Today the latest UK Confidential Enquiry into Maternal Deaths has been published by MBRRACE-UK.

This year the report – Saving Lives, Improving Mothers’ Care 2018 – examines in detail the care of women who died during or up to one year after pregnancy between 2014 and 2016 in the UK and Ireland from mental health conditions, blood clots, cancer, and homicide, and women who survived major bleeding.

Maternal suicide is the fifth most common cause of women’s deaths during pregnancy and its immediate aftermath, and the leading cause of death over the first year after pregnancy.

The report states that “there is now greater awareness of the importance of mental health during pregnancy and in the first year after birth. But there is still a long way to in recognising symptoms, supporting women with mental health problems and providing access to specialist perinatal mental health care.”

Maternal deaths are not evenly spread across the population. Black women are five times and Asian women two times more likely to die as a result of complications in their pregnancy than white women.

In response, Dr Alain Gregoire, Chair of the Maternal Mental Health Alliance said:

“The human tragedies described here emphasise the urgency of addressing the gaps in perinatal mental health care in pregnancy, postnatally and pre-conceptually.

The enquiry shows that maternal suicide is the fifth most common cause of women’s deaths during pregnancy and its immediate aftermath, and it remains the leading cause of death over the first year after birth.

Alongside improvements in specialist mother and baby mental health services – that are becoming evident in England and Wales, women need professionals in all services to be as interested, knowledgeable and skilled in mental health care during maternity as they are in their care of women’s physical health. Women and babies also need services to work together and to have the capacity and resources to provide routine detection, prevention and treatment, and crisis care, all of which are needed to ensure care is both effective and safe.”

Read the full report on the MBRRACE-UK website.

This month the MMHA published the final report for our  Mums and Babies in Mind project (MABIM). The project supported local commissioners and providers to improve services and pathways for mums with perinatal mental health problems and their babies.

MABIM took a whole-system approach, working with professionals from a range of disciplines not only to improve services, but also to create local pathways and partnerships, which are essential to ensure that all women experiencing perinatal mental health problems get the right support at the right time.

The final project report describes the activity that took place through the MABIM project and its reach and impact. This is accompanied by a more detailed evaluation report produced by Professor Susan Ayers and her team at City University. Both reports demonstrate that MABIMwas very well received and seems to have resulted in positive changes to local services and care pathways. They contain useful messages about barriers and enablers to local progress in tackling perinatal mental illness.

You can view the final report here and the evaluation report here.

Sally Hogg attended the Marce Society 2018 Biennial, to share learning and gain insights into global best practice in maternal mental health.

It was an absolute privilege to attend the International Marce Society Biennial meeting in Bangalore last week. The meeting brought together over 500 delegates from 31 countries to discuss the latest science and practice in protecting and promoting maternal mental health. I was there to share learning from the MMHA Mums and Babies in Mind Project, alongside trying to capture useful insights for those at home.

This was the first time that a Marce conference had been held in the Global South. The conference really opened my eyes to the challenges facing Low and Middle Income countries where the vast majority of the world’s babies are born, the prevalence of perinatal mental health problems is particularly high, and there are fewer resources to support families. The conference chair, Jane Fisher, powerfully reminded us that enabling mothers to be healthy is key to enabling children, and therefore societies and economies, to reach their full potential and thrive.

The conference was held in the National Institute for Mental Health and Neuroscience (NIMHANS) in Bangalore, which is a large mental health hospital and academic centre. NIMHANs has a 5 bedded Mother and Baby Unit, which is the only unit in a country where 26 million are babies born each year. The facilities were, in many ways, basic compared to the UK. But there was much that we could learn from them: The MBU had beds for a family member to stay with women (albeit only for female relatives – not dads or male partners). There was a strong multidisciplinary team including lactation support, which was particularly interesting to me, as we have recently done some work about the need to improve breastfeeding support and advice for mums with severe mental illness. NIMHANs hospital – including the MBU – incorporates yoga into the care they provide to patients. I was sorry that due to the full conference programme, I didn’t get a chance to learn more about the use of yoga.

