Maternal Mental Health
(3 years, 9 months ago)
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Mr Laurence Robertson (in the Chair)
I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will also be suspensions between each debate. Members participating physically and virtually must arrive for the start of Westminster Hall debates and are expected to remain for the entire debate. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. Members attending physically are asked to clean their spaces before they use them and before they leave the room.
Sarah Olney (Richmond Park) (LD)
I beg to move,
That this House has considered maternal mental health.
It is a real pleasure to serve under your chairmanship, Mr Robertson, and indeed to have Members participating virtually in this afternoon’s debate. Maternal mental health should be among our principal concerns. Pregnancy and birth can be the trigger for poor mental health among those who did not previously suffer from mental health problems, and they are a major factor in the escalation of existing ones. The first two years of a child’s life are vital in their development, and the right support and guidance for families at this time can make a big difference to their long-term outcomes.
For many women, becoming a mother presents psychological challenges. They might have experienced conflict or abuse in their own childhoods, which resurface when they contemplate the reality of becoming a parent themselves. They might be used to setting high standards for themselves and derive their sense of worth from their ability to meet them, but find that their baby does not comply with their drive to meet their parenting targets. They might simply be overwhelmed by the awesome responsibility of having another human being entirely dependent upon them, and fear that they do not have what it takes to be able to be an effective parent.
Because everybody has had a mother at some point in their lives, we all, knowingly and unknowingly, have formed a picture of what a mother is and what a mother should do. These assumptions about motherhood crowd around every new mother, complicating her own feelings about her new baby and her new role. New motherhood can be extremely lonely, especially in the dark, still hours of the early-morning feeds, and that loneliness creates a fertile space for doubts and anxieties.
Lockdown has exacerbated so many of these issues. I asked for today’s debate so that we can talk about the impact of covid on the mental health of new mothers, and to urge the Government to prioritise this as we come out of lockdown. Loneliness has been a major issue for almost all of us during the past year, but the lack of contact has been particularly acute for those who have had babies during this time. I am enormously grateful to the parliamentary digital engagement team for organising a survey in advance of this debate to ask members of the public for their experiences. We had more than 11,000 responses, with some extremely moving testimony among them. I thank everybody who took the time to share their experiences, but especially those whose experiences were difficult and painful.
The overwhelming theme of the responses was how difficult isolation had made the experience of giving birth and caring for a newborn. I was particularly struck by the experience of Zilia from the south-east when she told us:
“All appointments attended alone and in sterile conditions. Childbirth alone, no visitors in hospital, no family able to meet your newborn and help you out thereafter. Just the most isolating and lonely experience I have been through.”
Reflecting on my own experiences, I overcame the early challenges of motherhood with a combination of a supportive partner present at the birth, a delighted family who rallied round with practical help, professional health support delivered through home visits, and a peer group of other new mothers in the neighbourhood. To have been denied any one of those would have made the job of adjusting to motherhood considerably harder. We now have thousands of mothers battling through the early months of motherhood without having had any of those essential forms of support, and this has taken its toll on their mental health.
This is how Emily from Scotland describes the impact on her:
“My mental health is awful. I have never felt so lonely or isolated. I shielded from March until June last year and saw nobody for my second trimester other than my husband. My husband’s family are yet to meet our baby, who is our first, and he is coming up to six months old. I have developed post-natal OCD, which is horrendous, and I am still waiting for professional help to cope with this.”
Other covid-19 factors that have worsened the experience for new mothers in lockdown are financial uncertainty, lack of access to childcare, and bereavement. The industries worst hit by the lockdown employ a large proportion of females. Some 20% of mothers have lost their jobs during the pandemic, compared with 13% of fathers. The closure of schools has left many mothers trying to juggle home schooling for older children with looking after a newborn, and many families are dealing with the trauma of losing family members to covid.
The impact of the pandemic has changed the way that we all access healthcare, as resources are prioritised towards emergency admissions and efforts are made to reduce contact. In some parts of our healthcare system, it has led to an increase in digital and telephone consultations. In many parts of the country, this has included perinatal care. Many of the respondents to the survey reported receiving follow-up care in this way, including Jennifer in the west midlands, who reported:
“Very limited midwifery care. I didn’t see a midwife at all until I was 28 weeks. No health visitor service whatsoever. Apart from one very brief phone call, I have had no contact from a health visitor. My baby has not been weighed since 10 days old, and they are now almost six months. Overall, my pregnancy experience has been unnecessarily stressful and left me feeling constantly anxious and unsupported.”
In my conversations with new mothers in my constituency, many of them brought up how difficult they found the lack of professional support. They were unable to access guidance about breastfeeding or sleeping, and unable to ask questions or seek reassurance. Many of them found that they experienced much greater anxiety about their babies as a result. I have at least one case in my constituency where the lack of a physical examination led to a major genetic condition being missed—one in which, tragically, early intervention can make a significant difference to the quality of life.
The survey we conducted found that, of those mothers who had received an online consultation, 60% said they were not affected, compared with only 3% who said they were affected. I have spoken to the Institute of Health Visiting and the Royal College of Psychiatrists, and they have confirmed to me how vital such face-to-face support is for new mothers in the first weeks. The value of the home visit is that the mother does not need to identify the need for help and then go out and seek it for herself; someone comes to her and asks her how she is. A trained and experienced health visitor can observe mother and baby and identify whether additional support is needed. That kind of support cannot be replicated on Zoom or over the phone. Furthermore, as the Royal College of Psychiatrists has highlighted to me, it is much harder to identify whether there are issues of domestic violence or coercive control between a mother and her partner when contact is one-dimensional.
The impact of perinatal mental illness can have long-lasting impacts on families. Stephanie from the east midlands told our survey:
“I have previously not had any mental health issues, but I have really struggled with my mental health since having my baby. I have severe anxiety and now perinatal OCD. I have intense fear and stress about leaving my child, and I am not receiving anywhere near enough support.”
The long-term societal cost of perinatal mental ill health is estimated at £8.1 billion annually for each one-year cohort of births, and about three quarters of that is the cost of the impact on children. The financial value of early interventions to support struggling families is clear, and there is also the very human value of building loving and supportive families.
We already have the structures and mechanisms to provide support through the health visiting service. I should declare an interest here: my mother was a health visitor for many years, so I have learned at first hand from her about the times when a friendly knock on the door made all the difference to an overwhelmed new mother. However, it is a service that was already chronically underfunded and understaffed before the pandemic took hold. There has been a 31% decrease in the health visiting workforce since 2015, and many local authorities target their scarce resources at those deemed most at risk.
I believe that only a universal health visiting service can properly identify and support mothers who are suffering from poor perinatal mental health, and that the Government should allocate sufficient resources to enable this to happen. We need better mental health support for all ages and stages, and better training throughout our health service to identify and support those who are struggling, but providing support to new mothers should be a priority, because of the long-term impacts that their poor mental health can have on the development of their children and on the rest of their family.
The first step is to address the shortage of health visitors. There cannot be quality service provision when 65% of health visitors have case loads of more than 500 children each. We also need to urgently address the staffing shortage among midwives, who have a critical role to play in supporting women’s emotional wellbeing during pregnancy, childbirth and beyond. The Royal College of Midwives has found that there is currently a shortage of 3,000 midwives. Alongside that, we need to increase training and specialist mental health support for midwives, so they are well equipped to deliver the necessary support.
The pandemic has forced us to use digital tools in every area of our lives. We may find that we continue to use some of them even after face-to-face contact is possible again. If I could make one plea to the Minister, however, it would be that we should not allow digital and telephone perinatal check-ups to become the new accepted standard. The Government should fund and resource home visits by health visitors to all new mothers so that we can properly address the issue of maternal mental health.
