the databases PubMed, Maternity and Infant Care, Science Citation Index, Social Sciences Citation Index, Medline, Science Direct and CINAHL were searched from 2011 to 2018, and reference lists of included studies were examined. Studies relevant to the role of midwives in the management and treatment of perinatal mental health issues were included; studies focussed on screening and referral were excluded. Thirty papers met inclusion criteria, including studies about the knowledge, skills, and attitudes of midwives and student midwives; the effectiveness of educational interventions in improving knowledge and skills; the delivery of counselling or psychosocial interventions by midwives; and barriers and enablers to embedding midwife-led mental healthcare in practice. Synthesis of the included studies indicates that midwives are interested in providing mental health support, but lack the confidence, knowledge and training to do so. This deficit can be addressed with appropriate training and organisational support, and there is some evidence that midwife-led counselling interventions are effective. Further research is needed to test midwife-led interventions for women with perinatal mental health problems , and to develop and evaluate models of integrated perinatal mental healthcare.

Implementing innovative evidence-based perinatal mental health screening for women of refugee background

PROBLEM

National guidelines recommend repeated screening for depression and anxiety for all women in the perinatal period. Routine screening in pregnancy is limited due to service, community and individual barriers.

BACKGROUND

Perinatal depression and perinatal anxiety affect up to 20% of all women. Women of refugee background are at even greater risk for perinatal mental health conditions due to refugee experiences and resettlement stressors.

AIM

To evaluate the acceptability and feasibility of a perinatal mental health screening program for women of refugee background from the perspective of health professionals.

METHODS

A mixed methods design guided by the Normalization Process Theory was used. Data were collected at a dedicated refugee antenatal clinic in the south-eastern suburbs of Melbourne, Australia. An online survey (n=38), focus groups (n=2; 13 participants) and semi-structured interviews (n=8; 11 participants) with health professionals were conducted.

FINDINGS

Under the four constructs of the Normalization Process Theory, health professionals reported improvements in identifying and referring women with mental health issues, more open and in-depth conversations with women about mental health and valued using an evidenced-based measure. Key issues included professional development, language barriers and time constraints.

DISCUSSION

Implementing a perinatal mental health screening program has been positively received. Strategies for sustainability include professional development and the addition of audio versions of the measures.

CONCLUSION

This perinatal mental health screening program is acceptable and a feasible option for health professionals. Health professionals value providing more holistic care and have more open discussion with women about mental health.

Mental health literacy of maternal and paternal postnatal (postpartum) depression in British adults

Background: Postnatal depression affects between 6 and 13% of new parents, but only a small proportion of individuals who meet diagnostic criteria receive optimal treatment. One reason for this is poor mental health literacy of postnatal depression.Aims: Studies have examined mental health literacy of maternal postnatal depression, but there are no similar studies of paternal postnatal depression, which we sought to rectify.Methods: A sample of 406 British adults was presented with vignettes describing cases of either maternal or paternal postnatal depression. Based on the vignettes, participants were asked to report if they thought anything was wrong with the targets and, if so, to describe what they thought was wrong. Participants also rated the targets on a range of attitudinal dimensions.Results: Participants were more likely to indicate that something was wrong when the target was female (97.0%) compared to male (75.9%). Of those who believed something was wrong, 90.1% of participants correctly described the female target as experiencing postnatal depression, but only 46.3% did so for the male target. Participants also held more positive attitudes toward the female target than the male target.Conclusions: There is a gender binary in symptom recognition of postnatal depression, which highlights the need for greater awareness of paternal postnatal depression.

A mixed methods review to develop and confirm a framework for assessing midwifery practice in perinatal mental health

AIM

To ascertain whether a new framework examining midwifery practice in perinatal mental health (PMH) is supported by the research literature.

BACKGROUND

The identification and care of women with PMH problems is increasingly considered part of midwifery practice. Research suggests that many midwives lack knowledge, skills and confidence. It would be useful to be able to determine barriers and facilitators to effective clinical practice. The authors propose a framework comprising five potentially measurable domains which have an impact on midwives' ability to identify, assess and care for women with PMH problems.

DESIGN

This mixed-methods review uses an innovative qualitative convergent design based on framework synthesis.

DATA SOURCES

Relevant electronic databases were searched for the period from January 2007-December 2016; 33 studies from nine countries met the inclusion criteria.

REVIEW METHODS

Study quality was assessed using critical appraisal tools. Study findings were mapped onto the five domains of the framework: knowledge, confidence, attitudes, illness perception and infrastructure. Findings were then synthesized for each domain.

RESULTS

All five domains are substantially represented in the literature, thus supporting the proposed framework. Several sub-domains and relationships between domains were identified. Varying levels of knowledge, confidence, attitudes and illness perceptions were found; evidence suggests that midwives benefit from further training within these domains. Features of organizational infrastructure act as barriers or facilitators to effective care; these need to be addressed at organizational level.

CONCLUSION

The proposed framework was confirmed and can be used to inform practice, policy and research.

Barriers and facilitators of accessing perinatal mental health services: The perspectives of women receiving continuity of care midwifery

OBJECTIVE

To explore what factors midwifery care recipients perceive to prevent or facilitate access to mental health care in the perinatal period.

DESIGN

A qualitative descriptive study based on semi-structured individual interviews and focus groups.

SETTING

Ottawa, Ontario, Canada.

PARTICIPANTS

Sixteen mothers who had received or were currently receiving midwifery care. Eligibility criteria were being 18 or older and self-identifying as having experienced or experiencing perinatal mental health concerns.

