My Blog
It was good to see the announcement this week by Dan Poulter, Minister for Health, that £25 million is to be made available to improve maternity wards and give more support to new parents. See the report here
Of course I applaud this; every move forward must always be viewed as positively as possible. Yet at the same time I ask questions if it is really getting to the root of the real challenges and problems. I have spoken to a number of people this week that are directly involved in this – a pregnant mum, a new mum and a midwife. I wish I could report that the plans outlined by the Health Minister will be a magic wand to fix the situation. In my conversations with these ladies, the following issues arose, painting a picture of vicious cicles leading to huge expenses in both personal and medical care.
The pregnant Mum has a history that screams ‘high risk of postnatal depression’. She has sought help from her GP and shows clear signs of antenatal depression. Relevant treatment now would reduce the emotional cost to the lady, her baby and her family, let alone the potential costs to the health service and state. Research shows that antenatal and postnatal depression can affect the baby. It also has an effect on relationships. What price can you put on divorce with all of the incumbent emotional wearing and tearing that is so much part of it? Over the years I have been stunned by how many ladies that tell me that they feel their postnatal depression wasn’t picked up or dealt with properly and they have gone on to have years of mental health issues.
Part of the new funding is to provide information to alert new parents about antenatal or postnatal depression so that they can go to their GP. That is offered as a ‘gold medal’ standard. It should be. Sadly it isn’t and this is where I feel Mr Poulter needs to put in URGENT action.
The pregnant lady I have spoken to did go to her GP and describe the high levels of anxiety she is currently suffering. She is very keen to get it treated and needs support. She wants to enjoy her pregnancy and be mentally well. This is a major step and one that people are encouraged to do. It can take courage to admit that you are feeling mentally unwell due to the stigma surrounding it.
Dr Poulter – what work is being done on reducing the stigma around antenatal and postnatal depression?
She has visited her GP several times recently. Initially she was referred to a specialist team (hooray) due to her history. The weeks passed and she anxiously waited for an appointment to come through. In the meantime she went back to her doctor and asked if there was anything else that could be done. She was told that there were no anti-depressants that can be taken whilst pregnant!
Wrong. The NICE guidelines on antenatal and postnatal depression are one of the sources of information that clearly state the safe drugs that are available. One of the reasons behind the tragic case of Felicia Boots who recently killed her two babies whilst suffering from postnatal depression showed her concern around taking antidepressants whilst pregnant and/or breast feeding. Her computer history showed she had been researching this herself just before her babies died.
Dr Poulter – what is going to be done to educate GPs and parents more on the safe medication that is available?
The pregnant lady continued to wait for her appointment and then contacted the specialist service who had never had any information through about her! She needed a new referral from her GP and for the process to start again. So she went back to her GP who then said that there was no need for her to see anyone and she ‘should’ be fine. The distressed lady then contacted me as she felt no-one else was listening to her. She is now under the care of the specialist team.
This lady is far from the first that I know of who HAVE been to their GP and bravely expressed their feelings of depression and anxiety. Some GPs are excellent and immediately suggest other avenues of help, e.g. support groups, self-help treatments, CBT and if needed, medication. Sadly though, other GPs are far from helpful. Mums and Dads tell me that they are dismissed with ‘you’ll be fine’. Some are given personal comments such as ‘I had four children and worked full-time – I coped so you should’. Others appear simply disinterested and so rushed for time that handing out a prescription for medication is as far as it goes. Very often the mother then does not take the tablets due to the fear about it being addictive; perceived as failure and/or harmful to their baby. The illness gets worse because they are then too scared to admit their continuing problems, leading to greater issues further down the line.
Dr Poulter, what is being done about training for GPs on antenatal and postnatal depression? Is there a rolling programme of training sessions within their practice?
One suggestion I have is to introduce postnatal classes as a regular practice, i.e. group sessions to support mothers after having the baby to discuss and inform all the changes. So much focus is placed on the birth, yet so little on the realities of being a new parent. Lynn Bertram has a great book on this ‘Supporting women in the postnatal period’.
It is great to encourage parents to go to their GPs. Yet this is futile unless the GP is has the correct attitude, skills and knowledge to offer the best help. They also need a bank of support to offer. What support groups are in the area? Is there a specialist midwife or health visitor? What is the communication network and care pathway in their area? All of these should be in place.
Dr Poulter, giving parents information is excellent, yet there MUST be the resources to follow it up.
