Six-week postnatal checks are failing many new mothers, Healthwatch England warns
As part of a review of maternal mental health care, Healthwatch England - our umbrella body - analysed experiences of pregnancy and postnatal care shared by 2,693 new mothers and birthing parents since April 2020. Whilst the survey participants were self-selected, their views are likely to reflect those of a significant group of recently pregnant people.
The analysis suggests that not all GP practices comply with the requirement to provide six to eight-week postnatal checks. And where those checks take place, it is not clear that GP practices are aware of NICE guidance which tells them in detail how to spot mental health problems and provide help.
The six to eight-week check-up was pointless. I have had longer chats with the postman.
Delays to accessing mental health support can have a devastating impact on new parents. Many people told us that their mental health suffered whilst waiting for treatment. Some struggled to leave the house, bond with their child, or experienced a breakdown of relationships.
Healthwatch England's review came following multiple systemic failures in maternity services in recent years, including at Shrewsbury and Telford NHS Trust. One of the key actions set out by the final report of the Ockenden review, aimed at preventing similar failures in future, emphasised the importance of making mental health support integral to all aspects of maternity service provision.
Key findings
- Over one in 10 (16%) of new mothers and birthing parents who shared their experiences said they hadn't received the six to eight-week check.
- Of those who said they had been offered the postnatal check, only one in five, 22%, were satisfied with the time their GP spent talking to them about their mental health.
- Nearly half, 44%, of respondents felt that the GP did not spend enough time talking to them about their mental health, while a third, 30%, said that their GP didn't mention this during the check.
- One in seven, 15%, said they had had their six-week check over the phone, with many new parents finding it hard to verbalise their mental health struggles and discuss physical issues. In the worst cases, respondents felt the way their mental health issues were discussed was inappropriate and potentially harmful.
Healthwatch England undertook the research between October and December of 2022 to find out to what extent mental health support has improved during and after pregnancy. Their analysis also found the following:
- Two-thirds, 1800, of the women and birthing parents who shared their experiences had struggled with their mental health during and after pregnancy.
- Nearly half of those, 41%, received no support to help with their mental health during and post-pregnancy.
- Delays in accessing mental health support can have a devastating impact on new parents, with some reporting they had struggled to leave the house, bond with their child and maintain relationships.
- First-time mothers are particularly vulnerable to developing mental health problems and are less likely to access timely care.
Of the 69 respondents from the Bristol, North Somerset and South Gloucestershire area:
- 60 said they had the six to eight-week check.
- 44 of those said mental health and wellbeing were not mentioned or not enough time spent talking about it.
- 12 said mental health support in the postnatal check was 'just right'.
The findings come after the Care Quality Commission warned of a "concerning decline" in women's experiences with maternity services due to a shortage of frontline staff.
Also, last year, a report by MBRRACE highlighted that in 2020, women were three times more likely to die by suicide during or up to six weeks after the end of pregnancy, compared to 2017-19. This is equivalent to 1.5 women per 100,000 giving birth.
Recommendations
- Integrated Care Systems (ICSs) should monitor the delivery of six to eight-week postnatal consultations as part of their primary care commissioning responsibilities.
- The Medical Licensing Assessment being introduced from 2024 should check understanding of the importance of postnatal mental health and the mental health element of postnatal checks.
- The section of the GP contract on delivery of postnatal consultations should be updated to include mention of signposting to specialist and community mental health services and point to best practice guidance around carrying out open-ended discussions.
- As part of its Maternity Transformation Programme, NHS England should consider what additional support and guidance it can provide for GPs to have quality conversations about mental health at the six to eight-week postnatal consultation.
- Deliver the Long-Term Plan commitments on improving access to specialist community perinatal mental health services.
I was referred to the perinatal mental health team multiple times by multiple people (two Health visitors, GP, and a midwife) and was consistently told I wasn't "bad enough" for them to take me on, despite being told by each person I absolutely was a risk to myself and my child. I then went through the standard mental health support. I was only offered their basic CBT over the phone as there wasn't enough support available for anything else. They believed I should be with the perinatal mental health team, which meant I got zero support from anyone and was left to deal with it all myself. I ended up paying a lot for private counselling because I was afraid about what would happen if I didn't.
Louise Ansari, National Director at Healthwatch England said:
"With mental ill health affecting up to a third of new and expectant mums, six-week postnatal checks are key to assessing their wellbeing after the birth. If left untreated, poor mental health can have a devastating impact on new parents and their families.
"Unfortunately, our findings show that although most new mothers and birthing parents are likely to be invited to a postnatal consultation, these are frequently carried out as a tick-box exercise, where mental health is not treated as a priority or not assessed at all.
"Monitoring the delivery of six-week checks should be the first step to ensuring there's a consistent approach to offering quality mental health support to all new mothers. NHS England should consider what additional support and guidance it can provide to GPs so that the help new parents get is of the best quality.
"We also need to ensure that maternal mental health and peri-natal services continue to remain on the government's agenda and a priority in workforce planning and funding budgets."