Tim Loughton (East Worthing and Shoreham) (Con)
It is good to see you in the Chair, Mr Robertson, in this new Chamber, which is a first for us all. I congratulate the hon. Member for Richmond Park (Sarah Olney) on securing the debate. It is good that we have had a number of debates in recent months about maternal challenges during the pandemic, the impact on families and the impact on the mental health of parents and children. There is little that is more important, frankly. It is something that we will have to spend a lot of time concentrating on as we build out of the pandemic in the coming months.
Let me declare my interests. I am chair of the all-party parliamentary group for conception to age two: first 1001 days. Given the hon. Lady’s comments, I think we have a new recruit. If she is not already one of our members, I would be delighted to welcome her along. It is a very active group. I also chair the all-party group for children, and until recently I was the chairman of trustees of the Parent-Infant Foundation charity, which concentrates on the initial 1,001 days and the attachment between parent carers and their children.
I was impressed by the response from the digital teams in the House. It was a very good exercise. As the hon. Lady said, 11,265 responses is not to be sniffed at. Alas, the responses were all too familiar. We have heard similar anecdotes from our constituents about what has been going on during lockdown. There were responses about parents, and particularly mums, feeling lonely. They feel isolated in hospital, particularly if they have to stay in for any length of time because of complications. They have problems even getting their partners—the fathers—to be able to visit them. They feel isolated from family support networks that we normally take from granted. They feel isolated from new mum and baby groups. One of the respondents to the survey called them a safety valve where completely new mums, in particular, learn from other mums—either new mums or experienced mums—and the babies interact too. It was interesting that, for colleagues who gave birth during the lockdown, it was several months before their babies were actually able to meet another baby, and there was a bit of a shock factor there. We perhaps underestimate the impact of that social contact from the very earliest stages after a child is born.
In particular, as the hon. Lady mentioned, there is the isolation from health professionals on a face-to-face basis. I know that there have been a lot of substitute virtual visits, but they are not a substitute and they must not become the norm. We need to build back our health visitor numbers, as we did so well in the coalition Government between 2010 and 2015, when we produced 4,200 additional health visitors, who were absolutely invaluable. They are the friendly face that new parents will welcome across a threshold, where they may be more suspicious of a social worker or other care workers. They are also an early warning system for problems that may be going on with a new parent and ultimately any safeguarding issues.
A report that the First 1001 Days Movement produced last year, called “Working for babies”, said that services supporting nought to twos were highly depleted during the first spring lockdown last year. The majority of services for nought to twos did not bounce back quickly as lockdown measures were eased. We need to make sure that mistake is not made again this time.
This lockdown has been especially stressful for first-time mums, single mums, and families having to balance working remotely, new forms of working and working covid-safely, and juggling home schooling if they have other children too—thank goodness all my children are above school age and we have not had that additional challenge. Even before the covid pandemic, at least one in six mums suffered from some form of perinatal mental illness—commonly anxiety disorders and depression. We know that the pandemic and lockdown have impacted on the mental health of just about everybody, but particularly on that cohort of mums.
A survey by the excellent baby charity Bliss found that, among its members who had received neonatal care during the pandemic, 90% of parents said they felt more isolated as a result of having a baby in neonatal care during the pandemic; 70% said their mental health was negatively affected as a result of the experience; 56% said the mental health of their partner and wider family had been affected; and 47% said they were not offered support for their mental health while their baby was in neonatal care. We know that, in extremis, suicide is the biggest cause of maternal death. We must do so much more to ensure that women do not get in that position and that support is there and accessible.
The shortage of health visitors is a false economy. I have always said that; we had a debate specifically on that last year. I pay tribute in particular to Cheryll Adams, who set up and has led the Institute of Health Visiting. She is retiring at the end of the month. The service she has given to that area has been extraordinary and has informed many debates in this place. I put on the record our thanks and gratitude to her.
There is also the whole issue of increased domestic abuse during pregnancy. The figure that I always find hard to take on board is that a third of domestic abuse happens during pregnancy as well, and we know that domestic abuse has gone up during the pandemic, so all the additional pressures on women who are about to give birth or who have just given birth are extraordinary.
The cost of perinatal mental illness, as calculated by the Maternal Mental Health Alliance some years ago—it still holds true, and today it is probably an underestimate—was £8.1 billion each and every year. On top of that, the cost of child neglect is £15 billion, so we as taxpayers are paying £23 billion-plus into the health service to get it wrong. To prevent us getting it wrong, if we spent a fraction of that on the support services—the health visitors and those networks—being there in the first place, that would be money well spent and well saved.
Of course, the key is good attachment between babies and their parents or primary carers from those very earliest stages and during conception, hence the founding of the First 1001 Days Movement. My right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) launched the 1,001 critical days manifesto back in, I think, 2012, which was signed up to by colleagues across parties, the royal colleges, clinicians, academics and children’s charities alike. It is still relevant today.
To quote research by the First 1001 Days Movement and the Parent-Infant Foundation—I pay tribute in particular to Sally Hogg, who does so much of the good work there—it is estimated that 10% to 25% of young children experience significantly distorted relationships with their main carer or carers, and from that a range of poor social, emotional and educational outcomes in childhood and across the life course can be predicted. Maternal mental illness in pregnancy and the early years of a child’s life can have adverse effects on the child’s brain development and long-term outcomes. Maternal mental illness can affect children both directly and indirectly. For example, exposure to stress hormones in the womb is thought to affect the child’s developing stress response systems, and mental illness after birth can affect a mother’s ability to care for her baby, her parenting style and her developing relationship with her baby. Even relatively mild mental illness, if untreated, can inhibit a mother’s ability to provide her baby with the sensitive, responsive care that they need.
This, again, is a statistic that I always use. If a 15 or 16-year-old teenager is suffering from some form of depression or low-lying mental illness, there is a 99% likelihood that that child’s mother suffered some form of perinatal mental illness—the connection is that close. So why are we not doing more to support the mother before and soon after she gives birth? The implications of not doing so will be with her child and her for many years to come, and often into adulthood for the child.
It is also important to note that although perinatal mental illness increases the risk of disruptions in early relationships, they are not inevitable. Some mothers can continue to give their babies the sensitive, responsive care they need, particularly with the right support—and good, effective support can be had, if it is available. That is the problem: it is not always there, or not always there at the right time or in the right place.
Other risk factors put early relationships and infant mental health at risk, including families where fathers or other care-givers have serious mental health problems themselves. Again, we underestimate the impact of becoming a father, particularly for the first time, on the mental health of dad. In most cases this is a joint partnership, but fathers often get overlooked. They often get excluded from the whole neonatal process within hospitals, as well. They need looking after too, because if they can be looked after, they can look after their partner and there is a mutual benefit from all of that. We need to do more for fathers.
The NHS long-term plan includes a commitment to expand access to evidence-based parent-infant interventions within specialist perinatal mental health services, which is indeed welcome. It will ensure that attention is given to the parent-infant relationship alongside the mother’s own mental health when mothers have moderate or severe mental health problems. We must not just look at the child or the mum in isolation; we are looking at the bonded family.
However, access to mental health services for babies should be dependent on the risks to their mental health and not contingent on other factors, such as their mother’s mental health needs. So, the NHS long-term plan for England also committed to improving access to specialist services for all children from 0 to 25, but delivering that commitment requires specialist provision for all babies who need it, as they are children, too. Such provision would need to be delivered by parent-infant specialists. However, the NHS long-term plan says nothing explicitly about specialist mental health services for the youngest children in their own right.
