The study revealed that most women found questions about mental health acceptable, with a smaller amount reporting difficulties. Many of the women who did report difficulties had a past or current mental health problem and/or a history of abuse.
Results indicated that, in general, women wanted:
- to be asked clear questions about mental health problems
- to have sufficient time to discuss issues
- to receive responses from midwives that were normalising (didn't make them feel like they were unusual or abnormal)
- for midwives to be well-informed about mental health.
In the UK, clinical guidelines now recommend that midwives conduct a brief mental health 'enquiry' with all of their patients. This usually takes the form of asking two questions known as the Whooley Questions, asked at the booking appointment, which have been shown to be effective in telling who is suffering from depression. These are the questions:
- 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 little interest or pleasure in doing things?
If the woman answers yes to 1 or 2 of the questions more questions are asked. NICE guidelines also recommend that midwives have a regular general discussions around mental wellbeing with patients.
To date, there has been limited research evaluating how women find these questions and any follow-up.
This study highlights that women want midwives to ask clearly-framed questions about mental health problems (addressing past and current mental health concerns), and value responses from midwives that are normalising, well-informed and allow for discussion.
This research also demonstrates the need for more training for midwives on how to appropriately respond to women's distress during mental health enquiry, and on referral to support services.
Implications for practice
These findings have important implications for practice. 1 in 4 pregnant women experience mental health problems and maternity appointments are a prime opportunity to identify these women so that they can access the support that they need.
It is therefore important that mental health discussions with women be carried out in a way that encourages disclosures, information provision and referrals.
The research also reiterates the importance of midwives having a general discussion about mental health concerns with their patients, as recommended within UK clinical guidelines.
Emma Yapp, author of the study, said:
These findings underscore the importance of professional training in abuse and mental health. Research consistently finds that women are happy to be asked about these topics by healthcare professionals when enquiry is conducted appropriately, but these findings additionally demonstrate that midwives’ confidence and competence in these subjects has a bearing on how women experience routine mental health enquiry. Women who disclose are seeking reassuring responses, and under-confident midwives may be unable to provide that if they don’t feel reassured themselves.
Co-author, Professor Louise Howard, also notes:
What is clear from this study is that women with mental health problems may find it difficult being asked about mental health at their first contact with maternity staff. Women need a trusting relationship with their midwife which often develops during the pregnancy. This study confirms the importance of asking about mental health at all contacts with women. Physical and mental health cannot be separated so asking about both routinely will ensure truly holistic care.
The Pregnancy and Post-birth Wellbeing Plan
Tommy's, in partnership with RCM, IHV, Netmums and NCT, has developed a two-page Wellbeing Plan, endorsed by NICE and RPsych, that can help you start thinking about how you feel and what support you might need in your pregnancy and after the birth.
You can use it to help you talk to your midwife, partner, family, friends or midwife about how you are feeling. You can also keep it private if you want to.
The plan is currently being made available digitally, and this will be available in July 2019.
Getting support with mental health
Midwives and others in your care team are there to support you with your emotional health as well as physical health.
When should I ask for help?
It’s natural to have periods of feeling worried or low when you’re pregnant or after birth. But it’s important to ask for help if you’re having bad feelings all the time or you feel you can’t cope.
You can find the full study here.
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