So onto my ‘new’ Mum. She has recently had her third baby after a gap. Her family have had a period of traumas including deaths, diseases, loss of jobs. Her sister has struggled with mental health issues since she was pregnant a few years ago. She was never treated fully and recently has become very unwell. My ‘new’ Mum has handled all of this until the last week when she has begun to suffer from anxiety. Her first port of call was to tell her health visitor. She was sympathetic yet had no advice to offer and got her an appointment with the GP! He did listen and suggested a mild dose of medication. My ‘new’ Mum was reluctant to take it as she was told it was addictive!
The impact of her sister’s health is spiralling amongst the family – their parents are suffering; her children are confused and anxious as she has needed hospital care; she is unable to work; her marriage is under a great strain and now her sister’s health is beginning to deteriorate. When will the true extent and impact of poor maternal mental health be realised?
If a person had a cut and left it to bleed and become infected, leading to septicaemia then everyone would complain that an antiseptic wipe and simple plaster to prevent infection in the first place was all that was needed. Prevention is so much better than cure!
So why aren’t we nipping these mental health issues in the bud? Both of these ladies HAVE identified that they need help and support. The main aim behind the £25 million pound investment is already there to a large degree. What isn’t, is the next step – which is vital.
So Dr Poulter, what will be done to educate and train the professionals so that they can guide the parents with what they need and what support services will be provided?
Then I met a midwife. She is a wonderful lady and has all the attributes that a pregnant lady about to deliver a child would relish – she is warm, knowledgeable, calm and has a serenity about her that oozes confidence. She has years of experience of the maternity services and is dismayed at what she sees. Recently she has been involved in a project looking at improving maternal mental health. She is very aware of the impact that midwives have upon new mothers. Pregnant, birthing and new mothers need a midwife who can be there for them; who has the time to explain what is happening to them; to share the most intimate and life changing and creating moment with them; to guide and reassure them through the process of breastfeeding and listen to their concerns about being a good mother.
Instead the ‘time’ aspect is so brief due to staffing levels. My ‘new’ Mum told me that when she had delivered her baby she could not stay in hospital for more than a few hours. They had the beds but not enough midwives. She told me that a ward cleaner was having to take blood pressure observations! The midwives are so pressured that they then have a tendency to make the women in their care feel a nuisance. This then leads to new mothers feeling incompetent and insecure. This has a knock-on effect with breastfeeding as they are too worried to ask for help and the midwives are too pressured to give it.
Breastfeeding is another issue! Of course I agree that it is best and the most natural. I did it for 7 months and will always feel robbed of it as I was hospitalised without my baby and it was forced to stop overnight (cruel to both my son and I). So much pressure is given by the NHS for women to breastfeed yet if they have difficulties there is no-one to spend the time to help and then they get a critical attitude for having to bottle feed! Midwives are encouraged to support breastfeeding, which I agree with, yet they must be given the time to do it! The negative attitude to bottle feeding immediately makes new Mums feel that they have failed. In some, this is the start is of postnatal depression. Often no advice is given to new parents on how to use formula milk and the need for sterilisation. I have been told that the numbers of young babies being admitted to the children’s wards due to malnutrition is rising. This seems absurd in a developed country like ours!
Dr.Poulter, what are you doing about the basics of feeding information and support?
I have had the privilege of meeting many midwives and student midwives. Generally they are a lovely group of people who want to care for women and new babies. They do not go into work intending to be snappy and upset people! Yet due to the pressures placed on them by poor staffing, that is what tends to happen. My ‘new’ mum told me that there used to be three community midwives when she had her first children. Two of them have left – one to Dubai and another to Australia where they can do the profession they love without the stresses.
Yes, it is good there is more funding for more midwives to be trained YET unless the cause of the shortage is tackled, it is like putting air into a tyre without sealing the puncture.
Dr. Poulter, what are you doing to stop the exodus of midwives?
I agree with the plan for better maternity provision as outlined in the £25 million proposal, yet what matters to women most? Yes, having a pretty room to give birth in is ‘nice’. I, along with many that I know and have spoken to, would rather have dated wallpaper and time with a midwife rather than the latest trend in wall décor and a harassed midwife.
I believe that we have all the people and information needed to drastically reduce the alarming figures around antenatal and postnatal depression in the UK.
What is needed is:
- A consistent and nationwide level of support and care pathways for maternity and maternal mental health
- Midwifery levels at a consistent high standard to ensure that all women receive the care and attention needed antenatally and postnatally
- Health professionals trained and aware of what is needed to maintain and improve positive maternal mental health
Dr.Poulter, I urge you to consider these points as ultimately they will make huge savings in the NHS budget and savings to personal suffering will be priceless.
I shall send Dr.Poulter my questions.
Have a wonderful week,
Elaine
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