The solution is that we need specialised parent-infant relationship teams providing therapeutic support where a baby’s development is most at risk due to severe, complex and/or enduring difficulties in their relationships. Such teams focus on the relationship between a baby and his or her parents or care-givers as the main way to improve infant mental health. However, there are fewer than 40 specialised parent-infant relationship teams in the whole of the UK, and most babies live in an area where these services just do not exist; vast areas of the country have no provision.
One of the aims of the Parent-Infant Foundation charity, which was set up by the right hon. Member for South Northamptonshire, is setting up parent-infant projects around the country, where practitioners are available, to work on the attachment of parents and their children. We just need it to be mainstream across the whole of the national health service.
As the Royal College of Psychiatrists has said, the need for more perinatal psychiatrists to work in these services is crucial. These specialist services need a highly trained specialist workforce, but the workforce census in 2019 showed that 13% of consultant and perinatal psychiatrist positions remained unfilled. Without more psychiatrists, ambitious plans to transform and expand services will be put at risk.
We are soon to have the Leadsom review, if I may call it that; it does not really ring true as “the South Northamptonshire review”. The right hon. Member for South Northamptonshire is producing the review; hopefully it will be published later this month. I have been privileged to play a part in it, and chaired a parliamentary advisory group.
Absolutely key to that review are a joined-up support service between the NHS, local government and other key professionals, to give that wraparound service to parents in those crucial early months and years; a digital record, so that all those professions are working from the same information, rather than every visit to mum being a new visit; and a national template of the quality that we need to reach, but with local implementation, so that a service in Richmond, although it may look a bit different from a service in my part of the world on the Sussex coast, is none the less required to produce quality outcomes and clear the same threshold.
We look forward to that report in the coming weeks and months, and I very much hope that the Government will take it on board and produce the goods, because little, if anything, is more important than the welfare, good health and good mental health of our children. And a child is given the very best opportunity—the best start in life—if their parents are in a safe and stable place as well.
Mr Laurence Robertson (in the Chair)
In order to call everyone, I wonder if I might ask all Back Benchers to stick to around five minutes in their contributions, please.
Ellie Reeves (Lewisham West and Penge) (Lab) [V]
I thank the hon. Member for Richmond Park (Sarah Olney) for securing this important debate today.
Maternal mental health problems are prevalent and are not talked about often enough. One in five women will develop some form of mental health problem during their pregnancy or in the year after giving birth, and research suggests that as many as seven in 10 mothers will underplay the severity of their feelings, due to stigma surrounding mental health.
Sadly, all of this has been exacerbated by the impact of the pandemic. As someone who has spoken in the House about prenatal depression while pregnant with my first child, this is an extremely important issue for me.
From a personal perspective, my second child was only four months old when we went into the first lockdown. My plans for baby yoga, music classes and meeting other mums for coffee to get through the sleep deprivation were suddenly out the window. Instead, the ensuing weeks were spent with him mostly in a sling while I home-schooled the eldest. With much of his little life spent in lockdown, his one-year check was done on the phone, he has not been weighed since he was six weeks old, and I cannot remember the last time he saw a health visitor.
Yet I feel lucky: lucky that he was born just before the pandemic hit, so my husband was able to be there the whole time I was in labour; lucky that he was my second child, so at least I had a vague idea about what I was doing; and lucky that we had those four months together before going into lockdown. For many of my constituents, having a baby during lockdown has been incredibly challenging. One of my constituents, Nina, wrote to me last autumn:
“I was pregnant for the entirety of the first lockdown and had to attend all scans for the twins I was carrying alone. This was bearable when I looked around and saw everyone making huge sacrifices.
When I gave birth to the twins in August, continued restrictive rules meant that my husband could not be with me on the labour ward. Add to the mix a fast-moving induction and I ended up giving birth to my babies with only midwives I’d never seen before in the room.
My husband simply wasn’t able to make it in time. If he’d been able to stay on the ward I would have had his much needed support through labour. As it was, I have had to recover mentally from a fairly traumatic experience.
And yet...I brought the twins home while everyone was still ‘eating out to help out’. How can this be right? Why do women’s and particularly mothers’ needs fall so far down the Government’s priority list?”
Nina’s story and many others show the profound impact that the pandemic has had. In September, the Government allowed families with a child under one to form a support bubble and the NHS now allows the birth partner to be present during labour and the birth, but for many families those changes came too late. The Government must be ambitious in their plans to support the babies born in lockdown and their families. That will be a huge task. For example, if health visitors are to catch up with the huge backlog in missed face-to-face appointments and provide a full service, proper funding will be needed. They provide an amazing service and invaluable support to parents, but about one in five were lost between 2015 and 2019 due to public health budget cuts.
As a result, in February, before the pandemic hit, almost a third of health visitors reported that they were responsible for between 500 and 1,000 children. The Institute of Health Visiting considers the optimal maximum for the work to be fully effective to be 250 children. Similarly, since 2010, cuts of 66% have led to the loss of over 1,000 Sure Start and children’s centres, which provide huge support to families, particularly those who are vulnerable or hard to reach. Funding needs to be restored, so that there is a one-stop shop for parents to get support for themselves and their children.
Early years and nursery providers provide huge support for parents, but according to the Institute for Fiscal Studies, they ran at a significant loss during the first lockdown, receiving less than £4 of income for every £5 of costs. In addition, playgroups and baby activities are often run by small businesses, and restrictions mean that their doors have largely been shut. I would like the Government to look urgently at sector-specific grant funding for early years, to maintain the viability of the sector as we come out of the pandemic.
It is clear that the added stresses of lockdown and the pandemic have exacerbated maternal mental health problems. A recent UK-wide study published in the Journal of Psychiatric Research found that during the first lockdown, 43% of new mothers met the criteria for clinically relevant depression and 61% met the criteria for anxiety. Given the consistent evidence that shows that postnatal depression and anxiety are linked to a range of negative outcomes for children’s health, development and behaviour, it is imperative that the Government do everything they can to protect maternal mental wellbeing.
That begins with many of the measures that I have outlined, but also by improving and maintaining access to perinatal mental healthcare. Although NHS resources and staff are under huge strain, investment is needed to ensure that mental health interventions can be timely and effective to prevent the escalation of symptoms and the formation of a larger burden on the NHS and other public services. That is not beyond our capabilities, and we owe it to the babies born in lockdown and their families to put that at the top of the agenda.
[Sir Edward Leigh in the Chair]
Cherilyn Mackrory (Truro and Falmouth) (Con) [V]
I thank the hon. Member for Richmond Park (Sarah Olney) for securing this important debate.
We have heard some of the shocking figures on maternal mental health and we have heard about the evidence that new mothers have experienced poor maternal mental health as a result of the pandemic. “Maternal mental health and coping during the COVID 19 lockdown in the UK” from the covid-19 new mum study found that more than half of new mothers reported feeling down, lonely or irritable, and that 71% reported feeling worried since the beginning of the first lockdown.
Mental health service guidance from the Royal College of Psychiatrists sets out that perinatal mental health care continues to be essential during covid-19, and that face-to-face contact will be necessary in some circumstances. The Government and the NHS have said that mental health services, including the specialist perinatal services, remain very much open for business during the pandemic, and that providers have looked to how they can maximise the use of digital and virtual channels. I agree that that is not ideal, but I acknowledge that hospital trusts in difficult circumstances have worked extremely hard to reach out to mums.
