Suicide remains the leading cause of direct maternal death in first postnatal year

Today, 11^th November 2021, MBRRACE-UK published their latest Confidential Enquiry into Maternal Deaths in the UK and Ireland.

The Saving Lives, Improving Mothers’ Care 2021 report investigates the deaths of women during or up to one year after pregnancy between 2017 and 2019. MBRRACE examines the reasons why each of the women died and what can be done to improve care in future.

Key maternal mental health findings

Mental health remains one of the leading causes of maternal death during pregnancy and the first postnatal year:^[1]

1. Maternal suicide is still the leading cause of direct (pregnancy-related) death in the year after pregnancy.
   
2. Almost a quarter of all deaths of women during pregnancy or up to a year after the end of pregnancy were from mental health-related causes.
3. Assessors felt that improvements in care might have made a difference in outcome for 67% of women who died by suicide.

The unequal impact of health inequalities

The report also highlighted remaining gaps in mortality rates between women from deprived and affluent areas, women of different ages and women from different ethnic groups:

1. Maternal mortality was more than four times higher for Black women, two times higher for mixed ethnicity women and almost twice as high for Asian women.
   
2. Women living in the most deprived areas are twice as likely to die than those living in the most affluent areas.
3. Women aged 40 or over had an almost fourfold higher maternal mortality rate compared to women aged 20-24 years.

New recommendations to improve perinatal mental health care

Many of the recommendations for health professionals and decision-makers from previous reports have yet to be fully implemented. On top of that, several new welcome recommendations have been made:

For policy makers and service planners, commissioners and managers

Pathways into specialist perinatal mental health care should be clear and explicit.

- All aspects of perinatal mental health provision, including specialist roles within midwifery and obstetric services, should be considered.

- Ensure perinatal mental health services do not exclude patients that would ordinarily be seen by general adult mental health teams.

- Ensure specialist services have the capacity to assess and manage all women who require secondary care mental health services and be able to adjust for the altered (generally lowered) thresholds for assessment in the perinatal period.[/su_spoiler]

For health professionals

Consider previous history, the pattern of symptom development and ongoing stressors when assessing immediate risk and management. Plans should address immediate, short-term, and long-term risks.

- If psychotropic medication has been discontinued before or during pregnancy, ensure women have an early postnatal review to determine whether they should resume.

- Where a woman with severe postnatal illness has previously responded well to treatment then there should be an expectation of a good recovery from subsequent episodes. Ensure that it is recognised that discharge from inpatient care before recovery is achieved is likely to be associated with continued risk.

- Relatives can provide invaluable support to the woman, but they should not be given undue responsibility or be expected to substitute for an effective mental health response.

- Women with substance misuse are often more vulnerable and at greater risk of relapse in the postnatal period, even if they have shown improvement in pregnancy. Ensure they are reviewed for re-engagement in the early postpartum period where they have been involved with addictions services in the immediate preconception period or during pregnancy.

Read the full list of all recommendations that need to be actioned

In response, MMHA Campaign Manager Karen Middleton said:

“We are deeply saddened by the latest report from MBRRACE-UK, which once again found maternal suicide to be a leading cause of maternal death.

“The fact that improvements in care might have resulted in a different outcome for 67% of women who died by suicide is particularly troubling and shows that addressing gaps in perinatal mental health care before, during and after pregnancy is both vital and urgent.

“The continuing impact of health inequalities was once again demonstrated very clearly and this needs to change. To save lives, we must ensure all women and families have equal access to essential perinatal mental health care.

“Whilst the key messages from the MBBRACE reports on maternal mental health are persistently similar year on year, we cannot forget the individual women and families behind these statistics.

“Despite investment in recent years, more is needed. This is an opportunity to act and deliver essential changes, so every woman has access to maternal mental health care, when and where she needs it.”

More information

For more detailed findings and commentary, download:

1. Full report
2. Lay summary
3. Infographic.

Visit our interactive Resource Hub for previous MBRRACE reports and other key perinatal mental health resources.

[1] Statistically, pregnancy remains safe in the UK and death during pregnancy and the postnatal period is rare (8.8 women per 100,000). However, this research exists to learn from every tragedy to make pregnancy safer and further improve care for women and families.