Midwives’ perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review

Perinatal continuity of care for mothers with depressive symptoms: perspectives of mothers and clinicians

Background

Mothers with mild to moderate depression in pregnancy are at risk of developing postpartum depression. Midwife-led continuity of care may support maternal mental health throughout the perinatal period. Research is needed to better understand how continuity of care may support mothers experiencing depression in pregnancy. This study aimed to investigate the perspectives of mothers with mild to moderate depression and clinicians regarding continuity of care in the perinatal period.

Method

Fourteen mothers and clinicians participated in individual interviews or a focus group. Analysis was conducted using inductive reflexive thematic analysis with a constructivist orientation.

Results

From the perspectives of mothers and clinicians, continuity of care during the antenatal period benefitted mothers' mental health by providing connection and rapport, information about pregnancy and referral options, and reassurance about whether pregnancy symptoms were normal. The experience of seeing multiple clinicians was noted by mothers to increase distress while participants discussed the value of extending continuity of care into the postpartum period, including having someone familiar checking in on them. The importance of having a second opinion and not always relying on a single provider during pregnancy was highlighted by some mothers and clinicians. Mothers also described how multiple modes of communication with a midwife can be helpful, including the ease and accessibility of text or email.

Conclusion

Mothers and clinicians perceived benefits of continuity of care for maternal mental health. Offering midwife-led continuity of care to mothers with mild to moderate depression during the perinatal period is recommended.

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.

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.

An Integrative Review Exploring Womens' Experiences of Retraumatization Within Perinatal Services

INTRODUCTION

Evidence indicates that retraumatization has a detrimental effect for those women who are accessing perinatal services. One in five women worldwide has a history of childhood adversity. Between 18% and 34% of women experience trauma, which is a well-known risk factor for the onset of chronic mental health disorders. There is a lack of evidence on women's experiences on retraumatization in perinatal care settings and how to prevent retraumatization from occurring. The purpose of this study was to conduct an integrative review on women experiences of retraumatization to determine preventive measures within perinatal services.

METHODS

This integrative review followed Whittemore and Knafl's 5-stage framework as it allows for the inclusion and integration of diverse research methodologies into an overall synthesis of the evidence. A systematic search of 5 databases was conducted (Web of Science, MEDLINE, CINAHL, ASSIA, and PsychINFO) with no date, language, or geographical limits set due to the paucity of research published in this subject area. This review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Fifteen studies met the inclusion criteria and were included in the thematic synthesis. The review identified that participants across the studies had a history of child sexual abuse, sexual abuse, and rape. Three main themes plus subthemes were identified: (1) activating (subthemes: positions in labor, intimate procedures, communications with health care professionals, loss of control); (2) outcomes (subtheme: emotional responses); and (3) interventions reducing or preventing retraumatization (subthemes: role of the health care professional, screening for abuse and history of trauma).

DISCUSSION

Our findings demonstrate that women are experiencing retraumatization in perinatal services, and there is evidence of formalized approaches being applied in clinical settings to prevent retraumatization from occurring. This study is the first to examine the factors that contribute to retraumatization in perinatal services and make recommendations to reduce the harmful practices in place in perinatal care settings.

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).

Initial programme theory development: The first step in a realist evaluation of a cross-sectoral intervention for expectant Danish parents living with psychosocial risks

A distinct inequality in maternity care exists, and women with psychosocial risks are at a greater risk of adverse birth outcomes. In several high-income countries, a psychosocial risk assessment early in pregnancy is recommended so that expectant parents are offered an appropriate level of care which facilitates relevant, tailored interventions for those in need. In 2017, a cross-sectoral and interdisciplinary intervention for expectant parents with psychosocial risks was developed and implemented in the North Denmark Region. The development process of the intervention has not been reported and theory-based knowledge about how supportive interventions bring about change for expectant parents with psychosocial risks is scarce. Through the initial phase of a realist evaluation, we aimed to elicit key contexts and mechanisms of change regarding the intervention for expectant parents with psychosocial risks. Through an initial programme theory, this article illustrates how, for whom and in which contexts the intervention is intended to work. Data is comprised of intervention documents, 14 pilot observations and 29 realist interviews with key stakeholders. A thematic analytical approach inspired by retroductive thinking was applied to identify and analyse patterns related to the incentive of the intervention, its structure, intended outcomes, generative mechanisms and contextual matters. Generative mechanisms responsible for bringing about change in the intervention were identified as healthcare professionals' approach, continuity, trust, early intervention and social network. Cross-sectoral collaboration and healthcare professionals' competencies were assumed to be central stimulating contextual factors. The initial programme theory developed in this study will serve as the basis for further refinement via empirical testing in a later phase of the realist evaluation.