FINDINGS

Five salient themes emerged from the data: cultural values, knowledge, relationships, flexibility, and system gaps. Barriers and facilitators to accessing perinatal mental health services are grouped under each theme. Stigma and fear, broken referral pathways, distant service location, lack of number/capacity of specialised services, baby-centredness, discharge from midwifery care at six weeks postpartum, and cost were barriers to accessing care. Information and midwives' knowledge/experience were context-specific factors that could hinder or facilitate access. Continuity, community, and advocacy were facilitators to accessing care. Many of these facilitators are an inherent part of the Ontario midwifery model of care. Conversely, some aspects of midwives' scope of practice in Ontario impeded access to perinatal mental health care, including inability to make direct referrals to psychiatrists and discharge from care at six weeks postpartum.

KEY CONCLUSION

Midwifery care based on the principles of continuity of care, woman-centred care, informed choice, and advocacy may help to enhance the uptake of perinatal mental health care, but access to such care also remains dependent on the characteristics of mental health services themselves.

IMPLICATIONS FOR PRACTICE

Midwives can enhance access to perinatal mental health services by developing relationships that create safe conditions for disclosure; providing information about symptoms of perinatal mental health concerns, treatment, and services to clients and their social support network; being knowledgeable about existing resources and referral pathways; and identifying when women need additional support to seek care and facilitating connections to available services.

Barriers to midwives and nurses addressing mental health issues with women during the perinatal period: The Mind Mothers study

AIMS AND OBJECTIVES

To explore barriers to midwives and nurses addressing mental health issues with women during the perinatal period.

BACKGROUND

Perinatal mental health is considered an important public health issue with health policy internationally identifying the importance of psychological support for women in the perinatal period. Midwives and primary care nurses are ideally positioned to detect mental distress early, but evidence suggests that they are reluctant to discuss mental health issues with women during pregnancy or in the postnatal period.

DESIGN

The research used a descriptive design.

METHODS

A total of 809 midwives and nurses completed an anonymous, online or hard copy survey. Designed by the research team, the survey listed 26 potential barriers to the provision of perinatal mental health care.

RESULTS

Participants identified organisational factors as presenting the greatest barriers. Organisational barriers included lack of perinatal mental health services, absence of care pathways, heavy workload, lack of time, lack of privacy and not seeing women regularly enough to build a relationship. Over 50% of participants identified practitioner-related barriers, such as lack of knowledge on perinatal mental health and cultural issues; lack of skill, in particular, skills to respond to a disclosure of a mental health issue; and fears of causing women offence and distress. Findings also indicated that the context of care and education influenced the degree to which participants perceived certain items as barriers.

CONCLUSIONS

Midwives and primary care nurses encounter many organisational- and practitioner-related barriers that negatively impact on their ability to incorporate mental health care into their practice.

RELEVANCE TO CLINICAL PRACTICE

Midwifery and nursing services need to develop strategies to address system- and practitioner-related barriers, including the development of services and care pathways, and the provision of culturally sensitive education on perinatal mental health in order to support practitioners to address issues with confidence and competence.

Reaching women with perinatal mental illness at the booking-in appointment

Purpose

The purpose of this paper is to look at the positive future gains of reaching women with perinatal mental illness at the first midwifery booking-in appointment, a unique opportunity that could be more widely used as a point of detection, awareness and prevention of illness in the perinatal period.

Design/methodology/approach

A more robust section of this appointment that includes focussed detection and awareness of prior and current mental health concerns as well as the stigma attached to these conditions will allow midwives to signpost women to get much needed treatment prior to delivery. Suitable treatment options also need to be available and in place at this point.

Findings

The existing booking-in process, for highlighting and diagnosing mental health conditions, has limited suitability. Detection in the postnatal period has inherent difficulties due to time pressures on women, the costs to the mother, baby, family and the economic costs to society, which are considerable. The postnatal period may be too late for treatment, with the harm already done to the woman, their baby and their family.

Research limitations/implications

Research is needed to assess the efficacy of such a strategy, including the costs to train the midwives to deliver this additional service, and the consideration of suitable treatment options at the antenatal stage. This may help to reduce the high levels of attrition within treatment programmes currently running.

Originality/value

This paper fulfils a need to diagnose and prevent perinatal mental illness at an earlier point in pregnancy.

Professional issues in maternal mental health scale (PIMMHS): The development and initial validation of a brief and valid measure

INTRODUCTION

The life-threatening consequences of perinatal mental health problems (PMHP) are well documented. Midwives are ideally placed to effectively identify women at risk and facilitate early intervention. However, a multitude of factors contribute to failure in recognition and treatment. It would be of value for service providers to be able to identify key professional issues in their own context. The present study sought to develop and evaluate a 'professional issues in maternal mental health' scale (PIMMHS), explore its psychometric properties and potential application.

METHODS

A cross-sectional design and instrument evaluation approach was taken to investigate the psychometric properties of the PIMMHS. A total of 266 student midwives from 10 UK institutions completed the PIMMHS via Survey Monkey.

RESULTS

PIMMHS comprises two sub-scales of emotion/communication (PIMMHSEmotion sub-scale) and training (PIMMHS-Training sub-scale). Both PIMMHS subscales demonstrate adequate divergent and convergent validity. Sub-optimal internal consistency was observed for the training sub-scale, however, the PIMMHS-Training had a more impressive effect size in terms of known-groups discriminant validity compared to PIMMHS-Emotion.

CONCLUSIONS

The PIMMHS appears to be a sound psychometric instrument for assessing professional issues that influence the practice of student midwives in PMH. The PIMMHS could support education providers to identify areas for curriculum development, as well as maternity services in proactive assessment of service provision, to identify training and service development opportunities.