Let’s Talk about Perinatal Mental Health

When I was pregnant with Button I was asked if I would take part in a local survey about mental health in pregnancy and as a new mum (perinatal). It’s sad to an extent they didn’t want to ask about new dad’s or dad to be’s mental health as it can be a stressful time for them too; especially when we still have the old “men must take care of their partners” and “men shouldn’t show their feelings” which I don’t agree with and won’t be teaching my son. I was picked to have an interview after they had collated all of the survey data, Button was less than a week old but I decided to participate. 

With having mental health issues no matter how minor growing up from feeling isolated due to IBD and hospital stays I always thought I was just automatically predisposed to poor mental health through pregnancy and parenting but let’s get one thing straight it isn’t always easy but that doesn’t mean you aren’t doing a great job!

So back to the survey I was recently emailed the results and for the most part it is sad that so many women feel let down or are struggling but on the other hand I felt a kind of solidarity or a kinship if you will with these unknown women. No I don’t want anyone else to be struggling but it was nice in a way not to feel alone, like I’m the only mum out there struggling or even that I’m a bad mum because of it.

According to Google dictionary the term perinatal means relating to the time, usually a number of weeks, immediately before and after birth.

The survey was undertaken by Kat Jackson, Debbie Smart and Raghu Lingam from the Institute of Health and Society at Newcastle University; they were asking women of the rural communities of North Yorkshire about their needs and experiences of their mental health during and after pregnancy. Most areas of the country are pretty damn underfunded but North Yorkshire is the largest county in England and is pretty much countryside with a dozen or so big towns and the odd city thrown in. So in my personal opinion the government don’t want to put money in to our county as it is so far flung in areas but that doesn’t mean we don’t need the services as the results below point out.

perinatal health

A summary report of findings from the Perinatal Mental Health in Rural North Yorkshire Research Study

Prepared by Kat Jackson, Debbie Smart and Raghu Lingam, Institute of Health and Society,
Newcastle University ‐ November 2017

Project aim

The Perinatal Mental Health in Rural North Yorkshire Study aimed to explore the needs and
experiences of women in rural communities of North Yorkshire relating to their mental health during and after pregnancy.

Study Design

The research took place between February and August 2017 and used a combination of quantitative and qualitative methods:

  • A cross‐sectional survey of women in the perinatal period was carried out to
    understand what percentage of women have anxiety and or depression across North
    Yorkshire (rural and urban areas) during pregnancy and up to 1 year after the birth of
    their baby.
  • Interviews and group discussions were undertaken with mothers living in rural areas
    who had current or previous experience of perinatal mental health difficulties within
    the past three years.
  • Semi‐structured interviews and focus groups took place with health and community
    professionals working in rural areas with mothers in the perinatal period.

The project was given ethical approval by the Newcastle & North Tyneside 1 Research Ethics Committee (212364).

Key findings

Survey with mothers

  • In total 268 women in the perinatal period living in North Yorkshire were included in the
    analysis of the survey.
  • The survey used the Edinburgh Postnatal Depression Scale and the Whooley scale to screen
    for depression, and the GAD‐2 to screen for anxiety. The key finding from the survey, was
    that women in rural areas were 10% more likely to have symptoms of depression or anxiety
    compared to those in urban areas (39% compared to 29%).

Qualitative research with women and professionals

  • Thirty‐five women and twenty‐seven professionals took part in a focus group or a one‐to‐
    one interview.
  • A key finding was that concerns about not being perceived as a ‘good mother’ were
    recognised as barriers to seeking help, or accepting and accessing care for mental illness in
    the perinatal period. The other findings have been grouped under the following areas:
    social support, professional support and environmental issues and are described below.

Social Support

  • Women and professionals acknowledged that practical and emotional support from families
    (the women’s own parents in particular) were important for women during the perinatal
    period. Some women in rural areas that did not have local support from family described
    feeling isolated. Some of these women felt that lack of family support had contributed to
    their feelings of depression and anxiety and isolation, and their rurality exacerbated this due
    to limited services nearby and the need to rely on transport.
  • During periods of perinatal mental illness, families played an important role in caring for
    women and their children, although disclosing feelings of anxiety or depression to family
    members was not always easy. Ultimately it seemed that family members were often central
    to enabling the women to seek professional help. Care from family, including childcare and
    companionship were important to women during these periods to enable them to manage
    their day to day life and to support them to get well.  When the women described gaps and
    or delays in professional support, family support if available often filled these gaps.
    Inequalities and challenges were experienced by women that did not have family support,
    and isolation caused by rurality added to this.
  • Many women indicated a desire for facilitated peer support and several participants
    described qualitative benefits of accessing a peer support group for their mental and
    emotional well being. Professionals also described that peer support could be valuable to this
    population and also enable them to support more than one woman at a time. Overall, it was
    considered that online peer support should be an addition to, rather than in place of face to
    face peer support.  Further work is needed to specifically assess the effectiveness and cost
    effectiveness of facilitated peer support groups in the perinatal period including the content
    and implementation.
  • Women and professionals reflected on the roles that health professionals and children’s
    centres could play in building community capacity. For example the women discussed that
    professionals may have an awareness of families that do not have local family networks,
    thus may be more vulnerable and in need of additional care. Health professionals’ knowledge of new mothers in local areas, could be utilised to make links between women living in rural communities.