In Cornwall, the Royal Cornwall Hospitals NHS Trust looks after 4,000 babies and mums every single year. I thank the midwifery team at the RCHT for looking after me and both my babies, one surviving and thriving and one whom, unfortunately, we lost. The trust has been reviewing visiting continually throughout the pandemic, and the latest arrangement of their services is that birthing partners are now available, that both parents may be in neonatal units at any time, and that partners may now attend the 12-week and 20-week scans. If other scans are required, they may also arrange that. That has come on from where we were during the first lockdown, so things are improving.
International data, from high, middle and low-income countries, suggests that perinatal illness is more prevalent among rural women. That is the second dimension that I would like to add to today’s debate, if I may. Cornwall is predominately rural, and the pandemic has absolutely exacerbated an already hidden issue, bringing it into the limelight.
For a new mum who lives rurally, it is very difficult to access baby groups and other new mums, to share stories and get peer support, mostly because of transportation issues. I agree that all new mums are suffering those difficulties in lockdown, but it is particularly an issue for rural new mums. Often, socioeconomically, rural new mums are on a lower income, so they cannot afford to get anywhere. It is also difficult for health visitors to get out and visit them.
When I was a brand-new mum, I did not get a midwife follow-up appointment; I had a phone call. My notes, I think, stated that I was well supported and absolutely fine, and yet eight months later I was diagnosed with postnatal depression. I did not know that I had postnatal depression; I thought I was tired, that I was not doing it properly and that I was not living up to being a real mum, and I did not know who to talk to. Even though I had close family support, I felt that I was not doing it right, until I broke one day. I saw my GP, and at that point I was diagnosed with postnatal depression. Luckily for me, not being in lockdown, I was able to go to group peer support and to meet other mums who were feeling exactly the same way, so I realised that I was perfectly normal and that it was something I would work through.
It is important that we recognise that that will be a growing problem because of covid. For a new mum, it is all about talking—we want to speak to other new mums, and when we cannot do that, we can get lost in our own head and everything feels a bit worse.
I have been working cross-party, and with my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) and my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) on the early years review, which I am privileged to be a part of at this late stage. It started its life, as we know, as the review into the first 1001 days. I will not repeat the words of my hon. Friend, who articulated this work wonderfully, but I look forward to the review coming, hopefully later this month.
My right hon. Friend the Member for South Northamptonshire was quoted as saying that the fact that babies have had little social contact during the first lockdown is clearly a bad thing, and that the repercussions are not yet known. Tackling some of the awful experiences of babies during lockdown and looking at how families can benefit from some of the positive experiences will be at the heart of the review. I look forward to its findings and hope that we can improve conditions for new parents and new babies because of it.
It is my sincere hope that when the new review’s findings come forward and policies are formulated, all parties will take a long-term view of all the important issues that we are discussing today, and that will come out as part of the review. I want to ensure that policy makers cease to use something as vital as the best start in life for babies and the mental health of mothers as a political football. Hopefully we can formulate something wonderful, so that when we look back at it in 20 years’ time we can all see how successful it has been and be very proud of it.
Mrs Maria Miller (Basingstoke) (Con)
I commend the hon. Member for Richmond Park (Sarah Olney) for securing the debate, because the three quarters of a million women who have given birth during this pandemic have not only experienced all the challenges that every woman experiences when they give birth, but have had those problems magnified. Other Members have already set out issues around isolation, anxiety and the need for proper, professional support, as identified by the excellent piece of work done by the Digital Engagement Team for the hon. Lady, which all of us who have been new mums can really relate to. I can only imagine how much more these issues can affect people when they have no family members to call on and no mothers’ group to allow them to pick up personal experience from others who have gone through it before them.
Outside of the pandemic, around one in five women experience perinatal mental health problems, which impact not only them but their children, and as my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said, that can cost the economy some £8 billion every year. I will add to the debate the conditions that create a higher likelihood of mental health problems emerging in the first place, which according to research is particularly stressful life events.
We know that, during the pandemic, people have been highly anxious—far more than they might have been otherwise. Indeed, some research suggests that around three in four pregnant women have had significant anxiety, and up to 40% have experienced depression. One of the biggest anxieties for any new parent has to be money—finance, income; making sure that they can care for their new family. Most families now have two working parents, and families depend on both incomes, so the fact that more than 50,000 pregnant women a year suffer discrimination that leaves them with no option but to leave their job should sound alarm bells, not only for our economy, but for its potential to trigger mental health problems, depression or anxiety.
Work by organisations such as Maternity Action and Pregnant Then Screwed shows worrying increases in reports of pregnant women losing their jobs during the pandemic, and we know that more women have been impacted, in terms of job loss, during the pandemic than in other similar economic events. The reported figure of 50,000 pregnant women each and every year leaving their jobs is likely to be the tip of the iceberg, because as well as those reporting leaving their jobs, there will be many more who are silenced from speaking out by non-disclosure agreements.
My right hon. Friend the Minister has done so much to support new mothers, but some women are still let down in the workplace, so as part of this debate I urge her to consider employment policies too, particularly given the impact of coronavirus on women’s employment. No matter how good my right hon. Friend is at her job, in terms of putting support in place, if pregnant women are concerned about losing their jobs, even if they do not do so—and being pushed out of work is not uncommon in the workplace when women become pregnant—the job of the Department of Health and Social Care will be severely undermined if these issues are not addressed.
Other countries have looked at this closely, and I believe we can learn from their experiences. Germany, with a similar economy to ours, prohibits making pregnant women and new mums redundant, for the good of women, their children and their families. I have put into a ten-minute rule Bill the idea of adopting the German laws here in the UK, and I hope that my hon. Friend the Minister will look at it to see whether she could lend it her support.
My final point is that mental health problems on the arrival of a child do not just impact women. Up to one in four fathers may experience mental health problems in the year after the birth of a child. It can be difficult for fathers to manage the transition, and we need to ensure that support is there. In other countries, shared parental leave policies, on a use-it-or-lose-it basis, have been proven to help fathers with that transition. Will the Minister look at why we are still awaiting action following the review in the UK of this policy, which would explicitly help fathers to tackle these difficult issues?
My hon. Friend the Minister has done so much, but she needs her colleagues in the Department for Business, Energy and Industrial Strategy to do more. It is no good saying that we have good maternity protections when the Government know that probably 50,000 women a year lose their job because of how they are treated in the workplace. I ask the Minister to speak to her colleagues in the Department for Business, Energy and Industrial Strategy to look at effective broader policies impacting on pregnant women at work, because one of the most effective maternal health policies that the Government could adopt is stopping women being made redundant in the first place.
Sir Edward Leigh (in the Chair)
Order. Because Members have gone on beyond five minutes, I have to reduce the time limit again, otherwise not everybody will get in. The time limit is now four minutes.
Liz Twist (Blaydon) (Lab) [V]
It is a pleasure to serve under your chairmanship, Sir Edward. I am glad to have the opportunity to take part in this important debate, and I begin by congratulating the hon. Member for Richmond Park (Sarah Olney) on securing it.
Most mums look forward to having a baby, and the birth of a child to family, friends and people we know is something that we all greet with joy, pleasure and anticipation for the future of the child. We know that for some women, however, pregnancy and the time after birth can, sadly, be difficult. They may not have been able to talk to people about it when everyone imagines that they are having a happy time. This year, it may have been more difficult than ever as a result of covid-19 and the social isolation that it has brought for so many. They have not had the support of, or been able to share the joy and workload with, family and friends, and it has been difficult to get the face-to-face support that they really need. Let us not forget that many have lost out on financial support that has been offered to others, as the campaigning organisation, Pregnant Then Screwed, has evidenced.
