Leading change

Two midwifery support workers in the community midwives team at Northern Lincolnshire and Goole NHS Foundation Trust developed a one to one antenatal and postnatal support service for mental health, which has improved the outcomes and experiences of women throughout their pregnancy and postnatally.

Where to look

The midwifery support workers identified that many women were disclosing anxieties around pregnancy or their mental health as early as their 8 week booking appointments. On researching perinatal mental health, they found there was unwarranted variation in the provision of specialist perinatal support in North East Lincolnshire, which was minimal in comparison to other areas of the country. Women told them they were seeking more regular support than the midwives could offer and the other options of support from their General Practice (GP) and self-referring counselling service did not meet their needs. Women often would see different midwives at appointments which reduced their experience of continuity of care and reported feeling they didn’t want to repeat their concerns.

What to change

Midwifery support workers had always offered a one to one service to parents but focused on parent craft, baby care and breastfeeding support. When going out to parents in the community, it was noticed that there was a need for a mental health service alongside that of parentcraft. The midwifery support workers identified there was a need for one to one support in the community.

Women fed back to them that they felt rushed in their 15-minute antenatal appointment and didn’t feel they had the time with the midwife to explain their thoughts and feelings in that short time period. They would often not disclose their thoughts and feelings as they wanted to prioritise their baby’s health. Also, a high number of calls were received from women, often asking questions around medical terminology or about their thoughts and feelings about themselves or their baby they had not raised with the midwife. Anxieties would also build between appointments.

How to change

The two midwifery support workers approached their manager to ask if they could take on a leading role in perinatal mental health. Once permission was received from the manager and Trust, they researched perinatal mental health and undertook free distance learning courses from a local college in understanding mental health conditions and counselling skills to enhance their active listening skills. A ‘Perinatal Mental Health Champions’ course was also undertaken so the midwifery support workers could train colleagues in perinatal mental health awareness. The two midwifery support workers teamed up as ‘buddies’ to provide a one to one antenatal and postnatal support service for mental health.

Midwives refer women to the service which begins with a telephone consultation, introducing themselves, learning a brief history and gaining an understanding of what support is required. The women are all offered one to one support. The midwifery support workers phone women regularly and offer home visits to listen and signpost to relevant health professionals if needed. If women are identified at the time of booking their first antenatal appointment as possibly needing the service, they are contacted by the midwifery support workers to ask if they would like their input.

The midwifery support workers assist women through their pregnancy and for 28 days postnatally. Regular phone calls and home visits are documented and updates provided to appropriate health professionals. It aims to support women and their families as early as their first antenatal appointment to prevent any negative experiences and anxiety around pregnancy from building up into something more serious such as postnatal depression, postpartum psychosis or post-traumatic stress disorder.

Adding value

Better outcomes – Within a few months of the service being set up, the referrals to the midwifery support workers doubled and were received from health visitors, social workers and specialist midwives as well as women phoning and asking for the midwifery support workers. This has meant more women are receiving support.

Better experience – An evaluation care form is currently being developed but feedback from women and their families has been very positive. The one to one service has improved experiences during pregnancy and around birth. Women have access to a named midwifery support worker and feel comfortable ‘opening up’ and asking any questions they may have without having to keep retelling their personal situation. Feedback has included: “Thank you for making my birth experience better than I could have ever imagined. I am really grateful for all of your help and support”.

Better use of resources – The one to one service has reduced pressure on midwives in the antenatal appointments as the midwifery support workers have developed the capability and capacity to provide one to one mental health support. There are now 8 midwifery support workers and a perinatal mental health midwife trained to provide the one to one antenatal and postnatal support service. Each midwifery support worker has a day allocated each week to enable visits and phone calls to be planned accordingly.

Challenges and lessons learnt for implementation

• Documentation takes time but is crucial to maintain updated records at every contact;
• It is hard work in the beginning; working and training at the same time. Perinatal mental health is an important wide-reaching issue, the more health professionals become aware of signs and symptoms and how to care for people, the more of a positive outcome it will have.

Find out more

For more information contact:

• Emma Gibney, Perinatal Nursery Nurse, emma.gibney1@ntlworld.com
• Emma Hanson, Advanced Health Care Assistant, emma.hanson@nhs.net