A study carried out by safeguarding specialist and clinical team lead, Joanna Goddard found that 85% of women at high risk of postnatal mental illness, who were offered a care planning meeting prior to their baby’s birth took up the offer, thus safeguarding the welfare of their newborn child.
It comes as a national report criticises the NHS for not providing enough help for women at risk. The Maternal Mental Health Alliance (MMHA) found that the NHS offers patchy and at times dangerously inadequate care to women who suffer mental health problems linked to having a baby. Only 40% of NHS services across the UK offer a specialist team to support women who are known to be at risk. But the Rosie has an established system, which has now been proven to work.
Jo Goddard decided to carry out the research as part of her Masters degree on child protection and adult safeguarding. “I was scouting round for a dissertation topic and thought about how I’d helped to set up the perinatal mental health service with some of the consultants here at the Rosie. We felt strongly that there needed to be an element of care planning for women with mental health issues. So we instigated a 32 week pregnancy pre-birth planning meeting. It works because everyone involved in that woman’s care is invited to the meeting -- from GPs, health visitors, midwives and social services, as well as her friends and family – and she is given control over her plan and what she wants to happen. Women tell us they like this support and really value the time and care devoted to the planning.”
The Rosie team has also taken on a new specialist midwife, (Jane Miller) trained in perinatal mental health, who plays a pivotal role in the women’s journey through pregnancy, birth and beyond. The combination of this and the planning meeting has proved successful.
“A lot of women who’ve had mental health issues are very self aware and very anxious about how they’ll cope when their child is born because they know they’re at risk. We know that a lot of pregnancies in this group are unplanned; we know that many women take themselves off their medication which can make them vulnerable. Women invested quite a lot of themselves in coming for the meetings and they were very proactive.”
NICE guidelines state that women are at more risk of developing mental health issues during pregnancy and the first postnatal year than at any other time. If they have a pre-existing mental illness condition, that risk can be increased.
The team at the Rosie is trying hard to normalise high risk women’s experience by enlisting the support of family and friends. The research found that, in line with NICE guidance, women with mild to moderate mental health issues can often be safely looked after in the community. Those with serious mental illness are sometimes at greater risk. “If a mother is struggling with no support and mental health issues postnatally, obviously that will impact on her relationship with her baby and sometimes women can become emotionally unavailable. This may have significant, long-term effects on the baby, family life and future relationships,” said Joanna.
The work of the Rosie has been recognised by the NSPCC. A letter sent last year highlighted the excellent work being done and acknowledged the important role played by the hospital in supporting families with complex needs and preventing harm to children. But there is still room for improvement. At the moment, for those women who are seriously ill and need hospital care, there are no specialist beds available in the hospital. It means they are either sent to Fulbourn Hospital outside Cambridge where they must be separated from their child or to mother and baby units, further afield.
“We know there is still work to do and we’re particularly keen to up-skill partners and families of these women so they can be safely cared for at home. We have found that with better mental health care in the community even sick women can remain at home. It’s better for baby and mother because at all costs what we want to do is preserve that special bond. That’s what so important in the first few months of life.”
• For the background article on national mental health provision in pregnancy see: http://www.theguardian.com/uk-news/2014/jul/08/nhs-inadequate-care-mental-health-postnatal-depression
• Joanna Goddard studied to become a nurse and midwife in London before transferring to Cambridge University Hospitals in 1986. She is a midwife at the Rosie hospital where she became involved in safeguarding. She is now the named safeguarding specialist working across multidisciplinary teams to support women and children through pregnancy and birth.
• Her research in child protection and adult safeguarding was carried out at Buckingham New University in High Wycombe.
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For further information, please contact: louise.gosling@addenbrookes.nhs.uk tel: 01223 586 730
Communications Department, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ
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