Low mood, anxiety and depression are common mental health problems that occur during pregnancy and in the year after childbirth. The pain that these conditions cause women and their families is significant, as is the negative impact on their health and wellbeing. The Royal College of Obstetricians and Gynaecologists states that up to one in five women develop mental health problems during pregnancy or in the first year after childbirth, and around a quarter of all maternal deaths between six weeks and a year after childbirth are related to mental health problems.
Sometimes, hearing in this House the lived experience of constituents really brings home the issues that we are discussing, and the need to address them. A constituent of mine has asked me to tell her story.
“In 2017 I became a Mum for the first time, I knew that I needed to provide for my child but I felt no more attachment than for someone I had just met. I started to Google ‘how to have my child adopted’ and felt like I was a failure as a woman.
I started to have panic attacks, I’d imagine walls falling on my child, people grabbing her and running away. I would lock myself in the house and was terrified to be alone.
It was when I started to record the times that the trains went past my house that realised that I was seriously contemplating suicide. I went to the GP who made an urgent mental health referral although it was five months after my child was born that I actually got any help…and…anything was done. I was diagnosed with severe post-natal depression and have been receiving help ever since.
When my second child arrived, I realised just how traumatic my first experience has been. The shame and anguish have been replaced by joy and love, and I was finally able to have those special moments with the newborn that people romanticise.”
Since that time, the local Newcastle Gateshead clinical commissioning group has invested in a specialist perinatal mental health service. That provides support, advice and planning of care and treatment following delivery, reducing the risk of significant illness and the potential for in-patient care. However, many women are not seeking the help they need, and the pandemic has had a huge impact on loneliness, making those early days so difficult.
This is an important debate and we must do much more to support women struggling with their mental health, before and after the birth of their child, to allow parenthood to be the joyful, if challenging and tiring, experience that it should be.
Mary Kelly Foy (City of Durham) (Lab) [V]
I thank the hon. Member for Richmond Park (Sarah Olney) for introducing this debate. I declare an interest as co-chair of the all-party parliamentary group on cerebral palsy
Maternal mental health has been one of the hidden impacts of the pandemic. Being a new mam is a special time for any woman. However, it can also be overwhelming and generally challenging. In normal times, many women receive support from their family and friends, who are there to offer invaluable guidance. However, for the past year, the public health restrictions needed to tackle covid-19 have meant that many women have had to make this journey on their own.
I had my first child, Maria, at 21. The advice from my mam was crucial in spotting the missed stages in her early development, which enabled her cerebral palsy diagnosis to come much sooner than it otherwise would have. I cannot put into words how valuable her support was following such heart-rending news. It was thanks to my family and friends that I felt confident enough to go on and have two more children.
It strikes me that if Maria had been born during this pandemic, the personal support I received from my mam and health visitors would have been much more limited. My heart truly goes out to those who have become mothers during the pandemic. I cannot imagine the impact that isolation is having on their mental health. I worry that sadly some may choose not to extend their families in future.
The pandemic has particularly affected those whose babies have received neonatal care, with more than 90% of parents who responded to a Bliss survey saying that they felt more isolated due to having a baby in neonatal care during the pandemic, and 70% saying that their mental health was negatively impacted as a result of their experience. The situation has not been helped by the fact that Bliss research also found that psychological support for parents experiencing neonatal care was inconsistent at best. Around half the parents said they were not offered mental health support during or after this care.
The impact of negative maternal mental health goes beyond the parent and is not limited to the short term. As we have heard, the first 18 to 24 months of a baby’s life are critical in their development, and the stress and trauma of poor maternal mental health has the potential severely to impact a child’s life chances.
In parts of the north-east, where my constituency is located, existing health inequalities mean that some children begin their lives with inferior life chances to those from less deprived regions. We simply cannot afford to place further obstacles in the way of their development and risk losing a whole generation. As a result of the pandemic, we are facing a potential mental health crisis in Britain and maternal mental health is significant.
It is unreasonable to suggest that, as a society, we could experience a collective trauma on this scale without it impacting on mental health. Inevitably, that will be challenging, especially when the existing foundations of mental health care in the country are already weak. It was therefore incredibly disappointing that health services were absent from the Chancellor’s Budget last week. He could do with learning that the damage to public health from the pandemic will not fix itself.
It seems fitting that the debate is happening in the week in which International Women’s Day falls. Not only have women consistently stepped up to the plate during the pandemic, with little to no reward, but they have shown resilience in coping with one of life’s toughest challenges—becoming a mam. We owe it to the women in our constituencies to have the best mental health support out there, for what is undoubtedly one of the most beautiful yet challenging life experiences they will face.
Christine Jardine (Edinburgh West) (LD) [V]
It is a pleasure to serve under your chairmanship, Sir Edward. I thank my hon. Friend the Member for Richmond Park (Sarah Olney) for securing this important debate.
It was during a recent Zoom call with friends that the real, current issues affecting maternal mental health struck home for me. [Inaudible.] All of us on the call with her that evening were both upset for her and inspired by her attitude. As an expectant mother, I had my family round me—mother, sisters, husband, friends—antenatal classes and the knowledge that there would be ample post-natal care and support; but in covid-19 that is simply not possible. The impact is the exacerbation of a problem that already, in the best of circumstances, will affect one in five women who give birth. Those women—it could be any of us—will experience anything from anxiety to obsessive compulsive disorder or post-traumatic stress disorder. I am sure that each one of us in the debate has personal experience of a close friend or relative who has experienced those problems after giving birth—perhaps we have even experienced them ourselves.
We have come a long way as a society from the time when post-natal depression was described almost dismissively as the baby blues, and talked of in hushed tones. We now acknowledge the scale and widespread nature of what many women have to cope with. We have heard many stories in the debate. However, I do not believe that we are adequately responsive, or that we provide correct and sufficient care. In the pandemic, we know that as with many other issues things are much worse. Women going into labour at the moment have not had the benefit of face-to-face antenatal classes, forming bonds with other expectant mothers for common support. They have not had the assurance that their partners can be there, or that their closest family and friends can visit within a few hours—or take part in baby groups or have post-natal visits. All of that is against the background of lockdown—perhaps a feeling of isolation, financial worries or keeping other children amused, cared for, or home-schooled.
A mother’s poor mental health can affect the future outcomes for the child, as we have heard, and that knowledge must be uppermost in our minds. We have heard stories in the debate of the disruptions to life, and the impact on the mental health of both mother and child. It is clear that we need to listen to all that, and act. Listen to the mothers now and in future, about how they are struggling; listen to those who have struggled in the past. With no support network, and delays for treatment, we need to ensure that there is support from healthcare professionals with sufficient training. We need funding. We need a system that provides robust, integrated physical and mental healthcare for new mothers. Maternal mental health must be a priority for the Government, not only for the future wellbeing of mothers, but for all our children.
Jim Shannon (Strangford) (DUP)
It is a pleasure to speak in the debate, Sir Edward. I thank the hon. Member for Richmond Park (Sarah Olney) for bringing forward what is an important issue, and all the right hon. and hon. Members who have made valuable contributions, setting the scene very well. The matter has been a great concern of mine for many years and I have raised it in the House on several occasions. I have probably spoken alongside my colleague and friend, the hon. Member for East Worthing and Shoreham (Tim Loughton), among others who are here, on almost every occasion when it has been brought forward.