Overcoming training bottlenecks: mixed-methods evaluation of digital training for non-specialists in postnatal depression self-help treatment

OBJECTIVES

This mixed-methods study evaluated the feasibility, acceptability and preliminary effectiveness of an interactive digital training programme for non-specialist supporters providing a guided self-help intervention for postnatal depression (PND).

METHODS

A total of 49 non-specialist trainees participated. Six digital training modules were flexibly delivered over a 5-week period. Training included a chatroom, moderated by a supervised assistant psychologist. Quantitatively, feasibility was assessed via participation and retention levels; acceptability was examined using course evaluation questionnaires; and effectiveness was measured pre-test-post-test quantitatively using a self-report questionnaire and pre-post using scenario questions. Participant focus groups explored feasibility, acceptability and effectiveness.

RESULTS

The training was feasible; 41 completed the course and 42 were assessed at follow-up. Quantitative course evaluation and thematic analysis of focus group feedback demonstrated high training acceptability. RANOVAs indicated training significantly improved knowledge and confidence pre- to post-test. There were demonstrable increases in specific skills at post-test as assessed via clinical scenarios.

CONCLUSION

This training is a feasible, acceptable and effective way to upskill non-specialists in supporting treatment for PND, however supervised practice is recommended to ensure participants embed knowledge competently into practice. The training offers an effective first step in upskilling non-specialist supporters to support women with PND treatment at scale.

Experience of postpartum depression among Chinese women: A meta-synthesis of qualitative research

Postpartum depression (PPD) is associated with various adverse health outcomes among mothers and babies. Meta-synthesis can improve our understanding of postpartum women's experiences. However, the meta-analysis of PPD among Chinese women is limited. Therefore, a meta-analysis was conducted to evaluate the prevalence of PPD among Chinese women and if and how traditional culture may exacerbate PPD. Qualitative studies on the experiences of Chinese women with PPD were searched from database establishment until May 2022 in ten databases. The meta-ethnography reporting guidelines and framework was applied to the writing and reporting of this review. The protocol for this systematic review was registered with the International Prospective Register of Systematic Reviews (CRD42022323388). 2321 studies were retrieved, and 11 studies qualified for the meta-synthesis. The final five themes extracted and re-conceptualized from these studies were as follows: the gap between expectation and reality, conflicts with family, physical and mental frustrations, critical needs for coping with changes, and measures against PPD. Chinese women with PPD frequently feel vulnerable physically, mentally, or both after childbirth and often have conflicts with their families due to the influence of traditional Chinese culture. Family relationships and social support often are factors preventing women from seeking help.

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.

Introduction of the London Measure of Unplanned Pregnancy at the booking visit and the midwives' perspective

BACKGROUND

Pregnancy planning and preconception care benefit women, their children, and future generations. The London Measure of Unplanned Pregnancy (LMUP) is a tool that can be used in antenatal care to identify women with unintended pregnancies who require improved access to such services. This tool was recently implemented into routine antenatal care in two maternity centres in New South Wales, Australia. This study explores midwives' attitudes to the LMUP 12 months after it was introduced into the booking visit and their understanding of its application to their scope of practice.

METHODS

This is a qualitative study using in-depth semi-structured interviews with midwives from two maternity care centres in Australia. All midwives performing antenatal booking visits were eligible to take part. Interviews were transcribed, analysed, and coded to define key themes. Recruitment ceased when thematic saturation was reached.

RESULTS

Ten midwives from two maternity centres were interviewed. Midwives support the inclusion of the LMUP into the booking visit and felt it was in their scope of practice to be using the tool. Time constraints, the impact of COVID-19 and the lack of structured referral pathways were identified as barriers to the implementation of the LMUP in routine care.

CONCLUSIONS

Midwives support the inclusion of the LMUP into the antenatal booking visit and see that it falls within their scope of practice. Service barriers were identified at the individual, organisational and external context levels. These need to be addressed to enhance the potential of this tool.

Women's experiences of trauma, the psychosocial impact and health service needs during the perinatal period

BACKGROUND

Traumatic events are associated with psychological and physical health problems for women in the perinatal period (i.e., pregnancy-12-months after childbirth). Despite the negative impact of trauma on perinatal women, the long-term impact of such diverse trauma and women's experience during the perinatal period remains understudied.

