1 Feb 2009 | Perinatal & Maternal Mortality Review Committee
On this page you can view presentations from the one-day workshop 'Keeping Mothers Healthy: Improving Maternal Mental Healthcare in New Zealand', which was organised by the Perinatal and Maternal Mortality Review Committee with support from the Ministry of Health.
We like to think that all women welcome being pregnant, look forward to motherhood, and are well supported at this time. There is however, a considerable amount of evidence to the contrary.
Terminations are most commonly granted on the grounds of mental ill health in the mother. Domestic violence increases in pregnancy, Depression is common in pregnancy and these illnesses usually persist postnatally. Women with serious mental illnesses become pregnant and the associated risks are commonly overlooked. Mental health problems are common in women of childbearing age and can result in considerable morbidity and mortality. In addition women with mental health problems often receive less than optimal antenatal care.
For many years we have been aware of the close connection between childbirth and mental illness. In 1858 Louis Victor Marce wrote ‘Traite de la folie des femmes enceintes’ ‘A treatise on madness in pregnant women’ (Marce 1858) The increased incidence of serious affective disorder in the postpartum period has been documented for about 25 years. Enquiries into maternal deaths from the UK since 1997 have highlighted suicide as a leading cause of maternal death.
We know from the Confidential Enquiries into Maternal Deaths CEMD in the UK that women who kill themselves in the perinatal period generally have serious mental illness and have deteriorated rapidly. In the UK there are various recommendations for the care of pregnant women which have resulted from their findings. These include screening for psychiatric illness in a systematic and sensitive way at booking, and for those women who have a history of serious psychiatric disorder seeing a psychiatrist in pregnancy and developing a written management plan.
In New Zealand the Perinatal and Maternal Mortality Review Committee (PMMRC) has been established to review perinatal and maternal deaths and advise the Minster of Health on how to reduce the number of deaths. A Maternal Mortality Review Working Group (MMRWG), which reports to the PMMRC has been set up to review all maternal deaths and identify any areas of possible improvements in maternal care.
This process has highlighted the importance of attending to the mental health needs of women in pregnancy. We know that some pregnant women are at risk of severe mental health problems during pregnancy and the post partum period. In particular we need to identify women who are at risk of severe mental health problems at this time so that appropriate management plans can be developed. Women are seen by a number of health professionals at this time, but care can be fragmented for a variety of reasons. Communication pathways are sometimes unclear, and risks not clearly identified.
The aim of this Workshop is to highlight maternal mental health (and ill health) and decide what we could be doing at a national level to improve outcomes for women and their families. We need to answer some important questions for care of pregnant women in New Zealand.
We will only recognise problems when we have some plan to deal with them, and this workshop is to help raise awareness of mental illness associated with the perinatal period. We are extremely fortunate to have Professor Margaret Oates as a key note speaker. Professor Oates was a member of the UK Confidential Enquiries into Maternal Deaths.