Covid has been difficult for my family, with the loss of a much-loved mother-in-law; but we have been blessed in that time with sunshine in the rain, as we have two beautiful new grandchildren, Max and Freya—both born during lockdown. It is important to have that opportunity, as a grandparent, to have grandchildren—and new grandchildren. We are up to five now, so I could have a five-a-side mixed football team of boys and girls—I look forward very much to that.
There was no joyful visit to the hospital. Indeed, the first view was through the living-room window and I have not seen the youngest one at all, even from a distance. It has always been on the wife’s video. Video calls are wonderful, but there cannot be anything sweeter than holding your grandchild. As tough as it is for grandparents, it is even more difficult for parents. That is what we have been trying to say today in the contributions that we are making. No mum or auntie is allowed to come round to help the new mum get sorted and into the routine; there are no mums or toddler groups to reassure her that she is doing a phenomenal job, that everyone struggles and that sometimes mum just needs someone to share that with; there are endless days in the house with a baby that she is too frightened to take out into this uncertain world. The impact on mums and dads has been vast and we will probably not know the full extent of it in the years to come.
My parliamentary aide, Naomi, who is a busy girl because she does all the speech writing for me, had two children in a short time. I remember them well. She told me—and she refers to it as her mummy guilt—that her eldest had little opportunity to enjoy her own time before she became the big sister, almost right away. She also talks about the mummy guilt of working full time. Although her parents are able to mind the children, who are well taken care of, the guilt remains that she is not the one picking them up from school, which is what she wants to do.
While I can look on objectively and see two lovely, well-adjusted girls, she sees only the things that she feels she did not do right and which she thinks she did wrong. I do not believe that is the case, but she feels that. All mums will be able to sympathise with the fact that lockdown babies are not able to see or interact with others—that is important. When my children were growing up—this is true of my grandchildren too, from what I have seen of them so far—I saw their interactions with their wee colleagues at school, and they made friends well; they would often hold hands with them in P1 or P2. That is what children do—they need interaction. They are more likely to be parented by the person who is at home with them. I can only imagine the feelings of isolation and guilt at what the child has missed out on and what would have been felt.
I was pleased to receive correspondence from one of my constituents, who wrote to me expressing the feeling of being robbed of her maternity leave and calling for an extension. I can do nothing but support her in that call. The experience of lockdown for new parents has been difficult; no music classes, no parenting groups, no one to reassure them face to face and see if they are truly okay. In addition, we must consider parents whose children went to a neonatal unit. The baby charity Bliss has conducted a survey of parents whose baby received neonatal care during the pandemic. I am not going to repeat the figures cited by the hon. Gentleman for East Worthing and Shoreham, but I remind everyone, including the Minister, to look at them.
Jim Shannon
I support my hon. Friend the Member for Belfast East (Gavin Robinson) and his early-day motion. In conclusion, I am pleased to stand with parents asking for the help and support that is needed. Give them the support that has been lacking for so long, and let them know that, even when socially distanced, they are not alone.
Sir Edward Leigh (in the Chair)
Thank you very much. We now return to virtual for the SNP spokesperson, Dr Lisa Cameron.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP) [V]
It is an absolute pleasure to serve under your chairmanship, Sir Edward. I commend the hon. Member for Richmond Park (Sarah Olney) on bringing this absolutely vital debate to Parliament. It is crucial and could not be more timely. Before I begin, I refer to my entry in the register as a clinical psychologist, and thank the British Psychological Society and the Maternal Mental Health Alliance for the work that they have done in this field, among the many other charities and organisations already referred to.
I thank everyone who has spoken so thoroughly today on many issues, including the first crucial 1,001 days, and the importance of digital records, which are essential in ensuring continuity of care. I understand that the Government is bringing in support for family hubs in future, so I am interested to hear from the Minister more about that and how it will support this work. Other issues that have been raised go to the core of mental health stigma and the impact of coronavirus on labour and prenatal care.
Members have spoken eloquently about their own personal experiences. It is absolutely crucial to ensure that we normalise wellbeing and mental health issues, particularly during this most crucial time in people’s lives, and also give due cognisance to the importance of ensuring that people can access services when they need to do so.
The first weeks, months and years of parenthood were absolutely some of the most difficult that I have experienced—fraught with sleepless nights, anxiety about the future and overly high expectations that I placed on myself about the responsibilities of being a new mum. Support is absolutely crucial at these times, and that has just not been available during covid-19.
Before the coronavirus pandemic, more than one in five women experienced mental health problems during pregnancy or in the first post-natal year and, as is true of so much of our lives in the past year, covid-19 has exacerbated those issues. The Baby Loss Awareness Alliance, led by the charity Sands, found that isolation increased during lockdown, with feelings of loneliness impacting 63% of new parents—compared with 38% before the pandemic—and those who had experienced extreme difficulties during birth. If symptoms are allowed to spiral, more severe perinatal mental health issues can be significant and can have long-term effects on mother, baby, father and different members of the family.
Research evidence suggests that the long-term cost of perinatal depression, anxiety and psychosis in the UK is £8.1 billion per year, equivalent to roughly £10,000 for every single birth in the UK each year. While the financial weight of the failure to help new and expectant families is stark, the reality of families having to cope with perinatal mental illness is also heartbreaking, with maternal suicide one of the leading causes of death for women during pregnancy and in the first year after birth.
In summing up, I want to highlight two areas to the Government where I think the situation can be improved. First, pharmacological interventions really have to be matched with high-quality specialist psychological therapies during the perinatal period. Significant steps have been taken towards integrated care across the UK and in the devolved Governments in the past few years, but much more needs to be done to ensure that maternal mental health needs are met in whatever context they first present. That might be in maternity services, adult mental health services, drug and alcohol services, learning disability services or child and adolescent mental health services that are supporting the whole family. Wherever families show signs of needing help, they must be able to access specialist psychological therapies as quickly and easily as possible if we are to ensure the best possible outcome.
That must also apply to specialist perinatal community teams. In many circumstances, these home visit teams are the first and sometimes the last opportunity to spot maternal mental health issues, and they must include individuals with specialist training in clinical psychology. The British Psychological Society has recommended that every specialist perinatal mental health team should include clinical psychology and that every woman identified as requiring a psychological intervention should be offered an assessment and treatment with a clinical psychologist within 28 days. I highlight that recommendation.
In 2020, the Scottish Government invested £1.4 million in specialist community perinatal mental health services, with an additional £1.5 million for infant mental health and maternal and neonatal psychological services across Scotland. I urge the UK Government to set out additional support to what has already been promised in the NHS long-term plan, in the light of the additional and compound need that we have heard about in the debate today, which has set out the impact of covid-19. The need has been exacerbated, and it is crucial that we do not fail families at this time.
Dr Rosena Allin-Khan (Tooting) (Lab)
It is a pleasure to serve under your chairmanship, Sir Edward, and it is an honour to respond on behalf of the Opposition in this vital and incredibly moving debate. I thank the hon. Member for Richmond Park (Sarah Olney) for securing the debate. All contributions have been incredibly valuable and have highlighted the urgency of focusing attention on maternal health. Debates such as these can go some way towards breaking down the stigma that still persists around mental health and the often harsh reality of pregnancy, birth and motherhood. It is simply heartbreaking that suicide is the leading cause of maternal death. More people are starting to speak up publicly about their experiences, but we need action from the Government.
The coronavirus crisis has had a disastrous impact on many women. I was honoured to listen to colleagues sharing their heartbreaking experiences of baby loss in a recent debate. My heart breaks for all the women who have had to go through that alone at any time, especially during the pandemic. It is simply inhumane. Will the Minister outline what mental health support will be offered to women who have experienced baby loss without their partner by their side? Such tragedies have a long-term impact on partners and families, too. Will any support be extended to families? We heard described today, very eloquently, the importance of also considering fathers and other partners in such circumstances.