METHODS

This study explored two research questions: 1) What are the psychological experiences of perinatal women who have experienced interpersonal traumatic events? And 2) What are the service needs and gaps expressed by women relating to perinatal medical protocols and psychological services? These questions were addressed via in-depth semi-structured qualitative interviews with nine perinatal women (one pregnant and eight postpartum) residing in central Canada who reported experiencing interpersonal traumatic events occurring from adolescence to the perinatal period. Recruitment and data collection occurred from October 2020 to June 2021. Interviews were audio-recorded, transcribed, and analyzed according to constructivist grounded theory.

RESULTS

The emergent grounded theory model revealed the central theme of the role of prior trauma in shaping women's perinatal experiences, with four related main themes including perinatal experiences during the COVID-19 pandemic, the role of social support in women's perinatal experiences, the barriers that women experienced while seeking psychological and medical services prior to the perinatal period and during the perinatal period, and the specific needs of perinatal women with a history of interpersonal trauma.

CONCLUSIONS

Findings of this research highlight the negative and long-lasting impact of traumatic events experienced on women's psychological health and psychosocial functioning during the perinatal period, as well as perinatal women's unmet psychological and medical service needs. A call to action for perinatal researchers and clinicians is imperative in furthering this important area of research and practicing person-centered and trauma-informed care with this population.

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.

Saving time, signaling trust: Using the PROMOTE self-report screening instrument to enhance prenatal care quality and therapeutic relationships

OBJECTIVES

Comprehensive screening of psychosocial vulnerabilities and substance use in prenatal care is critical to promote the health and well-being of pregnant patients. Effective implementation of new screening procedures and instruments should be accompanied by an in-depth investigation to assess their feasibility and impact on care delivery.

METHODS

In 2020, following implementation of the Profile for Maternal and Obstetric Treatment Effectiveness (PROMOTE) an innovative self-report screening instrument developed for outpatient prenatal clinics in the U.S., we conducted individual interviews and focus groups with twenty-two midwives, nurse practitioners, and obstetric residents focused on the PROMOTE and its impacts on care delivery. We used interpretive description for the qualitative analysis of the interviews.

RESULTS

Five themes were identified: Guiding Time Efficiently: "The Time I Don't Have," Preventing Missed Care, Signaling Trustworthiness, Establishing Trauma-Informed Foundations, and Promoting "Honest" Patient Disclosure.

CONCLUSION

Interviews suggest that patient completion of the PROMOTE before the medical encounter helps reduce previously reported barriers, is more time-effective, and makes history-taking easier. It also facilitates the patient-provider relationship.

INNOVATION

Findings offer insight into the breadth and depth of clinical impact resulting from the PROMOTE, and provide guidance for the implementation of such tools to optimize health outcomes.

Support and services for perinatal low mood and depression: A qualitative study exploring women's and healthcare professionals' experiences

This study aimed to explore women's experiences of support and care received from maternity healthcare professionals for perinatal low mood or depression, and healthcare professionals' experiences of providing support and care for women experiencing perinatal low mood or depression. In this qualitative study, face-to-face individual semistructured interviews and focus groups were conducted with 15 women and 19 healthcare professionals living or working in Yorkshire and the Humber, England in 2019. Thematic analysis was used to analyze the qualitative data. The following themes were identified: (1) lack of standardization in identification and support for perinatal low mood and depression; (2) unclear and nonstandardized pathways for perinatal low mood and depression; and (3) enablers and barriers of receiving support and care for perinatal low mood and depression. Providing training opportunities for healthcare professionals, especially midwives, may be helpful for filling the gray area for women who do not need a referral to mental health services but require support from healthcare professionals. Improving the variety of psychological therapies for the treatment of perinatal depression may also be helpful to meet women's expectations of treatments.

Understanding Healthcare Professionals' Knowledge on Perinatal Depression among Women in a Tertiary Hospital in Ghana: A Qualitative Study

Health conditions affecting women in the perinatal period still account for a major contribution to disease burden in Sub-Saharan Africa, yet there is a dearth of empirical research to understanding health professionals' perspective on their experiences and how they care for perinatal women in depression. We used a qualitative exploratory descriptive approach through a face- to face-interview to explore the knowledge of 11 health professionals of Komfo Anokye Teaching Hospital, Kumasi- Ghana. Interviews were taped recorded and transcribed verbatim. The study adopted Haase's modification of Colaizzi's method for the analysis. Four main themes emerged: ineffective communication (Referral lapses among care providers, long waiting time, lack of confidentiality), workload (Inefficient staff to meet perinatal women's need, no screening tools and time constraints), Reaction to patients symptoms (Identifying patient's symptoms, assessment through patient's centeredness and Education and counselling). Our results emerged that time constraints, stigmatization and lack of awareness delayed the care and management of perinatal depression among healthcare professionals in the hospital setting. There is the need to improve healthcare professionals' knowledge on perinatal depression and it is imperative for the hospital administrators to invest in continuous training and professional development for healthcare professionals.

