Midwifery Essentials: Perinatal Mental Health,

Chapter 1: This chapter will include an overview of mental health conditions. This section will also include eating disorders, which are not uncommon during the perinatal period. This is a particular area of concern and further guidance is needed for practitioners.

Chapter 2: Pharmaceutical interventions will be covered extensively in this chapter and whilst the authors acknowledge that all midwives should reference the most up-to-date BNF for medication guidance, it is useful to provide midwives with an understanding of the types of medication used to treat mental health illness in order to provide context within the sphere of midwifery practice. Compatibility with medication and breastfeeding will also be discussed.

Chapter 3: This chapter will discuss different types of psychological therapies to equip the midwife with a basic understanding of how therapy is used to treat some mental health conditions. This will include psychological approaches such as CBT, DBT (group interventions), psychotherapy and non-directive counselling. The fundamental approaches to therapeutic interventions will be evaluated.

Chapter 4: Complex social factors will be discussed in this chapter and will focus on FGM, sexual abuse, signs of abuse and exploitation, substance misuse, domestic abuse. Co-morbidities will be addressed investigating the complex relationship some women with mental illness may have with alcohol or recreational drugs. The authors will also approach the subject of gender identity.

Chapter 5: This chapter will discuss mental health in the context of culture. Stigma surrounding mental illness is present in all communities, but for some women who live within specific cultural groups there is a very real risk of being ostracised if ‘labelled’ with mental illness. These women and their families may become extremely isolated and not seek the help they need for fear of prejudice and stigma associated with mental health. The reasons for this will be explored and cultural differences will be highlighted to offer an intriguing insight into how the construction of societal belief systems within a cultural group can negatively impact on the woman and her family. Advice will be given on how the midwife can best support these women and their families.

Chapter 6 will discuss the parent-infant relationship and will include the impact of perinatal mental illness/trauma on the infant and how it can affect the development of the child. This chapter will also explore the partner’s experience. The 5 year forward planning report recognises the importance of supporting family members and the impact mental illness can have on the whole family. The authors will discuss depression in fathers/partner’s and offer practical, expert advice on how best to support and reassure father’s experiencing difficulties.

Chapter 7: This chapter will focus on the roles within multi-disciplinary teams. The authors believe that this will give the midwife a deeper sense of understanding about the role of specialist clinicians working in perinatal mental health services. An overview of each role will describe the type of work the practitioner may undertake with the woman. This chapter will also include an overview of mother and baby units and the type of care given to the woman whilst staying in this clinical setting.

Chapter 8: ‘The role of the midwife’ is fundamental to the book and will offer a comprehensive ‘tool-kit’ on how best the midwife can support the woman and her family while experiencing perinatal mental illness. The aim of this section is to enhance competence and confidence for midwives who may encounter women with mental illness and physical/psychological trauma.

The chapter will include advice and discussion on how the midwife can identify women in need of support during the antenatal, intrapartum and postnatal period. Assessment and screening tools will be given as examples such as HADS, BDI, EPDS, PHQ-9 and GAD-7 and 2. ‘How to have difficult conversations’ with women will be explored. Also, key points such as how to address women at risk of suicide and the use of crisis intervention will be included e.g. developing plans of care and ensuring that correct referrals have been made. A list of resources will be detailed at the end of the chapter for further support. Intrapartum care will also feature in this section and will explore how midwives can support and advocate for women with perinatal mental illness or those who have experienced abuse. The chapter will include all aspects of midwifery practice from risk management to case handling.

Better Births and continuity of care initiatives and the importance of building relationships with women will be discussed. This section will acknowledge that mental health can affect everyone, and that women who have never experienced mental health issues before may present during pregnancy or the postnatal period.

The second part of this section will explore the midwives own emotional wellbeing and experiences in relation to mental health. It will be acknowledged that supporting women with mental illness can be emotionally demanding for practitioners, and practical tips on how to nurture the midwife’s own emotional wellbeing through reflective practice will be supplied together with recommendations on how to seek support when required.