Within maternity services, there are huge inequalities. Black women are four times more likely than white women to die in pregnancy or childbirth. Pakistani women are more likely to have a premature baby or a neonatal death in the UK compared with their country of origin. Women from all ethnic minority groups in the UK receive fewer home visits from midwives and are more likely to give birth by emergency caesarean sections. What are the Government doing to address those discrepancies and to ensure that culturally appropriate mental health support is provided? Such racial inequalities are deep rooted and are further entrenched by covid-19. People from ethnic minority backgrounds are more likely to be adversely impacted financially by the pandemic, and the risk of death is much greater.
The Government’s only response so far to those shocking statistics has been to commission further research, but we need action now. The evidence is already clear that there are persistent inequalities in maternity outcomes and experiences, and that discrimination bias and a lack of cultural understanding are driving that. What action are the Government taking to eradicate these gross examples of health inequality? The five-year forward view for mental health made a recommendation that by 2020-21 in England 30,000 more women each year should be able to access evidence-based specialist mental health care during the perinatal period. During Monday’s statement on women’s health, I asked the Minister if she could tell us whether that target had been met. We did not get an answer, so will she provide one today?
Furthermore, the NHS long-term plan outlined that an additional 24,000 women per year with moderate to severe perinatal mental health difficulties and a personality disorder diagnosis would benefit from evidence-based care by 2023-24. Will the Minister please outline how many women are now benefiting from that? We also know that Health Education England was provided with £1.2 million of funding to increase skills and awareness around perinatal mental health. Will the Minister outline the progress on that and tell us where training initiatives might have been hampered by the pandemic?
The pandemic has had a profound effect on people’s mental health. We know how difficult and stressful pregnancy and birth can be at the best of times. Even outside of covid-19 it is vital that perinatal mental health services should promote prevention, early detection and diagnosis of mental health problems. Many women have been struggling to access the services they need during pregnancy, leaving them having to go through A&E. That is hugely distressing and can cause a great deal of anxiety for expectant mothers and their partners. It is therefore vital that those most at risk get the support they need now. Will the Minister outline what delays there have been during the pandemic in accessing perinatal services?
Working in a hospital, I have seen the fear that so many people present with: fear of contracting the virus, fear of taking the virus home and fear of wasting NHS time. Preventive measures around mental illness are crucial, especially now, for those most at risk. With more than half of new mothers having reported feeling down, lonely or irritable, and 71% reporting feeling worried since the beginning of the first lockdown, what steps is the Minister taking to ensure that new mothers know where to go to seek help?
A University College London report found that, during the pandemic, there was a redeployment of up to 80% of health visitors in some areas. That prevents the much-needed visits that we heard about earlier. Face-to-face visits are crucial in recognising issues early and in providing assistance. Will the Minister tell me what delays families have faced at this time and whether any additional resources will be offered to those who missed out on face-to-face visits?
As a mother of two under two at one point, I know how desperately stressful it can feel to have one baby already and have a new one arrive. I know what it is like to feel as though you are failing at motherhood and at being a working mother. I know just how challenging it can be, but I cannot imagine for a moment what it would have felt like to do that through the pandemic. We rely so much on being in playgroups, having other mothers and fathers telling us we are doing okay, and phoning the breastfeeding helpline at 2 am worried that you cannot make enough milk for your baby and having someone say, “Don’t worry. We can get a health visitor to come and see you tomorrow.” These are normal things, but for so many mothers they have been lacking throughout the pandemic. I fear for the effect that that will have on them, their families and their children in the long term.
My hon. Friend the Member for Sheffield, Hallam (Olivia Blake) asked last year about the additional counselling and support being provided for those who gave birth during lockdown. I noted that there was no clear answer on the proactive work that the Government have done to provide support to new parents. I ask the Minister whether that was because no additional resources have been provided. Does she recognise that maternal mental health has been overlooked in this crisis?
Pregnancy and childbirth can be such a beautiful time in people’s lives, but I know what it can feel like when it goes wrong. I know the fear of stepping into a hospital afterwards—the memories come flooding back. Your heart rate goes up, and you cannot even imagine what it would be like to be pregnant and to go through childbirth again. These things can be overcome, but not without the specialist help that people really rely on. I cannot imagine what it must be like for women going through this during covid, and yet it is another barrier in the way of getting the help that they and their families desperately need.
The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)
I thank the hon. Member for Richmond Park (Sarah Olney) for bringing forward this important debate. We have had a number of debates about maternal health over the past year, but this is particularly important, given the timing.
Pregnancy and motherhood are a period of great change for everyone. It has been particularly difficult for new mothers during the past year, while they have been in the middle of lockdown. I want to pick up a couple of points that the hon. Lady made. She cited a case study, which I cannot respond to because it is from Scotland, and, as she knows, health is a devolved matter. She asked about the number of midwives that we have, and that was mentioned by a number of Members. There has been an increase of 14.6% in full-time equivalent midwives in trusts and clinical commissioning groups over the past 10 years.
Let me answer a few quick questions that came up. My right hon. Friend the Member for Basingstoke (Mrs Miller) brought up workplaces. We need a call for evidence to gather the data that we need about what is happening to women in the workplace, both when they are pregnant and to do with their health. On Monday, I mentioned issues such as endometriosis, menopause and the musculoskeletal issues that women suffer from more than men. We need data about all that, which is why we made the call for evidence, and I do so again. It is very easy to click on the link and for women to let us know what is happening to them in terms of their health, both in the workplace and in healthcare settings. The number of respondents was in the thousands within a few hours of it going live, and we hope that it will give us the data we need to develop policies for the workplace.
My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) mentioned my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom), whom I spoke to last week. We await with great excitement the early years review. It started at the first 1,001 days. This has been my right hon. Friend’s life’s work. I have known her since she first came here as an MP and before, and this is something that she is absolutely passionate about and committed to. The cross-party review will be illuminating, and we are excited to see it launched, which I think will be later this year.
Although the perinatal period can be a time of celebration and joy, for some it can be a time of considerable anxiety and worry. Indeed, like the hon. Member for Lewisham West and Penge (Ellie Reeves), when I became a mother for the first time I was actually alone, because when my baby was 14 days old my husband had to go and work abroad for six months. So I was completely alone, and I absolutely remember waking up in the middle of the night, having nobody with me and being entirely alone trying to breastfeed a baby, totally struggling and not being able to do it. So I remember how hard it is.
Actually, I think I am allowed to say that I am about to become a grandmother for the first time, and I really hope that I can be there for my daughter. I hope that we are over this pandemic and out of it by the time that my daughter gives birth, so that I can be there for her, to help her through what will be difficult times, because every new mother feels that difficulty.
I would like every new mother to know that support is there. Increasingly—indeed, at a rate of knots—we are expanding services, and there is no shame in seeking help, including through the pandemic. Specialist and in-patient perinatal mental health services have remained open during lockdown. There have been restrictions, but services have been providing digital and remote support. For those with severe needs or those who are in crisis, perinatal or otherwise, all mental health trusts have set up new 24/7 crisis helplines—I remember the call on 4 April last year when we decided that we would do this, and those helplines rolled out and were open. I have spoken to the chief executive officers of mental health trusts, and one told me yesterday that the volume of people using those 24/7 helplines has been tremendous. They have been set up and they have been used, including by new mothers.