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.

Fostering Collective Approaches in Supporting Perinatal Mental Healthcare Access for Migrant Women: A Participatory Health Research Study

Perinatal mental health is a growing public health concern. The mounting evidence examining the prevalence of perinatal mental illness identifies specific vulnerabilities and risk factors among migrant women. We know that migrant women experience persistent and systematic barriers in accessing healthcare and that healthcare services do not always respond appropriately to migrant women's needs, highlighting the need for targeted interventions in supporting positive perinatal mental health among migrant women. The purpose of this participatory health research study was to explore perinatal mental healthcare for migrant women in Ireland, from the perspectives of a diverse range of stakeholders (healthcare service providers, community organisations/networks/associations and migrant women). A key focus of this study was to collaboratively explore solution-focused approaches to improving access to supports and healthcare services for migrant women experiencing perinatal mental illness. Following ethical approval, data were collected during three key convenings, utilising the design principles of world café philosophies. Thematic analysis led to the generation of the following two themes: Building Capability and Capacity and Empowering Migrant Women. The main conclusions lie in the provision of whole-system approaches in collectively, collaboratively and proactively planning strategies that address the many factors that affect access to healthcare services for migrant women experiencing perinatal mental illness. Drawing on the collective perspectives of a wide range of stakeholders, our innovative solution focused on providing recommendations aimed at strengthening supports and healthcare services for migrant women.

OUP accepted manuscript

The majority of people living with dementia are cared for by their families. Family carers play a vital role in upholding the formal care system. Caring for a family member with dementia can be fulfilling. However, this role can have a considerable negative impact on family carers’ mental and physical health and quality of life. Several empirical research studies have recently been conducted that explore the potential benefits of music interventions for family carers of people living with dementia. Singing has been the primary musical medium employed. This article presents the first review of this literature to date. It investigates the impact of music interventions on the health and well-being of family carers of people living with dementia, and how they experience and perceive these interventions. Whittemore and Knafl’s five-stage integrative review framework was utilized: (i) problem identification; (ii) literature search; (iii) data evaluation; (iv) data analysis and synthesis; and (v) presentation of the findings. A total of 33 studies met the inclusion criteria. Analysis and synthesis resulted in three overarching themes: impact on family carers, carer perceptions of music interventions and null quantitative findings in small studies. The review found that singing and music interventions may improve family carers’ social and emotional well-being, enhance their ability to cope and care and ameliorate the caring relationship, contributing to experiences of flourishing. However, it highlighted that this area is under-researched and pointed to the need for larger, more rigorous studies.

Adaptation of the Edinburgh Postnatal Depression Scale in the Indonesian Version: Self-reported Anxiety and Depression Symptoms in Pregnant WomenAdaptation of the Edinburgh Postnatal Depression Scale in the Indonesian Version: Self-reported Anxiety and Depression Symptoms in Pregnant Women

BACKGROUND: Anxiety and depression disorders in pregnant women are often not identified so that early treatment is not optimal. Indonesia already has comprehensive integrated antenatal care, including services for pregnant women with mental disorders, but until now Indonesia does not yet have a standardized instrument that is valid and suitable as a screening tool to assess symptoms of anxiety and depression in pregnant women. The Edinburgh Postnatal Depression Scale (EPDS) is a screening instrument with high sensitivity and specificity, has been translated into Indonesian, but until now, the Indonesian version of the EPDS instrument has not been evaluated for validity and reliability in the population of pregnant women. AIM: this study aimed to adapt the Indonesian version of the EPDS instrument, including testing the validity and reliability of the instrument when used on pregnant women in Indonesia. METHODS: This research is a cross sectional study. The number of pregnant women who participated were 125 samples. Data were collected randomly, and the assessment of symptoms of anxiety and depression was self-reported via online. Content validity was assessed with a content validity index from 5 experts, construct validation was analyzed by Explanatory Factor Analysis and Confirmatory Factor Analysis and Convergent Validity. The reliability of the EPDS instrument was assessed by construct reliability and Cronbach's Alpha. RESULTS: Content validity index shows expert agreement with a value of .98. The Indonesian version of the EPDS shows assessing three factors, namely: Depression (5 items), Anxiety (3 items), and Anhedonia (2 items). The reliability of the Indonesian version of the EPDS instrument is good with Cronbach's Alpha .80 and the internal reliability of the 10 items (Cronbach's Alpha .767-.812). CONCLUSION: The Indonesian version of the EPDS instrument is valid and reliable to be used to assess symptoms of anxiety and depression in pregnant women in antenatal care in Indonesia.   Keywords: pregnant women, EPDS, validity, reliability

