Smita Hanciles writes of the need for more cohesive support encompassing breastfeeding and perinatal mental health services. For more on this subject, come along to the BfN virtual conference on 2nd October, where Smita will be giving a presentation. Click here for full details and tickets.
Up to 20% of new and expectant mothers experience a perinatal mental health (PMH) problem. Depression and anxiety disorders are the most common, affecting 15% of women. However, these figures pre-date the pandemic during which women and their families faced extra pressures on their mental health, including anxiety about giving birth during lockdown.
In January 2016, the Five Year Forward View for Mental Health outlined plans that led to an expansion of specialist community PMH services to work with women experiencing moderate to severe illness. In February 2019, the NHS Long term plan built on this commitment with the aim of ensuring that women in all parts of the UK have access to specialist community services and inpatient mother and baby units and extending service provision up to 24 months after birth. It is hoped that by 2023/24, at least 66,000 women with moderate to severe PMH difficulties can access care and support in the community. This will account for around 10% of women giving birth. However, some women experiencing difficulties may not disclose symptoms, others may not reach the threshold for referral to these services and even those that are referred may need continued support when they are discharged. Peer Supporters could provide crucial support to these women especially when integrated within universal services.
All women will be feeding their babies regardless of their mental health status and will have feeding assessments carried out by maternity and health visiting services and some will access peer support services for help with breastfeeding challenges or social and emotional support. What role do these services play in supporting the mental health and emotional wellbeing of mothers? A recent evaluation of the Camden Peer Support service showed that parents reported improvements in emotional wellbeing when receiving breastfeeding peer support even when this was only available via online groups and video calls. Peer support reduces social isolation which is a risk factor for mental ill-health and it also provides listening support and a safe space where women may disclose symptoms or talk through difficult birth experiences.
If feeding difficulties are playing a part (as is often the case) in how a mother is feeling, then resolving these issues may also be helping to prevent escalation of symptoms of anxiety and depression in new parents. But the often-complex interrelationship between infant feeding and perinatal mental health is frequently overlooked as services supporting each have developed quite separately from one another. There can be a perception in PMH services that breastfeeding will add unnecessary pressure and hinder recovery from perinatal ill-health, or staff may want to help protect breastfeeding when it is important for the mother to do so but lack the training and skills to enable this. Multi-disciplinary teams within PMH services now include 8 new roles including Perinatal Peer Support workers with lived experience of perinatal ill-health but there are no specialist or peer support roles that focus on Infant Feeding.
Perinatal Peer Support workers are also being recruited as part of Maternal Mental Health Services that are being set up to integrate maternity, reproductive health and psychological therapy for women experiencing mental health difficulties directly arising from or relating to the maternity experience. Support will be provided for PTSD following birth trauma, baby loss or fear of childbirth and pilot schemes are underway to build the evidence base and identify replicable models. Could this be an opportunity to pilot the impact of including access to specialist infant feeding and breastfeeding peer support within these services? Increasing numbers of women are living with the painful emotions that come with trying very hard to breastfeed but failing, usually due to lack of timely and consistent support. Any attempt to promote breastfeeding where so many have been failed by an inadequate system is like trying to cross a field littered with mines. Information will be perceived as judgement or pressure and any celebration of breastfeeding could re-trigger painful and traumatic memories. As there is a move towards implementing a more trauma-informed approach to care in the perinatal period, it is necessary to recognise that healthcare teams and peer support workers can potentially exacerbate their own birth and breastfeeding trauma histories when supporting families which can create unconscious bias. How do we build supportive structures for individuals providing care to those experiencing distress related to breastfeeding difficulties and perinatal mental ill-health? How do we diffuse the emotional land mines to make way for meaningful discussions about the need for investment in Infant feeding support and training across all services that women access in the perinatal period?
If you’d like to see Smita’s presentation (and much more!) at the BfN Conference on 2nd October, please click here for information and tickets:
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