Maternal health and wellbeing in the perinatal period

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Principal investigator: Maggie Redshaw (NPEU (Former member))
Collaborators: Ingrid Rowlands (Queensland Institute of Medical Research, Brisbane, Australia)
Topics: Antenatal care, Labour and delivery, Mental health and wellbeing, Women's experience of maternity care
Funder: DH - Policy Research Programme
Start year: 2010
End year: 2013

Summary

Identifying which groups of women experience poorer physical and mental health and understanding which factors are most likely to influence outcomes has implications for practice and will enable midwives and other health professionals to better support women during pregnancy and after childbirth.

Physical and psychological problems before and after childbirth are common, and may have a significant negative and long-term impact on women's wellbeing and daily functioning. Several studies have been carried out on maternal mental health and psychological wellbeing using the 2010 National Maternity Survey data from more than 5000 women with the aim of better understanding the factors associated with poorer and better mental health.

A study of postnatal psychological symptoms associated with different types of delivery was undertaken. Multinomial logistic regression models were used to examine the association between women's self-reported psychological symptoms, health problems and mode of birth.

Key findings

Women who had forceps-assisted vaginal births and unplanned caesarean section births reported the poorest health and wellbeing.
The risk of reduced postnatal health and wellbeing was higher amongst the women who had forceps-assisted vaginal births but not amongst women who had ventouse-assisted vaginal births.
Those women who had unassisted vaginal births and planned caesarean section births were less affected by the birth process.
For most women their physical and emotional health appeared to improve with time, however, those who had a forceps-assisted vaginal birth were more likely to report ongoing posttraumatic-type symptoms several months after the birth.

It was concluded that mode of birth was associated with differences in outcomes at three months postpartum. This would suggest that it is important to differentiate the different types of instrumental delivery relative to the other modes of birth and that women who have forceps-assisted births should be monitored carefully by health professionals in the months after childbirth and checks made on their wellbeing.

Maternal mental health in pregnancy was also the focus of two other quantitative studies utilising the same data set. The first study aimed to investigate factors associated with experiencing antenatal depression and developing subsequent postnatal depression.

Key findings

Risk factors for antenatal depression were multiparity, black and minority ethnic (BME) status, physical or mental health problems, living in a deprived area, and unplanned pregnancy.

Different factors for postnatal depression were evident among women who had experienced antenatal depression: being multiparous and BME status were protective, whereas being left alone in labour and experiencing poor postnatal health increased the risk of postnatal depression in this group.

The study confirms previous research on risk factors for antenatal depression, stressing the importance of continuous support in labour and vigilance in the postnatal period regarding the potential ill effects of continued postnatal health problems.

Identifying which groups of women experience poorer physical and mental health and understanding which factors are most likely to influence outcomes has implications for practice and can enable midwives and other health professionals to better support women during pregnancy and after childbirth. A further study has been carried out on women experiencing anxiety in the antenatal and postnatal period.

Although a degree of anxiety is normal in pregnancy, for some women it can become a serious problem. This study also used the 2010 National Maternity Survey data on antenatal and postnatal health and well-being.

Key findings

Antenatal anxiety was reported by 14% of women and postnatal anxiety by 5% of women
Antenatal anxiety was associated with younger age, Black and Minority Ethnic status, single parenthood, living in a disadvantaged area, having an unwanted pregnancy and long-term health problems.
Of these factors, only long-term mental health problems were associated with anxiety in the postnatal period.
In the logistic regression models long-term mental health problems dominated the findings.
Significant differences in the perceptions of the care experienced were evident in the responses from women with anxiety during pregnancy and postnatally.

In summary the study showed that antenatal and postnatal anxiety are influenced by health and social factors. Asking women about their current physical and psychological health and past history during pregnancy and following up on their well-being in the postnatal period is essential in targeting and planning care to meet their needs.

Publications

Journal Articles