Mental health first aid, trauma and the perinatal period
Sally Hogg is the Strategic Lead of the Mums and Babies in Mind project
This year’s World Mental Health Day focuses on psychological first aid – the support that we offer people who experience trauma, crises and distress.
There are two aspects to psychological first aid during the perinatal period (which we define as pregnancy and the year after birth). One element of first aid is to provide a woman who experiences traumatic events with warm help and support to promote and protect her emotional wellbeing. The second is to respond quickly when a woman experiences a mental health crisis to ensure that she gets the care she needs.
Reducing the impact of trauma for new mums
Sadly, women and their families can experience traumatic events in the perinatal period, such as traumatic birth or the loss of a baby. Women can also find less objectively traumatic events – such as an inability to breastfeed – very upsetting and detrimental to their mental health. Obviously we would hope that these traumas could be avoided – and many can – but when they do occur, it is important that a woman’s mental health is well looked after. The long-term impact on a woman’s mental health is determined as much by how she experiences an event, and the reactions and responses of others, as the objective facts about the event itself.
In her Mums and Babies in Mind blog, Josephine Harrison, a clinical psychologist and psychotherapist based in Haringey, talks about the experiences of mums who have had a traumatic birth:
"Many women face shock and the loss of what could have been a positive experience of welcoming their child to the world. Often, early bonding can be hindered because the mother cannot breastfeed straightaway due to medical treatment or she is in distress, so that she is less able to care for and enjoy her baby."
In the worst cases, a traumatic birth can trigger post-traumatic stress disorder (PTSD), which affects between 1% and 5% of new mothers. Symptoms of postnatal PTSD can include flashbacks; intrusive memories and nightmares; feelings of terror; avoidance behaviours and hypervigilance.
PTSD can be prevented through realistic preparation for birth, and trusting, sensitive relationships and clear communications during labour. Women who have had a traumatic birth can benefit from the chance to describe and ask questions about their birth.
Mental health crises in the perinatal period
We know that new mothers are more at risk of mental health crises and admission to inpatient psychiatric services in the first weeks after birth than people at any other stage in their life. Postpartum psychosis is a severe, but treatable, form of mental illness that occurs in the weeks after having a baby and affects around 1 in 500 women. It can come on very quickly and the symptoms can be very severe, so it should be treated as a medical emergency.
In the Maternal Mental Health Alliance, we are campaigning for specialist perinatal mental health services and in-patient mother and baby units, which can undertake preventative and early intervention work to reduce the incidence and impact of postpartum psychosis, as well as providing specialist care quickly for women who do get ill. Sadly many areas of the country do not have these services in place – but things are improving, and we’ve been pleased to see new investment from NHS England.
Taking the long view on trauma
Psychological first aid is an important aspect of dealing with trauma, but sadly trauma isn’t something that can be dealt with quickly - sometimes its effects can last a lifetime. Women who have experienced birth trauma or loss are likely to need additional support with subsequent pregnancies and births. There are some excellent services that provide this support but sadly these services aren’t available everywhere.
Traumas that women have experienced at other times of their lives can also affect them in the perinatal period. Elsa Montgomery at Kings University has written about how pregnancy and birth can be traumatic for women who have experienced child sexual abuse, and how the situation can be made worse by care providers.
One of our Mums and Babies in Mind sites, Blackpool, is developing a trauma informed approach to care for women and their babies, with services such as the Survivor Mums Project, which help women who have experienced trauma to prepare for and cope with pregnancy and birth.
To conclude, psychological first aid is a critical aspect of perinatal mental health care, and it is important that professionals – particularly those in universal services – understand how to support women who experience trauma and mental health crises. How we respond to these events can have long-term consequences for women and their babies. But psychological first aid refers only to a moment in women’s lives, and we know that a comprehensive response to mental health looks right across the whole life course.
Perinatal mental health services must also work to prevent trauma and crises, and to provide care and treatment which reduces the impact of mental health problems on women and their families, now and in the future.