It was a very full conference, with three long days of high quality presentations and discussions. As is often the case at events with many parallel sessions, it was hard to choose what to attend. I focussed on presentations which had clear implications for policy and practice, which meant I missed a lot of interesting stuff about the biological determinants and mechanisms of mental health problems.

So what were my highlights and take home messages from the presentations and symposiums I did attend?

I was challenged by a symposium chaired by Susan Ayers that really brought to life the complexities and limitations of screening.

I was excited by Jane Fisher’s launch of the new WHO nurturing framework which I think provides a useful way to talk about early child development with policy makers.

It was heartening to see that the UK is one of the countries that is leading the way in the provision of specialist community and inpatient services. Our campaigning is inspiring others too – we heard about maternal mental health alliances developing in Canada and Africa and of people considering how to replicate our powerful maps of provision, and there was regular use of the #everyonesbusiness message.

I was encouraged to hear about how services were being designed with implementation and scaleability in mind: Maria Muzik discussed the co-production of the MomPower intervention, and Heather Rowe described research with parents, providers and policy makers to inform the development of support for new parents.

Birth trauma was a recurring theme in the conference. As Evita Fernadez described in a plenary, “the way in which we give birth has major implications for women’s future health and that of their babies” and yet there is a “crisis in childbirth” with many women experiencing traumatic births in India and around the world. Evita spoke encouragingly of the tide starting to turn thanks to powerful campaigns to harness womens’ voices and to global recognition of women’s rights to respect, support and choice in their birth, by organisations such as the World Health Organisation. In another plenary, Jon Cox prize winner Bryanne Barnett called on professionals to gain an in-depth understanding of the current and past experiences of women, including recognising and respond to both the physical and mental harms that result from traumatic birth. In a great symposium on birth trauma, Susan Ayers discussed evidence that positive support during birth can buffer against stressful events, whereas a lack of support or interpersonal difficulties increase risk of PTSD. Pauline Slade presented the Straw-b self-help tool which contains information and psychological exercises for women at risk of PTSD. And, in perhaps the most surprising study of the conference, Antje Horsch, showed that women who play tetris for 15 minutes in the 6 hours following an emergency c section are less likely to develop PTSD (which is thought to be because visuo-spatial tasks can change the way in which therefore reduce the likelihood of intrusive memories.)

Whilst the conference showcased a wealth of fantastic practice, we were constantly reminded that the majority of women in the world who are experiencing perinatal mental health problems are not getting support. It wasn’t all doom and gloom however. There were a number of examples of innovations which could enable more women to access evidence based support: Atif Rahman shared the evidence of the impact of the Thinking Healthy (CBT based) intervention which has had a proven impact on women’s mental health in LMIC countries when delivered by community health workers or peer supporters.

Cerith Waters shared how his stretched service in Wales had developed a Perinatal Play and Development group, which enabled the service to have more contact with women. The 6 week group includes mindfulness, psychoeducation and elements of watch, wait and wonder.

Finally, a number of speakers from Australia, including Jeannette Milgrom and Jane Fisher showcased digital interventions which could drastically improve the reach of services. We were reminded that 63% of the population in low and middle income countries have a smart phone (something that was clearly on show when out and about in Bangalore!).Siobhan Loughnan shared positive results from use of a short, three session perinatal iCBT intervention called MUMentum, which can be used as self-help or as an adjunct to face-to-face support. Jeannette and Jane spoke about  the Mumspace website, which hosts a range of universal, targeted and specialist interventions (including the Baby Steps, Mind Mum MumMood Booster apps) and the What Were We Thinking intervention, which helps parents to learn about caring for their baby (including crying, soothing and sleep) and about their journey as parents  (including their relationship) through a group based seminar for parents, website, app and moderated peer-to-peer blog, all supported by a training programme for maternal and child health nurses (equivalents of our health visitors)  .

There were some things missing from the conference. The audience was largely health professionals or academics. I felt that the input of community or charitable organisations was missing, and I didn’t see much on place-based and whole system approaches.

But overall it was a fantastic three days. I left feeling that although there is a huge amount to do, but there is lots of valuable work to learn from, and in the UK we are privileged to have opportunities to put this learning into practice.