Are mental health problems in new mothers being missed?

New findings from NCT (National Childbirth Trust), a charity which supports new parents, and Netmums, have shown that 47% of new mothers who have recently given birth get less than three minutes or no time at all to discuss their mental and physical health at their six week postnatal check. A quarter of mothers were not asked about their emotional or mental health during the appointment.

At six weeks after giving birth, most new mothers see their GP for a postnatal check-up which is often the last routine appointment they have which focuses on them rather than their baby. Some women experience excellent care at their six week check which reassures them about their own health and gives them the tools they need to handle life as a new mother. However, other women feel rushed and unable to discuss their well-being.

In summer 2017, NCT surveyed 1,000 women who had recently had a baby, finding that half had experienced a mental health or emotional problem during pregnancy or after giving birth. Of these, almost half said that their mental health problem was missed by a healthcare professional and thus they hadn't received any treatment or support. 95% of the women who had a mental health problem said it impacted their ability to cope as a new mother.

Currently, GPs have to fit the six week check into their workload and they do not receive any extra payment for carrying out the check. One mother described the appointment as a 'tick box exercise'.

As a result, two thirds of mothers were found to have had their six week check squeezed in with checks on their baby, with most or equal amounts of the appointment focused on the baby. 31% of the women surveyed had three minutes or less for their maternal check. 16% of mums had no time to talk about themselves at all as the whole appointment focused on their baby. A mother of two from Kent said: "I think the time slot given for the postnatal checks is too short and you are rushed and made to feel a burden."

As well as short appointments, the findings showed that women are also not being asked the right questions at their appointments. A quarter of mothers were not asked about their mental health at all. Half of mothers who were experiencing an emotional or mental health problem that they wanted to discuss did not feel able to, either because of time constraints or believing that the healthcare professional would not be sympathetic. Two thirds of mothers with an emotional problem they didn't disclose said they were embarrassed, ashamed or worried that the healthcare professional would think that they weren't capable of looking after their baby.

As a result of their findings, NCT launched their #HiddenHalf campaign aiming to draw attention to the lack of support for new mothers struggling with their mental health. They have released recommendations to those who work with new mothers to open up discussions about emotional well-being and provide resources to those who need them.

Among the recommendations, NCT is pushing for full funding of the six week postnatal check so that GPs have time to give each mother a full and focused check. They are also calling for more resources and training to be provided to GPs so they understand maternal mental health problems including postnatal depression and know which questions to ask to open up a conversation about emotional well-being.

"Many new mums don't find it easy to admit they are struggling so it's impossible to make them feel comfortable enough to discuss their concerns in less than three minutes," said Sarah McMullen, Head of Knowledge at NCT. "It's vital mothers are given adequate opportunity to discuss any health problems to prevent them from getting worse. If they aren't given the support they need at this crucial time it can have a devastating impact on the whole family."

Official NICE guidelines already encourage doctors to ask about emotional well-being and spot mental health problems but greater awareness of the benefits of the six week check for mothers could make this practice more widespread, suggest NCT.

Taking the time to talk with mothers about their mental health is a valuable part of postnatal care, says Dr Stephanie de Giorgio, a Kent GP. "As a GP who's looked after postnatal women for years, I know many of them can find it difficult to talk to us for all sorts of reasons. Dedicated time for them is vital so we can find out who is struggling and let them know how to seek help if they start to find things too difficult.

"The only way that health professionals are going to be able to do this is if the government and NHS England agree to fund an appointment solely for new mothers."

Anyone who is concerned about their mental health, including new mothers, can self-refer to NHS services and support through Patient Access.