A scoping review of maternity care providers experience of primary trauma within their childbirthing journey

OBJECTIVE

To examine and summarise available literature on maternity care practitioners having experienced primary trauma during their childbirthing journey and whether this impacts their mental well-being and/or care provision when subsequently caring for childbearing women.

BACKGROUND

Birth trauma affects 1 in 3 women; 1 in 20 women show post-traumatic stress disorder symptoms by 12 weeks after birth. However, what is not known is what percentage of these women are maternity care providers experiencing or having experienced personal trauma during their child birthing journey. This scoping review aims to examine and summarise available literature on maternity care practitioners having experienced primary trauma during their childbirthing journey and whether this impacts their mental well-being and/or care provision when subsequently caring for childbearing women.

METHODS

Arksey and O'Malley (2005) six-stage scoping review framework was revised and utilised. A search of the relevant databases (MEDLINE Embase, CINAHL, APA PsycInfo, Scopus) was undertaken with several keywords related to trauma and personal experience. Reference lists were also searched of studies identified for reading the full text.

FINDINGS

The search strategy identified 2983 articles. The studies excluded were considered to be unrelated to the topic directly. A total of 352 articles were reviewed by abstract, and 29 additional studies were identified from reference lists; 32 were reviewed by full text. A total of 0 studies met the inclusion criteria for the scoping review.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The scoping review identified a gap in the literature as maternity care practitioners personal experience of trauma during the child birthing journey has not been researched. Research is needed to explore and conceptualise the experiences of maternity care practitioners having experienced trauma and the ongoing implications this may have on their personal and professional lives.

Reconsidering fear of birth: Language matters

Interest in fear of childbirth has grown exponentially since the 1980s, but the landscape of birth has shifted considerably since then, with evolving feminism; moving from a patriarchal environment in a biomedical model of care to a holistic model which recognizes the birth and sexuality rights of women and birthing people. Distinguishing the spectrum of fear from low to high and severe is important rather than aggregating all individuals with fear of childbirth. However, the terms 'fear of childbirth' and 'tocophobia' have been used interchangeably. In this paper we urge clinicians to use the term 'tocophobia' with caution since it may be construed negatively and there is a limited understanding of the underpinning aetiology of tocophobia. Furthermore, using the label may be disempowering for women and birthing people making decisions about their birth. Further research is warranted to better understand the experience, refine and define the issue and meet the individual needs of people with fear of childbirth and tocophobia.

Postnatal depression and anxiety screening and management by maternal and child health nurses in community settings: A scoping review

OBJECTIVE

To examine the range and nature of primary research evidence on postnatal depression and anxiety screening and management by maternal and child health nurses within community settings.

BACKGROUND

Maternal and child health nurses are well-placed to identify and support women at risk of, or experiencing, postnatal depression and anxiety- a prevalent public health issue which remains largely undetected.

METHODS

Scoping methodology, guided by the Arksey and O'Malley (2005) framework, was used. The following electronic databases were searched in June 2019 and again in July 2020: Cumulative Index of Nursing and Allied Health Literature, MEDLINE, PsycINFO, and COCHRANE Library. Primary studies that were published in English, between 2008 and 2020, were included. PRISMA checklist and PRISMA flow diagram were used to adhere to best practice guidelines.

RESULTS

Twenty-three articles, relating to 22 studies, met the inclusion criteria. Two principal themes were identified: 'screening for postnatal depression and anxiety' and 'factors that influence postnatal depression and anxiety management'. Subthemes in the former related to attitudes toward screening, routine screening practice, screening efficacy, and attitudes toward the Edinburgh Postnatal Depression Scale. Subthemes in the latter included availability of formal care pathways, referral options, knowledge and confidence, and multiagency collaboration.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

While maternal and child health nurses value their role in identifying and supporting mothers at risk of postnatal depression and anxiety, certain individual and organisational factors contribute to a gap between best practice and clinical practice. Narrowing the gap between evidence and practice is unlikely without directly addressing these barriers. Gaps in maternal and child health nurses' knowledge, skills and confidence regarding effective screening and management of mothers experiencing, or at risk of, postnatal depression and anxiety, impacts the quality of care provided. Ongoing training and professional development which adequately addresses these gaps is required.

Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research

Objective: To discuss and develop a statement on the current state of the evidence and opinion in Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide recommendations. Background: A group met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were agreed as the focus of the meeting. Methods: 12 internationally acknowledged experts, in this or a closely related area (e.g. PTSD) met to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity. Keys points: Work focussed on tokophobia is recent and there remains a wide range of issues, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding, which creates challenge for robust assessment and the identification of risk factors. An improved aetiological and developmental understanding of the tokophobia is required to underpin appropriate, effective and evidence-based interventions. Evaluation of pathways of care and relevant interventions, should be a focus of future research. Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research is necessary.

Health care practitioners' views of the support women, partners, and the couple relationship require for birth trauma: current practice and potential improvements

AIM

To examine health care practitioners' views of the support women, partners, and the couple relationship require when affected by birth trauma, barriers to gaining such support, and potential improvements.

BACKGROUND

Ongoing distress following psychologically traumatic childbirth, also known as birth trauma, can affect women, partners, and the couple relationship. Birth trauma can lead to post traumatic stress symptoms (PTSS) or disorder (PTSD). Whilst there is a clear system of care for a PTSD diagnosis, support for the more prevalent experience of birth trauma is not well-defined.

METHOD

An online survey of health care practitioners' views of the support parents require for birth trauma, barriers to accessing support, and potential improvements. Practitioners were recruited in 2018 and the sample for the results presented in the article ranged from 95 to 110.

RESULTS

Practitioners reported differing needs of support for women, partners, and the couple as a unit. There was correlation between practitioners reporting having the skills and knowledge to support couples and feeling confident in giving support. The support most commonly offered by practitioners to reduce the impact on the couple relationship was listening to the couple. However practitioners perceived the most effective support was referral to a debriefing service. Practitioners observed several barriers to both providing support and parents accessing support, and improvements to birth trauma support were suggested.

CONCLUSIONS

Practitioners indicate that some women, partners, and the couple as a unit require support with birth trauma and that barriers exist to accessing effective support. The support that is currently provided often conflicts with practitioners' perception of what is most effective. Practitioners indicate a need to improve the identification of parents who need support with birth trauma, and more suitable services to support them.

Opening the door: midwives' perceptions of two models of psychosocial assessment in pregnancy- a mixed methods study

Background

One in five women experience psychological distress in the perinatal period. To support women appropriately, Australian guidelines recommend routine depression screening and psychosocial risk assessment by midwives in pregnancy. However, there is some evidence that current screening processes results in higher rates of false positives. The Perinatal Integrated Psychosocial Assessment (PIPA) Project compared two models of psychosocial assessment and referral – Usual Care and the PIPA model – with a view to improving referral decisions. This paper describes midwives’ perspectives on psychosocial assessment, depression screening and referral at the antenatal booking appointment and compares midwives’ experiences with, and perspectives on, the two models of care under investigation.

Methods

A two-phase, convergent mixed methods design was used. Midwives providing antenatal care completed a self-report survey in phase one prior to implementation of the new model of psychosocial assessment (n = 26) and again in phase two, following implementation (n = 27). Sixteen midwives also participated in two focus groups in phase two. Quantitative and qualitative data were compared and integrated in the presentation of results and interpretation of findings.

Results

Midwives supported psychosocial assessment believing it was a catalyst for ‘Opening the door” to conversations with women. Midwives were comfortable asking the questions and tailored their approach to build rapport and trust. Overall. midwives expressed favourable views towards the PIPA model. A greater proportion of midwives relied mostly or entirely on the suggested wording for the psychosocial questions in the PIPA model compared to Usual Care (44.4% vs 12.0%, χ²=5.17, p=.023, φ =-.36). All midwives reported finding the referral or action message displayed at the end of the PIPA psychosocial assessment to be ‘somewhat’ or ‘very’ helpful, compared to 42.3% in Usual Care (χ² = 18.36, p < .001, φ = −.64). Midwives were also more likely to act on or implement the message often or all of the time) in the PIPA model (PIPA = 69.2% vs Usual Care = 32.0%, (χ² = 5.66, p < .017, φ = −.37).

Conclusion

The study identified benefits of the new model and can inform improvements in psychosocial screening, referral and related care processes within maternity settings. The study demonstrates that psychosocial assessment can, over time, become normalised and embedded in practice.

