Perinatal Mental Health Midwife

Application for Temporary perinatal health midwife There is increasing awareness of perinatal mental health as a public health issue. The Government is keen for midwives to further develop their role in public health. Midwives need to be adequately prepared to take on a more developed role in perinatal mental health if practice improvements are to be made. I am aware that death from psychiatric causes has been the leading cause of maternal death for the last few years.

Although the most recent Confidential Enquiry into Maternal and Child Health indicated that this is no longer a leading cause, mental health problems before and after childbirth have a significant impact on the health of women, family relationships and children’s subsequent development. I believe that midwives need to be able to detect women with current mental health problems and those at high risk of a serious mental illness following delivery, in order to improve the care and support offered to them throughout their contact with maternity services.

One of the most serious areas where we see ongoing harm is in adult mental health. Recent research shows that a large proportion of adult mental health problems can be laid at the door of early childhood. We need to consider the likely future effects of not breaking the cycle while these people are young. The ACE Study estimates that 54 per cent of current depression and 58 percent of suicide attempts in women can be attributed to adverse childhood experiences, which also correlate with later high levels of alcohol and drug consumption.

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In order to screen systematically and sensitively, and to enable them to refer on appropriately, I feel that midwives need to understand why they are asking questions about mental health; how to encourage women to disclose past and current problems; what the risks of recurrence and relapse are; and what services are available in their area of practice. 1|Page I feel very strongly that having post graduate qualifications and experience like my own in counselling and different approaches to psychotherapy are essential attributes for this post.

The facts about childbirth and mental illness are startling (reference, Oates M 2001): About one in ten women will develop postnatal depression after delivery. < After psychosis (puerperal) postnatal develop will women 500 in one> Suicide is one of the leading causes of maternal death in the UK. A woman is 20 times more likely to be admitted to a psychiatric hospital in the two weeks after delivery than at any time in the two years before or after. Despite this, talking about and confronting the issue of mental illness during pregnancy or the postnatal period still poses challenges for healthcare professionals.

Motherhood is loaded with emotive expectation. This contributes to a large number of cases of perinatal mental illness going undiagnosed. This can have serious consequences including poor bonding between mother and baby; reduced quality of life for the mother, baby and father; prolonged disability caused by living with an untreated serious mental illness; and potential risk to the health and safety of the mother, baby or other family member, either through neglect or harm due to illness.

As a midwife with 20 yrs of clinical practice and with some experience as a service user, I was pivotal in setting up the current bereavement service and have been Counselling women and their families at West Middlesex Hospital since June 2009. I also have experience of providing supportive psychotherapy to a diverse range of clients with differing pathologies in a primary care and private setting since 1999. In my Role as Midwifery Matters facilitator (2007-2009) South East Strategic Health Authority, I regularly travelled across the patch, giving presentations to multi professional audiences.

I am confident in designing, producing and presenting a 2|Page range of presentations, including role play, power point, interpersonal workshops and formal lecture format. I have experience in writing academic papers (published) and information leaflets, guidelines and information posters. I am a naturally creative person who enjoys implementing evidence based practice change at a strategic and operational level. I am very excited about the opportunity to be potentially involved with designing an E-learning package.

Whilst working with other experts in this industry I have gained some knowledge in the process of elearning development. I think that routine antenatal and postnatal care present an excellent opportunity to screen the mental health of pregnant women and women with a new baby. To do this effectively however, requires working more collaboratively across different professions to meet the needs of our patients. Having the post of a specialist midwife in mental health could allow me to provide focused care to pregnant women with mental illness. This could include co-morbid substance & alcohol misuse problems.

I envisage the role as working closely with a perinatal psychiatry team at W. M. U. H and as an important point of liaison between the other midwives, especially safeguarding and case loading midwives, obstetricians, health visitors, child and family social services, obstetricians in the hospital, and mental health services. A useful means to achieve partnership working would be for the S. M. M. H to attend the weekly midwifery team meeting. Here, all midwifery community and labour ward teams meet to discuss the caseload and update the antenatal progress notes.

