A new Rapid Response report from Mothers and Babies: Reducing Risk Through Audits and Confidential Enquiries across the UK (MBRRACE-UK) investigates maternal deaths in the UK related and associated to SARS-CoV-2 (COVID) during May-August 2020.
Overall, 16 women died during the perinatal period in the three months covered by this report:
- Four died by suicide
- Ten with COVID or COVID-related complications
- Two because of domestic violence
- Seven (88%) were from black and minority ethnic groups.
Context: how services responded to the pandemic
Health services, including maternity and perinatal mental health, were advised to plan and prepare for staffing levels of between 20-80%.
In some cases, service changes were dramatic, including for specialist perinatal mental health, community midwifery and health visiting. As plans were led by local teams, there was variety throughout the country, with different services being deemed “essential”.
The impact on perinatal mental health care
With regards to the four women who died by suicide, MBRRACE-UK said: “changes to service provision as a direct consequence of the pandemic meant that women were not able to access appropriate mental health care.”
Sadly, they also suggest that “receipt of the specialist care they needed may have prevented their deaths.”
Recommendations for perinatal mental health and maternity care
Responding to the evidence and learnings from this report, MBRRACE-UK make several new recommendations. These are particularly important in the context of planning for a potential ‘second wave’:
- Establish triage processes to ensure that women with mental health concerns can be appropriately assessed, including face-to-face if necessary, and access specialist perinatal mental health services in the context of changes to the normal processes of care due to COVID-19.
- Repeat referrals for mental health concerns should be considered a ‘red flag’, prompting a clinical review, irrespective of usual access thresholds or practice.
They also reiterate recommendations from their previous reports which are still relevant (see page 11 for the full list).
The need to protect women with multiple disadvantages, who are over-represented amongst women who die during pregnancy and postnatally, remains of critical importance.
Learning from this tragic loss
As MBRRACE-UK states in this report, “perinatal mental health care is as essential as other aspects of maternity care”. We urge decision-makers to learn from the tragic findings contained in this report and PLAN for the mental as well as physical health needs of women and their families, including protecting the perinatal mental health workforce.
Those struggling with their mental health during pregnancy or early parenthood should be encouraged to ask for help as soon as possible. Health services, including specialist perinatal mental health, Mother and Baby Units and maternity services remain open and guidance for new and expectant mums is available.
We must ensure pregnant and postnatal women, their families, and babies receive the care they need during and beyond the pandemic.
Our thoughts are with the friends and family of the women who lost their lives.