Midwives' experiences of supporting women's mental health: A mixed-method study.

OBJECTIVE: To explore midwives' skills, knowledge and experiences of supporting women's mental health. RESEARCH DESIGN AND SETTING: This paper reports the second phase of a larger project, the 'Mothers' Mood Study', which recruited women and midwives to explore their experiences of perinatal mental health and service provision and focuses on midwives' experiences of supporting women with perinatal mental health problems. This paper reports on midwives' experiences through self-administered questionnaires and focus groups. Descriptive statistics were used to analyse questionnaire data and focus group data were thematically analysed. PARTICIPANTS: All midwives employed at one Health Board in South Wales UK, were eligible to participate. Recruitment took place between February and October 2018. Questionnaires were completed by 145 midwives and 15 attended one of three focus groups. FINDINGS: Questionnaire data showed the majority of midwives had cared for women with mental health problems, most commonly anxiety (95.0%, n = 138) and depression (87.0%, n = 127). Midwives assessed women's mental health informally by observing or asking questions about mood (99.3%, n = 144), anxiety levels (94.5%, n = 137), levels of support (91.0%, n = 132) and mental health history (95.9%, n = 139). The majority of midwives (82.8%, n = 120) indicated they would make some sort of mental health assessment at least 50% of the time. Around a third of midwives 31.7% (n = 46) reported receiving training relating to perinatal mental health in the previous two years, however only 21.4% (n = 31) of these suggested this had helped them in their practice. Three themes were generated from the focus groups, 1) Conversations 2) Support 3) Knowledge and skills. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A lack of time and continuity at appointments and a focus on physical health of mother and baby reduced the opportunity for conversations around mental health. In addition a lack of experience reduced midwives' confidence resulting in a low threshold for referring women to other services for support. Midwives' main concerns were a need for training on aspects of day-to-day practice and referral options to support women's mental health. A package of training to improved skills and confidence as well as a clear pathway of care will enable midwives to be better placed to support women's mental health.

Women's experience of mild to moderate mental health problems during pregnancy, and barriers to receiving support.

OBJECTIVE: To explore the experiences of women during pregnancy with mild to moderate mental health problems and describe the barriers to receiving support in relation to their mental health. RESEARCH DESIGN AND PARTICIPANTS: This paper reports part of a larger project which recruited women and midwives in one hospital in Wales. Participants completed questionnaires in early pregnancy in an antenatal clinic, and the characteristics of women with and without symptoms of anxiety and depression compared. All women were invited to express interest in a follow up interview in late pregnancy. Women identified to have depression and anxiety in early pregnancy, but not under the care of perinatal mental health services, were eligible for interview. Interviews were conducted with 20 women using a visual timeline to aid discussion and were thematically analysed. FINDINGS: In late pregnancy mental health disorders were reported by nine women, of which five were diagnosed during adulthood. EPDS scores found 15 women had symptoms of mild to moderate depression and GAD-7 scores indicating 15 women with mild to moderate anxiety. Three themes were identified: moods and emotions - past, present and future; expectations and control; knowledge and conversations. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Due to limited access to specialist perinatal mental health services women relied on support networks and self-care to maintain their mental health. More time and better continuity at antenatal appointments along with improved mental health literacy may increase discussions regarding women's mental health during pregnancy. In addition investment is required to develop strategies and improve access to mental health services for women with mild to moderate mental health problems.

Prevalence and predictors of poor mental health among pregnant women in Wales using a cross-sectional survey.

OBJECTIVES: To assess the prevalence of self-reported mental health problems in a cohort of women in early pregnancy. To describe the relationship between poor mental health and sociodemographic characteristics, self-efficacy and support networks. To assess if participants were representative of the local antenatal population. RESEARCH DESIGN AND SETTING: The UK government has pledged money to provide more support for women with perinatal mental health issues. Understanding the prevalence and predicting women who may need support will inform clinical practice. This paper reports part of the larger 'Mothers Mood Study', which explored women's and midwives' experience of mild to moderate perinatal mental health issues and service provision. Routinely collected population level data were analysed and a smaller cross-sectional survey design used to assess predictors of poor mental health in early pregnancy in one health board in Wales. PARTICIPANTS: Routinely collected data were extracted for all women who registered for maternity care between May 2017 and May 2018 (n = 6312) from the electronic maternity information system (pregnant population). Over a three month period 302 of these women completed a questionnaire at the antenatal clinic after an ultrasound scan (participants). Eligible women were aged ≥18 years, with sufficient spoken and written English to complete the questionnaire and a viable pregnancy of ≤18 weeks' gestation. The questionnaire collected data on sociodemographic status, self-efficacy and support networks, self-reported mental health problems. Current anxiety and depression were assessed using the General Anxiety Disorders Assessment and Edinburgh Postnatal Depression Scale. FINDINGS: Among the pregnant population 23% (n = 1490) disclosed a mental health problem during routine questioning with anxiety and depression being the most common conditions. Participants completing the detailed questionnaire were similar in age and parity to the pregnant population with similar levels of depression (15.6%; n = 15.6 v 17.3%, n = 1092). Edinburgh Postnatal Depression Scale and General Anxiety Disorder 7 scores identified 8% with symptoms of anxiety (n = 25) or depression (n = 26) and a further 24.2% (n = 73) with symptoms of mild anxiety and 25.2% (n = 76) with mild depression. Low self-efficacy (OR 1.27, 95% CI 1.12-1.45), a previous mental health problem (OR 3.95, 95% CI 1.37-11.33) and low support from family (OR 1.13, 95% CI 1.00-1.27) were found to be associated with early pregnancy anxiety and/or depression. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Around one in five women who register for maternity care may have a mental health problem. Mild to moderate anxiety and depression are common in early pregnancy. Services need to improve for women who do not currently meet the threshold for referral to perinatal mental health services. Assessment and active monitoring of mental health is recommended, in particular for pregnant women with risk factors including a history of previous mental health difficulties, poor family support or low self-efficacy.

Placental expression of imprinted genes varies with sampling site and mode of delivery.

UNLABELLED: Imprinted genes, which are monoallelically expressed by virtue of an epigenetic process initiated in the germline, are known to play key roles in regulating fetal growth and placental development. Numerous studies are investigating the expression of these imprinted genes in the human placenta in relation to common complications of pregnancy such as fetal growth restriction and preeclampsia. This study aimed to determine whether placental sampling protocols or other factors such as fetal sex, gestational age and mode of delivery may influence the expression of imprinted genes predicted to regulate placental signalling. METHODS: Term placentas were collected from Caucasian women delivering at University Hospital of Wales or Royal Gwent Hospital within two hours of delivery. Expression of the imprinted genes PHLDA2, CDKN1C, PEG3 and PEG10 was assayed by quantitative real time PCR. Intraplacental gene expression was analysed (N = 5). Placental gene expression was compared between male (N = 11) and female (N = 11) infants, early term (N = 8) and late term (N = 10) deliveries and between labouring (N = 13) and non-labouring (N = 21) participants. RESULTS: The paternally expressed imprinted genes PEG3 and PEG10 were resilient to differences in sampling site, fetal sex, term gestational age and mode of delivery. The maternally expressed imprinted gene CDKN1C was elevated over 2-fold (p < 0.001) in placenta from labouring deliveries compared with elective caesarean sections. In addition, the maternally expressed imprinted gene PHLDA2 was elevated by 1.8 fold (p = 0.01) in samples taken at the distal edge of the placenta compared to the cord insertion site. CONCLUSION: These findings support the reinterpretation of existing data sets on these genes in relation to complications of pregnancy and further reinforce the importance of optimising and unifying placental collection protocols for future studies.