Postnatal checks failing many
Thank you to everyone who told us about their experiences of maternal mental health care. Healthwatch England has analysed the responses shared by 2,693 new mothers and birthing parents since April 2020 and you can read the findings below.
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.
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 postanal 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.
Six-week postnatal checks
In April 2020, the Government introduced the six to eight-week postnatal check after Healthwatch England shared the experiences of almost 1,800 women on mental health during their journey to parenthood.
General practitioners in England have since been contractually obliged and paid to assess new mothers’ mental health and wellbeing, providing an opportunity for referral to specialist services and additional support. Crucially, the checks must take place separately from a postnatal check focused on the health of the baby.
The latest research took place between October and December of 2022 to find out to what extent mental health support has improved during and after pregnancy.
Experiences of mental health support during and post-pregnancy
- 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.
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.”
Recommendations
Healthwatch England has made five recommendations to help ensure every new mother and birthing parent receives the six-week check, and that it is of the highest quality:
- 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.
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