Professional support during the postpartum period: primiparous mothers' views on professional services and their expectations, and barriers to utilizing professional help

Background

Primiparous mothers who lack of experience and knowledge of child caring, are usually overwhelmed by multifarious stressors and challenges. Although professional support is needed for primiparas, there is a gap between the necessary high-quality services and the currently provided poor services. This study aimed to explore Chinese primiparous mothers’ views on professional services, identify barriers to utilizing professional support, and further understand mothers’ expectations of and preferences for the delivery of professional services.

Method

A descriptive phenomenological study design was utilized in this study, and semi-structured interviews were conducted with 28 primiparous mothers who had given birth in the first year period before the interview and were selected from two community health centres in Xi’an city, Shaanxi Province, Northwest China. Each conversational interview lasted between 20 and 86 min. Colaizzi’s seven-step phenomenological approach was used to analyse the data.

Results

Three major themes were identified: (a) dissatisfaction with current professional services for postpartum mothers, (b) likelihood of health care professional help-seeking behaviour, (c) highlighting the demands for new health care services. The related seven sub-themes included being disappointed with current hospital services; distrusting services provided by community health centres, private institutes and commercial online platforms; preferring not seeking help from professionals as their first choice; hesitating to express their inner discourse to professionals; following confinement requirement and family burden prevents mothers from seeking professional help; experiencing urgent needs for new baby-care-related services; and determining the importance of mothers’ needs. The necessity of professional support in the first month after childbirth was strongly emphasized by the participants. Online professional guidance and support were perceived as the best way to receive services in this study.

Conclusion

The results of this descriptive phenomenological study suggested that the current maternal and child health care services were insufficient and could not meet primiparous mothers’ need. The results also indicated that identifying barriers and providing services focused on mothers’ needs may be an effective strategy to enhance primiparous mothers’ well-being, and further suggested that feasibility, convenience, and the cultural adaptability of health care services should be considered during the delivery of postpartum interventions.

Knowledge, attitudes and practices in mental health of health professionals at the end of their curriculum in Burkina Faso: A pilot study

Aim

To study the knowledge, attitudes and practices regarding mental health amongst health professionals at the end of their curriculum in Burkina Faso.

Design

A descriptive and cross-sectional study was adopted.

Methods

A simple random sampling was used to select 420 health students in Burkina Faso. Self-administered questionnaires on sociodemographic profile, knowledge, attitudes and practices about mental health were distributed.

Results

The response rate to the questionnaires was 93%. Our study sample included 391 students amongst whom 35% (138/391) were nurse students, 32% (125/391) medical students, 26% (100/391) midwife students and 7% (28/391) were pharmacy students. A quarter of our sample had completed an internship in psychiatry. Medical students' average knowledge, attitudes and practices in mental health were significantly higher than that of other students. Medical students had more time dedicated to mental health lectures and more opportunities for a mental health internship, unlike nurse students.

The role and outcomes of music listening for women in childbirth: An integrative review

AIM

To synthesise primary research on the role and use of music listening for women in childbirth.

DESIGN

Integrative review.

METHODS

Whittemore and Knafl's (2005) five-stage integrative review method was utilized to complete a systematic search of the literature. Studies were included if they were (a) peer-reviewed, (b) written in the English language, (c) published between 1 January 1979 and 5 April 2019 and (d) described the use of music listening during labour and birth. Studies were appraised for quality and methodological rigor using standardised assessment tools including the Critical Appraisal Skills Programmes (CASP) checklist for the qualitative studies and the Joanna Briggs Institute Critical Appraisal Tool for the quasi-experimental studies and randomised control trials. Data extrapolation, methodological quality assessment and Thematic Content Analysis (Braun and Clarke, 2006) were carried out.

FINDINGS

A total of 931 articles were retrieved and 24 papers were included in the review (12 randomized controlled trials, 9 quasi-experimental and 3 qualitative). The quality of the studies was moderately good overall. Two overarching themes emerged including 'outcomes of using music in childbirth' and, 'music application during childbirth'. Within 'outcomes of using music in childbirth' four subthemes are described: 'pain', 'anxiety', 'psychological supports' and 'progression of labour'. Within 'music application during childbirth' four themes are presented: 'timing of the music application', 'type of music', 'birth preparation using music' and 'mode of music listening'.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

The findings indicate that music listening has a significant role to play for women in childbirth. This non-pharmacological intervention can reduce pain and anxiety while offering a multifaceted form of psychological support to alleviate stress and promote an increased sense of control in women during labour. However, further awareness is needed around the idiosyncratic nature of the music listening experience.

