How Can Midwives Develop Their Support Skills for Women with Mental Health Needs during the Antenatal Period? An Action Research Study

Abstract

Context and Background: Pregnancy and childbirth is a time of great physiological, emotional and social change; when mental health difficulties can emerge or intensify, and impact negatively on obstetric outcomes. Currently in Ireland, there is a lack of perinatal mental health services for pregnant and postnatal women attending maternity services; however, midwives are ideally positioned to identify and support women with perinatal mental health difficulties.

Aim: The overall aim of this research was for midwives to develop their self-identified and expressed skills in supporting women with mental health needs during the ante-natal period, through creating a communicative space for dialogue and collaboration.

Research Methodology: An Action Research approach was used incorporating Action Research Cycles of constructing, planning action, taking action and evaluating action, in an urban tertiary referral maternity hospital with access to a perinatal mental health service. Three co-operative enquiry meetings with participating midwives (n=7) took place over a period of four months from March – June 2014. Data were analysed using thematic content analysis.

Key Findings: Participating midwives developed awareness of identifying and supporting women with perinatal mental health needs during pregnancy. Data suggest that core skills, such as decision making, listening skills and problem solving, increased midwives’ confidence to support women. Findings led to the development of an algorithm/referral pathway to services, and screening, incorporating ‘open ended’ questions, to promote conversations with pregnant women about mental health. Midwives reported that open questioning about perinatal mental health enhanced collaboration between women and midwives and potentially facilitated more accurate detection of mental health difficulties than using standardised self-reporting screening tools alone.

Conclusion: Midwives as key stakeholders in the provision of routine antenatal care, when presented with the opportunity to develop their skills, identified specific areas for further training in listening, problem solving, and decision-making in managing perinatal mental health.