Maternal and Infant Mental Wellbeing
Ann Kerr, Team Head NHS Health Scotland
Content
How the work got started How the work was carried out What the recommendations are Next steps
Refreshing the Maternity Services Framework 2001 Last Maternity Services Framework 2009 Maternity Services Action Group (MSAG) commenced revision Health inequalities and health improvement identified as key gaps MSAG workshop focus on health improvement Decision to focus on maternal and infant mental wellbeing 2010-2011 Short life working group 2011 recommendations to MSAG
Working group
Role and remit agreed with MSAG Membership: British Psychological Society Consultant midwives Health Promotion Managers Group Health Scotland National Childbirth Trust NHS Education for Scotland Mental Health Improvement Specialists Group Royal College of Obstetrics & Gynaecology Scottish Government
Process
• Initial brief review of systematic reviews and current work • Logic model • Review of reviews • Development of recommendations
Appendix 1: Logic Model for Maternal and Infant Mental Wellbeing Activities
Reach
Short term outcomes
Intermediate outcomes
Long term outcomes
Decrease in unplanned pregs
Promote healthy relationships & sexual wellbeing to adolescents (Link 1)
Parent education, parenting skills progs & promote positive relationships with infants (Link 2)
Increased understanding of importance of strong relationships & communication
School students Education services Young pregnant women/ mothers
Identify and engage all pregnant women early in appropriate services (Link 3)
All pregnant women/ mothers (1st and subsequent) Wider family (e.g. partners, grandmothers)
Improve preconception & antenatal care in appopriate settings (Link 4)
Inequalities sensitive practice from all care providers (Link 5)
Improve quality and availability of appropriate post natal support (incl. peer support) (Link 6)
Develop key competencies, incl.awareness of MH problems, appropriate interventions, soft skills & modelling of key behaviours, in NHS & partner staff who manage & deliver maternal and infant care (Link 7)
Women at social risk (e.g. domestic abuse, addictions, previous mental health problems)
Improved preparation for pregnancy & childbirth; improved awareness, understanding & implementation of techniques/ approaches to promote bonding & attachment.
Positive/trusting relationships between mother & caregiver (midwife/GP/HV)
Women engage early with high quality services
Women at risk of poor bonding & consequent poor attachment of child are identified & engaged earlier
Wider NHS and LA services with a role in providing ante and post natal care (e.g. general practice, specialist services such as mental health services, addiction services, homeless services)
Frontline staff have improved knowlege and skills to identify and refer women at risk of mental health problems
'leaders' in NHS, local authority and vol sector, including planners, managers
Increased parental confidence
Relationships, communication & transitions between midwives, HVs, GPs/primary care team, & specialist services are improved
Indicators, data collection systems and records support the early identification and ongoing care of women at risk of poor outcomes
Increased secure attachment & reduced disorganised attachment
Increased social support for parents
Reduced domestic abuse & other social risk (e.g. addictions) during pregnancy & PN period
Increased amount of positive experiences of pregnancy & childbirth All women (including those at risk of poor outcomes) receive timely, tailored support the right support at the right time
More staff enabled to deliver compassionate, caring & competent care
Professionals in maternity care services provide consistent information and care, including use of soft skills, & model/enable appropriate behaviours
Systems, structures and leadership reflect the importance of maternal & infant mental health Coordinate and improve quality of care and communication antenatally, intranatally & postnatally (Link 8)
Increased breastfeeding
(Both) parents have knowledge & skills to provide responsive and consistent care to infant
Dedicated maternity care profressionals involved in ante, intra and postnatal care (midwives, obstericians)
Third sector care providers and support groups
Infant receives responsive and consistent care from primary caregiver
Services more responsive, accessible & appropriate to the communities they serve: barriers removed
Improved emotional and behavioural outcomes for children and young people
Improved maternal mental wellbeing & reduced postnatal depression
Decreased inequalities in maternal & infant mental health
Pregnant women choose healthier behaviours
NHS services value parenthood and children and demonstrate this through service provision
Recommendations Definitions Context: Dyad
Recommendations cont 1. There should be coherence and consistency between the Parent Education Curriculum and the wellbeing components of the Curriculum for Excellence. 2. Parent Education and relevant parts of the Curriculum for Excellence should be integrated into Scottish Government’s wider parenting strategy 3. The partnership that developed the new Parent Education Curriculum (HS, NES and HIS) should ensure that its implementation and effectiveness, in terms of short and medium term outcomes, is robustly evaluated.
Recommendations cont 4. The use of equipment that allows physical or face to face contact between mother and infant (such as soft baby carriers, and parent facing buggies) should be promoted. 5. Pre conceptual care should be provided by sexual health staff, general practice, maternity care and specialist mental healthcare providers in order to improve their identification and care for women who are planning a pregnancy and are at particular risk of poor mental health related outcomes.
Recommendations cont 6. All interactions between antenatal service providers and pregnant women should be used to promote mental wellbeing using strengths and asset based approaches, as well as to assess risk and need. 7. Staff providing postnatal care should be suitably skilled to be able to identify and respond to signs of mental health problems, and appropriate systems and pathways should be in place to allow appropriate referral where necessary.
Recommendations cont 8. Postnatal social support (which might include peer support) is anecdotally very important but this is not yet reflected in highly processed evidence. There is evidence, however, that new mothers most at risk of poor outcomes do not access group based support. 9. Interdisciplinary training in maternal and infant mental health and wellbeing should be available for all staff providing maternity care, including managers, and should incorporate shared definitions and guidance, and focus on the important contribution of maternity care to promoting and maintaining maternal and infant mental wellbeing. This should include maternal and infant attachment.
Recommendations cont 10. Effective assessment using the GIRFEC practice model should be integral to maternity care practice 11. Continuity of carer(s) and the development of trusting relationships should be provided for all women and ensured for the safe care of women with complex health and social care
Recommendations cont 12. The way in which a woman is supported during labour and childbirth is central to how the woman feels about her childbirth experience and can have significant implications for her postnatal mental well-being. Staff providing intrapartum care should be suitably skilled to identify and respond to women’s needs during labour and to provide continuous positive care that enables women to feel engaged and to have a sense of control. All women should be given the opportunity to spend quiet private time with their baby and enabled to have skin to skin contact with their baby if they choose as soon as possible after the birth.
Recommendations cont 13. New technologies (e.g. texting, social media) should be used as mechanisms for improving continuity of care and ongoing postnatal support.
Next steps MSAG endorsed recommendations and wrote to all relevant agencies for action Merger of MSAG and the implementation group for the new Maternity Care Framework Maternity care and public health special interest group Parenting Strategy Antenatal access HEAT target Dissemination of evidence reviews and recommendations
Contacts:
www.healthscotland.com
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