Barriers to Seeking and Accepting Treatment for Perinatal Depression: A Qualitative Study in Rio de Janeiro, Brazil

Few studies have investigated the reasons why pregnant and puerperal women fail to seek or accept treatment for perinatal depression in low- and middle-income countries, where there is a high prevalence of this disorder. To help fill this gap, this study investigated the factors influencing the decision not to seek or to refuse treatment for perinatal depression in a low-income community in Rio de Janeiro, Brazil. Qualitative research was conducted in two primary health care units in Rio de Janeiro, Brazil in 2017-2018. Five focus groups were held with 26 women. Convenience sampling was used, and the sample size was determined by data saturation. A content analysis methodology was used to identify theme categories to objectively describe the group's manifest contents. Ten categories were obtained: stigma and misconception, self-image as a mother, socioeconomic stigma, lack of knowledge, lack of a health service approach to mental health, difficulty recognising depression symptoms, fear of children being removed, negative reaction to patient referral, denial of the problem and previous experience with the care unit. Perinatal depression is permeated with stigma and prejudice, and there is a belief that women with depression are unable to be good mothers. It is important to conduct programmes disseminating information about perinatal depression and implementing an approach that includes routine consultations so that women can access perinatal mental health services.

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.

Irish general practitioners' view of perinatal mental health in general practice: a qualitative study

Background

Identification of perinatal mental health problems and effective care for women who experience them are important considering the potentially serious impact that they may have on the wellbeing of the woman, her baby, family and wider society. General practitioners (GPs) play a central role in identifying and supporting women and this study aimed to explore GPs' experiences of caring for women with perinatal mental health problems in primary care. The results of this study may provide guidance to inform policy, practice, research and development of curriculum and continuous professional development resources.

Method

In-depth semi-structured interviews were undertaken between March and June 2017 with GPs (n = 10) affiliated with a University training programme for general practice in Ireland. Thematic data analysis was guided by Braun and Clarkes (2013) framework.

Results

Data were categorised into three themes with related subthemes: identification of perinatal mental health problems, decision making around perinatal mental health and preparation for a role in perinatal mental health. GPs described the multifaceted nature of their role in supporting women experiencing perinatal mental health issues and responding to complex psychological needs. Inbuilt tools on existing software programmes prompted GPs to ask questions relating to perinatal mental health. Limited access to referral options impacts on assessment and care of women. GPs desire further continuous professional development opportunities delivered in an online format and through monthly meetings and conference sessions.

Conclusions

GPs require access to culturally sensitive; community based perinatal mental health services, translation services and evidence based perinatal psychological interventions. A standardised curriculum on perinatal mental health for trainee GPs needs to be established to ensure consistency across primary care and GP education should incorporate rotations in community and psychiatry placements.

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.

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.

Care and self-reported outcomes of care experienced by women with mental health problems in pregnancy: Findings from a national survey

BACKGROUND

mental health problems in pregnancy and the postnatal period are relatively common and, in pregnancy, are associated with an increase in adverse outcome. It is recommended that all women are asked about their emotional and mental health and offered treatment if appropriate.

OBJECTIVES

to describe the care received by women self-identifying with mental health problems in pregnancy, and to describe the effects of support, advice and treatment on outcomes in the postnatal period.

DESIGN

this study used cross-sectional survey data collected in 2014 which described women's experience of maternity care.

SETTING

England PARTICIPANTS: a random sample of women who had a live birth in January 2014.

MEASUREMENTS

the questionnaire asked about sociodemographic characteristics, whether women were asked about emotional and mental health in pregnancy, support and treatment offered, about postnatal wellbeing, and questions relating to attachment to their baby. Descriptive statistics and logistic regression were used to examine the associations between mental health and outcomes taking account of sociodemographic characteristics.

FINDINGS

the survey response rate was 47%. Women with antenatal mental health problems were significantly more worried at the prospect of labour and birth, had lower satisfaction with the experience of birth, worse postnatal mental health, and indications of poorer attachment to their baby. They received substantially more care than other women but they did not always view this positively. Support, advice and treatment for mental health problems had mixed effects.

CONCLUSIONS

this study describes the significant additional care provided to women self-identifying with mental health problems in pregnancy, the mixed effects of support, advice and treatment, and the poor perception of staff interaction among women with mental health problems.

IMPLICATIONS FOR PRACTICE

health care professionals may need additional training to effectively support women with mental health problems during the perinatal period.