Midwives’ experiences of caring for women’s emotional and mental well‐being during pregnancy

Abstract

Aims and Objectives To explore midwives’ experiences of caring for women's emotional and mental well‐being during pregnancy. Background Transitioning to motherhood is a major life event for any woman and while it is a joyful experience for the majority, 15%–25% of women will experience a perinatal mental health problem. Providing psychological support to mothers by midwives is acknowledged internationally. The 2016 Irish National Maternity Strategy identifies midwives as being ideally placed to assess women's emotional needs. The research revealed a paucity of qualitative research from an Irish context in this area; therefore, this study addressed this gap in the literature. Design Qualitative descriptive design. Methods Semi‐structured interviews were conducted with a purposive sample of 10 midwives recruited from the Irish midwifery e‐group. Data were analysed using Burnard (Nurse Educ. Today, 11, 1991, 461) thematic content analysis. Transcripts were coded, and meanings were formulated to reflect significant statements, which were categorised. Categories were then evolved into subthemes, and eventually, three themes were emerged using the COREQ checklist. Results Three salient themes emerged from the data are as follows: ‘awareness of Perinatal Mental Health’, ‘discussing emotional well‐being’ and ‘the woman has something to divulge’. The themes convey the midwife's awareness, recognition and perceptions of mental well‐being during pregnancy. How midwives discuss and assess emotional well‐being, the observational skills they use, and what they perceive as the barriers and facilitators to discussing mental well‐being were all identified. Conclusions Midwives reported an awareness and acceptance that women's emotional health was as important as their physical health. Midwives used every antenatal opportunity to raise awareness about perinatal mental health, whilst also identifying key challenges in getting women to talk. Relevance to Clinical Practice Care pathways for assessing and identifying Perinatal Mental Health issues should be available in all maternity services. More support for midwives is required to debrief, which would assist them in supporting women's emotional well‐being.

Midwives’ descriptions of strategies and requirements when following up pregnant women at risk of developing perinatal depression - a qualitative study

“…Our findings on security and work experience are supported by, among other things, the study by Fontein-Kuipers et al (35) in which midwives cited work experience as their most important source of knowledge when it came to mental health. This is consistent with Fletcher et al (9), who also found a clear connection between work experience and midwives' self-confidence, as well as their ability to detect and deal with women with antenatal depression. This is also supported by Ross-Davie et al's (36) study which concluded that midwives felt that their education prepared them too little for addressing mental health versus physical health in pregnancy.…”

“…Lack of time is often reported as a problem when it comes to addressing mental health (28). Several studies show that a lack of time can prevent sensitive topics from being addressed (9,10,34) which was also confirmed by the midwives in our study. Higgins et al suggest that role-playing games and digital tools can be used to develop midwives 'skills in opening up conversations, as it is challenging to bring up sensitive topics in a short time and at the first meeting with a patient (10,34).…”

“…Yazici et al found that up to 92% of women with untreated depression in pregnancy developed postpartum depression, compared to those who received treatment for their depression (8). Given such a high risk for pregnant women with undiagnosed or untreated depression, studies from Fletcher et al (9) and Higgins et al (10) highlight that midwives in antenatal care lack training and experience in mental health during pregnancy. The same need for knowledge is also demonstrated by midwifery students, as the subject of mental illness during pregnancy does not occupy a prominent place in the midwifery curriculum (11,12).…”

The midwife's support during transition to motherhood: A modified Delphi study among care providers and childbearing women

“…The findings suggest that this can only occur when the midwife can base support on both professional knowledge about the transitional process (education) and the experiential knowledge of the woman [5, 49]. The midwife also has to regard maternal emotional health as equally important as physical health [8, 53–55]. Our findings also show that the midwife needs to be empathic and emotionally mature to provide support to women in adapting to the maternal role and identity during and after pregnancy.…”

RAPID-2 study protocol: a cluster randomised feasibility trial of a midwife facilitated intervention for pregnant women with symptoms of mild to moderate anxiety

“…Non-pharmacological interventions developed specifically for pregnant women with anxiety symptoms are promising, although interventions have not been evaluated in definitive trials 21–26. In England, midwives provide care for all women throughout pregnancy, thus midwives are ideally situated to identify mental health concerns and support women’s emotional and psychological well-being 20 27 28…”