Professional Support

  • Women felt their well being during the perinatal period was affected when health
    professionals only emphasised the well being of their baby, rather than the “mother and
    baby”. Some thought their physical health was treated without consideration of how it
    might affect their mental health. Overall, a key finding was that it was essential for a mother
    to look after herself so she could care for her baby.
  • Women thought more could be done in the antenatal period to raise awareness of perinatal
    mental health.  Antenatal classes were also perceived as important for building social
    networks in the perinatal period. However, recent changes to centralised antenatal classes
    in some areas were seen as a barrier to women in rural areas being able to access antenatal
    classes; as many women travelled to access these services they were no longer felt to be
    local.
  • Women thought they would benefit from more generalised professional facilitated support
    groups that focused on mother’s needs, experiences and concerns. It was discussed that this
    type of support was currently available for women that were breastfeeding, but was not
    accessible to all.
  • Many women described the value of having conversations with health professionals that
    were tailored to their own circumstances and past experiences.  Continuity of support and
    being able to build a relationship with the same health professionals was seen as beneficial
    and facilitated the disclosure of information about mental health and past experiences.
  • Professionals discussed that a barrier to signposting families to prevention services was the
    lack of up to date information about services that were available. During the research health
    visiting and prevention teams were establishing Facebook sites with the intention that this
    would promote support available to families.
  • Health visiting and the Improving Access to Psychological Therapies (IAPT) service were
    working to deliver an equal service for perinatal mental health across the whole county. IAPT
    was forming new partnerships and developing new ways of delivering their service while the
    research was taking place. However, there was inconsistency in the level of service offered
    by maternity hospitals and children’s centres across the county, and while some areas had
    voluntary and sector provision others did not. The range of NHS organisations and CCGS
    across the county, particularly on the borders of the county, was perceived to cause
    complications and challenges.

Environmental Issues

  • Professionals perceived rural communities to have been hit the hardest by the current economic climate. The winter months when weather caused isolation, and school holidays when some important universal services did not run, were seen to be particularly challenging.
  • It was discussed that internet access was poor in some areas and thus, online services and information was not always accessible to women in the most rural areas of North Yorkshire.
  • It was recognised that a lack of public transport was a barrier and that women without transport replied on partners or friends to transport them to services.

I understand that they can’t have children centre’s or antenatal classes in every village but having some in of the easier to access towns or even being able to go to the next county if you are on the border like myself would mean less mums would turn down going due to travel. It can be stressful working to a set time especially if you have to catch a bus and knowing when the bus times are. More and more children centre’s are closing which also makes this harder for mums to access groups or activities.

The social aspect can be useful from these sessions for new mums who may not know any other mums locally or just want a coffee and a chat; often the stay and play weigh in sessions held by health visitors or the children centre staff can be useful. Dependent on where you live and the staff is to whether these are available to you, your health visitor should be letting you know if there are any available. I have found that in the two places I have lived since having my babies the methodist churches have been pretty good for having tots group sessions often only charging a pound. This maybe a more viable option again depending on where you live – I can’t speak for other religions but maybe ask at your local place of worship as they maybe more than happy to accommodate this you never know until you ask. With Ra-Ra we took her to a sensory group where I met some lovely mum’s and Button when my mental health was okay (until he went to nursery) he went to a music group held by one of the mum’s who used to be a primary school teacher. It all depends on how much money you are able to free up regarding what you do but it isn’t just for the kids you are still *insert name* not just so and so’s mummy.

I am a member of a few support groups on Facebook but I’m not sure I would join one for mum’s in my local area, maybe because I still have social anxiety but I would like to think it is because I am friends with some mums in the village. Some are younger, some are the same age and some are older but the ones I talk to no matter how frequently or infrequently I know that they are there if I need them, which means a lot. Some of us try to organise meet ups but they sometimes fall through and do you know what? It is okay because life happens you don’t have to be this awe inspiring super mum with an amazing social life and immaculate house – I’m sure not one of those mum’s! Never be afraid to speak up when you need help; they won’t take your babies away from you because you need a little extra support it is more normal than you think.

What is the maternal mental health support like in your area? Do you agree or disagree with the results? Baring in mind it was area specific.

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