This provides a valuable opportunity for potential referrals to be discussed, both with the specialist mental health midwife and the perinatal lead psychiatrist/obstetrician. Many women will prefer and only require additional support and advice from a midwife with specialist expertise, rather than see a psychiatrist. However, some pregnant women will need to see a perinatal psychiatrist for expert advice, for example, if having severe mental illness, or to discuss medications in pregnancy or breastfeeding. 3|Page

The referrals could be women with a history of mental illness during childbirth or preexisting mental illness who are now pregnant. However, quite often at booking or routine antenatal checks, midwives may pick up new onset psychological distress in pregnant women who have no history of mental illness. Women may at first feel more inclined to disclose things to a midwife rather than a psychiatrist or doctor. This may include apprehension or fear centred on the impending delivery itself, increased general anxieties about coping, depression or other psychological symptoms.

The National Institute for Health and Clinical Excellence guidelines (2007) on antenatal and postnatal mental health have sought to address this, suggesting that at a woman’s first contact with primary care, at her booking visit and postnatally (usually at four to six weeks and three to four months), healthcare professionals (including midwives, obstetricians, health visitors and general practitioners) should routinely ask the following two screening questions to identify possible depression: During the past month, have you often been bothered by feeling down, depressed or hopeless?

During the past month, have you often been bothered by having little interest or pleasure in doing things? A third question should be considered if the woman answers “yes’ to either of the initial questions: Is this something you feel you need or want help with? As a specialist mental health midwife, I would want to scope the current service and rapidly undertake a gap analysis to work towards providing equal access to perinatal mental health services. I could provide consultation and advice with the knowledge and skills that I already have and from which I accrue whilst undertaking my MSc in Psychodynamic approaches to Mental Health.

I could perhaps investigate the possibility of providing a link to the local mother and baby unit. 4|Page In This role I could also act as a useful resource for other staff and support other midwives with their clients. They can be involved at an early stage in antenatal care and assist with monitoring women who may be developing or at risk of mental illness in childbirth. They can link up between physical and mental healthcare and can work in partnership with pregnant women to develop care plans for their individual needs.

Having this post would give me the opportunity to hopefully address the stigma around mental illness and childbirth and improve screening and detection of women who need further specialist help — ultimately improving clinical outcomes and quality of life for new mothers and their families and long term financial benefits to the Trust and the N. H. S. A study of provision of perinatal mental health services has already been undertaken in two English strategic health authorities: views and perspectives of the multiprofessional team.

Reports and policy recommendations have highlighted the need for early detection, appropriate referral and management. (Rowan1, McCourt 2 & Bick 3 (2010) This study has reported the in-depth views of relevant healthcare professionals on the extent to which perinatal mental health services are meeting policy and practice guidance. Their views highlight that although there have been developments in service provision, gaps persist particularly with respect to appropriate ongoing identification of needs and appropriate follow-up of women. Real challenges for the maternity ervices persist in relation to complex boundary issues that impacts on opportunities to support effective continuity of care and funding issues. Additionally, examples of good practice may still depend on the initiative and commitment of individual professionals, rather than the support of the organisation, including dedicated resources. Further research is required to ascertain the extent to which resource issues and the drive to cut NHS healthcare budgets are limiting appropriate service provision for women with perinatal mental health needs. 5|Page There is always a need to elicit the views of the women who use the service.

I would approach this by Iinking with our existing Maternity Service Liason comittee and carrying out appropriate patient satisfaction surveys and audit. References Felitti V & Anda RF (2008) ‘The relationship of adverse childhood experiences to adult health, wellbeing, social function and healthcare’ in R Lanius & E Vermetten (Eds) The Hidden effects of unresolved trauma. 134Epidemic: The Impact of Early Life Trauma on Health and Disease, Cambridge University Press, Mary Ross-Davie, Sandra Elliott, Anindita Sarkar, Lucinda Green British Journal of Midwifery 14(6): 330 - 334 (Jun 2006) National Institute for Health and Clinical Excellence. 007. Antenatal and postnatal mental health: clinical management and service guidance. NICE clinical guideline 45. London: NICE. Oates M. 2001. Perinatal maternal mental health services. Recommendations for provision of services for childbearing women. London: Royal College of Psychiatrists Cathy Rowan1 RM, PGCEA, MA. Christine McCourt2 BA, PhD. Debra Bick3 RM, BA, MedSc, PhD. (2010) Evidence based Midwifery:Volume 8 (2010) » issue 3 » Provision of perinatal mental health services in two English strategic health authorities: views and perspectives of the multi-professional team.. 6|Page

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