One of the lines I was most pleased to hear at Labour conference was health secretary Yvette Cooper’s: “I will not stop until every mother is given the care she deserves.” Off the back of sobering reviews into maternity services in this country, the secretary of state has pledged to make better maternity care one of her highest priorities in office. The government is bringing in new national maternity standards and launching a maternity and neonatal action plan.
One aspect of maternity care that risks being overlooked is mental health support during pregnancy and after a baby’s birth. We still assume too often, especially in our Instagram age, that this is solely a time of joy and celebration. For many women it is. But for one in four, it can be a time of depression or anxiety, OCD or post-traumatic stress. For some women this can be extremely serious. The leading cause of death for women in the period from six weeks to a year after birth is suicide. I learnt this in the most agonising way when one of my best friends, Sophie, took her own life after the birth of her third daughter. Her death floored me, and the shock and sadness still sit with me today.
In theory, women are asked about their mental health, in their first booking appointment and at the six-week check-in after birth. In theory, they are referred on to specialist support if problems are picked up.
But in reality, their experiences vary wildly. Some are asked a few hurried questions between blood pressure checks, while others are not asked at all. Some GPs and midwives have the training and time to offer support; others don’t. Some have established mental health services to which to refer women; some are almost afraid to ask the right questions, because they do not trust that a referral will kick in.
The result is a postcode lottery, whereby a pregnant woman’s support depends on the NHS trust that she happens to fall under or the individual healthcare professionals whom she happens to see. It is also a lottery that a woman is more likely to lose if she is young, black, Asian, experiencing domestic violence, or living in poverty.
I introduced my Perinatal Mental Health Assessments Bill – “Sophie’s Law” – to parliament, to start to address these holes in the system. It would require every pregnant woman to have a mental health check-in. My friend’s death was the starting point for my bill, but its end goal is protecting every other woman whose story doesn’t need to end in tragedy.
My bill has four prongs. First, that every pregnant woman deserves a proper mental health assessment, with trauma-informed conversations rather than tick-box exercises. The evidence shows that outcomes are better when interventions happen as soon as possible during pregnancy, so this needs to be a routine part of antenatal care.
Second, the bill would improve training and supervision for everyone involved in maternity care. GPs, midwives, obstetricians, health visitors and community mental health practitioners all need the knowledge and confidence to ask the right questions. I’m calling for a national training standard, that also recognises the specific needs of women from diverse backgrounds and the different ways that mental health challenges are experienced and expressed.
Third, we need clear referral pathways. A specialist perinatal mental health midwife should be embedded in every maternity service to ensure that risks are flagged and referrals made. The appropriate support will be different for every woman, but one important option is the NHS Talking Therapies programme, to which I know the government is committed. I have seen in my own constituency of Aylesbury how helpful that can be for women, and I urge NHS Talking Therapies services to consider women in the perinatal period a priority group for support. There are also fantastic voluntary services in communities across the country, such as PANDAS, and yet many women are not made aware of them.
Fourth, I’m calling for clear accountability for perinatal mental health assessments. NHS England and integrated care boards would be responsible for ensuring that local maternity systems introduce the single standardised assessment process, but then also, crucially, capture data and track outcomes. There must also be improved oversight of these services from the Care Quality Commission as part of its maternity inspections.
I know resources are tight across the NHS, and I know there are particularly acute challenges in many of our mental health and maternity services, including a national midwife shortage. But I also know how transformative the relatively modest measures in this bill could be. The government is developing new maternity and mental health strategies, and this could be an opportunity to give mums the full benefits of both. I believe that this could have made a difference for Sophie, and it could still make a difference for so many women.
