Discuss generic physical health, mental health and wellbeing using ASK, ADVISE and ACT Model. Normalise conversations about planning for pregnancy during routine visits and provide advice for optimal preconception health. Signpost to local services where they can get further help.
Mental health problems in the perinatal period are very common, affecting up to 20% of women. Examples of these illnesses include antenatal and postnatal depression, anxiety, obsessive compulsive disorder, post-traumatic stress disorder and postpartum psychosis. Perinatal mental health problems occur during the period from conception to the child’s first birthday. Untreated perinatal mental health problems affect maternal morbidity and mortality, with almost a quarter of maternal deaths between 6 weeks and one year after pregnancy attributed to mental health related causes; 1 in 7 maternal deaths during this period were by suicide.
Refer individuals with suspected or known severe mental illness to a secondary mental health service, preferably a specialist perinatal mental health service, for assessment and treatment.
Integrate stepped care involving maternity, health visiting and general practice as not all women will meet the threshold for specialist services but may require additional support with their emotional and mental health.
Ensure a collaborative care planning approach is embedded in your workforce to safeguard equitable access across operational mental health pathways that improves the wellbeing of people with a mental illness and reduces mental health inequalities.
Frontline staff have the skills and ability to be confident and competent in recognising signs of signs of mental distress and ability to appropriately support people to improve their mental health, including referral to mental health services.
Invest in perinatal mental health services, including preconception care, community outreach clinics and specialist services to achieve a green map of services available across all areas in England.
Familiarise yourself with the UK Chief Medical Officers’ guidelines on the amount and type of physical activity people should be doing to improve their health.
Ask all women and their partners: ‘Are you drinking at the moment?’ Identify their response according to alcohol guidelines, provide brief advice and signpost to information and support if necessary.
Encourage women to abstain from alcohol use during pregnancy and where necessary referring to further, specialist, support (including specialist clinical support to withdraw from alcohol).
Ask about illicit drug and medicine misuse, providing information, advice, help and referral into specialist treatment where indicated. If you remain in contact with a patient who has reported using drugs, review their drug use at each session.
Complete the misuse of illicit drugs and medicines e-learning session. This brief interactive e-learning has been developed to increase the confidence and skills of health and care professionals, to embed drug misuse prevention in their day-to-day practice.
Support referrals into and engagement with specialist alcohol and drug treatment services. You can find details of your patient’s nearest specialist alcohol or drug treatment service by going to the FRANK website and searching using their postcode.
Provide all women with a problem with alcohol or drugs, they should be given the name and phone number of a midwife or doctor who has special experience in the care of pregnant women with alcohol or drug problems. They should be put in touch with an alcohol or drug treatment programme.
Offer Bacillus Calmette-Guérin (BCG) vaccination to all babies up to 1 year old who have a parent or grandparent who was born in a country where there is a high rate of TB.
Collaborate and work across boundaries to address complex needs, including flexible commissioning and supporting the third sector. Ensure to include agencies that provide housing and other community services to enhance care for women living in complex circumstances. Involve local community leaders, third sector organisations and lay groups, including the Maternity Voices Partnership, to actively co-produce the design of universal and speciality services will ensure they are accessible, acceptable, appropriate and not stigmatising.
Audit local outcomes using national indicators such as ethnicity, language status, country of birth and migrant status to drive changes to services in order address areas of greatest local need.