In the 2020 spending review we also announced up to an additional £500 million for mental health services. That was on top of the £2.3 billion a year that we are investing to address waiting times for mental health services and to give more people the support that they need.
We have also taken action to ensure that mothers can continue to have broader support throughout the perinatal period, both from statutory services and from family support. Health visitors, who are ideally placed to support families, and the health visiting service continue to provide an opportunity to identify families who may need support. The health visiting service has remained in contact with families throughout the pandemic and it will continue to do so and to prioritise very young babies and vulnerable families.
Recognising the support that a father or the mother’s partner can bring, we published guidance in September to reintroduce access for partners, visitors and other supporters of pregnant women in English maternity services. We also launched a campaign to ensure that people continue to access services and get support early.
We have continued to deliver on the ambitions for maternity and mental health services that we had before the pandemic, to ensure that mothers get help earlier. From April 2020, we have invested an additional £12 million per year for every mother to be offered a six to eight-week post-natal check by her GP. I think that my hon. Friend the Member for East Worthing and Shoreham campaigned on this for some considerable time. Through the post-natal health check, every mother can now expect to have the opportunity and the time to discuss any concerns that she may have about her physical or mental health and wellbeing.
We remain committed to making perinatal mental health services a priority through the NHS long-term plan. There is now—this point is very important—a specialist community perinatal mental health service in every area of England, and we are further increasing access to perinatal services, so that at least 66,000 women will be able to access perinatal mental health services in 2023-24.
I went to see one of these perinatal services at the beginning of my time in post, 18 months ago; they had just begun to roll out. I have been to see one of these perinatal mental health teams working, and it was just tremendous. The nurses had only been in place and operating for a matter of weeks, but they had already had something like 120 referrals and mums they had seen. That demonstrated the need for such a service and almost endorsed the reasons why they were there, as well as highlighting the services that they were providing to those young mums.
Importantly, we are extending the length of time for which specialist perinatal mental health community services will be available, so those services, which currently run from preconception to 12 months after birth, will be available from preconception to 24 months after birth. We are also developing and implementing maternal mental health services or maternity outreach clinics, which bring together maternity and reproductive health and psychological therapy for women experiencing mental health difficulties directly arising from or related to the maternity experience.
As the hon. Member for Richmond Park can see, we have put a huge amount of work into maternal mental health. She is quite right. I cannot remember who highlighted the fact—it may have been the hon. Member for Tooting (Dr Allin-Khan)—that suicide is still the biggest cause of death in the period from, I think, eight weeks post delivery to 12 months. It is still the biggest cause of maternal death. That is why this issue is so important to us. To reduce the figures and ensure that suicide is not the biggest cause of maternal death, we have to put the services in earlier. We need to ensure that both at an antenatal stage and at the time of the check with a qualified GP at six to eight weeks, those perinatal mental health services, which are now available in every area of the country, are in place. We have done that through the funding that there has been from the £2.3 billion that has been allocated to the long-term plan.
Many mothers who experience mental health problems in the perinatal period are treated in the community, but a very small number will need hospital admission for their mental health, as the hon. Member for Richmond Park will know. It is right that, where possible, we keep mother and child together. That is why—this is also an announcement; a fact that I am proud of—NHS England has expanded the capacity of mother and baby units in England, with additional four to eight-bed units now providing specialist care and support to mothers who are experiencing severe mental health problems during and after pregnancy. I checked just before I came into the room for this debate, and we are now up to 152 beds across England, which represents a tremendous increase in the number of those units. It is so important in those first days to keep mother and baby together as much as possible.
The units support women with serious mental health issues by keeping them together with their babies and with specialist staff who nurture and support the mother-infant relationship on the ward at the same time as the mother is treated for her mental illness. That is a huge step forward from how things used to be not so long ago. Mothers who are at that severe stage of mental illness post delivery can have that treatment in those beds; they can be treated by those specialists. Mother and baby are together, and there are psychiatric services at the same time. That is a huge leap forward.
We recognise that maternal ill health can also have an effect on the child’s father or the partner of the mother. We are therefore also offering partners of women accessing specialist perinatal mental health services and maternal mental health services evidence-based assessments for their mental health and signposting to support as required. In the future, partners of expectant and new mothers who are seriously unwell will be offered a range of help, such as peer support, behavioural couples therapy sessions and other family and parenting interventions.
We are also taking forward work to ensure that all babies and young children in England receive the best start in life. I will come on to the early years review. My right hon. Friends the Secretary of State for Health and Social Care and the Prime Minister jointly commissioned in the summer of 2020 the early years healthy development review. It is important, so I will say this again. The review looks across the first 1,001 critical days. The SNP spokesperson, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), also spoke about the importance of the first 1,001 days, from conception to the age of two. This is about ensuring that babies and young children in England can be given the best start in life. Phase 1 of the review is in its final stages, and the vision for brilliance, setting out policy actions for the Government, will be published shortly.
I hope that my response goes some way to assuring all hon. Members that this Government remain committed to supporting mothers throughout the perinatal stages and up to 24 months after giving birth and ensuring that we can reach out to mothers who may need help coming forward about their mental health.
I would like to end by talking about women’s health more broadly. Pregnancy, childbirth and motherhood are just some of the stages of life that many women can experience. Throughout the course of our lives, the physical milestones, the changes to our bodies and our experience of the world have an impact on our health. I reiterate that we are having our International Women’s Day debate tomorrow, and I hope that the call for evidence will be mentioned, so that we can better understand women’s experiences of the health and care system but also, as I said at the beginning, their experiences of health, including motherhood and maternity, in the workplace. Without that evidence from women, we do not have the data and the information that is necessary in order to adapt and develop policies moving forward.
I will finish by urging all women to share their experiences through the call for evidence. It will form the basis of a new women’s health strategy—the first of its kind. This is the first time any Government have called on women for evidence, so that we can set an ambitious and positive new agenda to improve health and wellbeing and to ensure that health services are meeting the needs of women everywhere, especially in perinatal mental health.
Sarah Olney
This has been a really fantastic debate, and I am so grateful for the contributions from Members, both in the room and on Zoom. I welcome the contribution from the hon. Member for East Worthing and Shoreham (Tim Loughton) and all the work that he has done, particularly as the chair of the APPG for the first 1,001 days. He has highlighted the work of the right hon. Member for South Northamptonshire (Andrea Leadsom), and I am very much looking forward to reading her review, which will be really interesting. He also highlighted the importance of fathers, and I am really grateful to him for raising that important aspect of the debate.
I am grateful to the hon. Member for Strangford (Jim Shannon) for mentioning grandparents. Some of the most distressing correspondence I have had during this pandemic has been from grandparents who have been unable to see and hold their new grandchildren, so I thank him for raising that issue. I congratulate the Minister on her impending grandmotherhood and hope that all goes well.
I am particularly grateful to Members who have shared their own experiences throughout the debate. I thank the hon. Member for Truro and Falmouth (Cherilyn Mackrory), whose experience highlights what I was saying about the inadequacy of telephone and digital follow-up appointments. She spoke of her experience of post-natal depression, and I am really grateful to her for sharing that. If I could stretch out a virtual hand, I would like to say to her that we share the experience of baby loss, and I know what that is like.
I am grateful to the hon. Member for City of Durham (Mary Kelly Foy) for highlighting another really important aspect: babies who are born with additional needs, the particular needs of their families and how they have been affected during this pandemic. I really hope that their needs can be prioritised going forward. I also want to mention the right hon. Member for Basingstoke (Mrs Miller). It feels as if a mother’s financial experience is almost an additional thing, but she is absolutely right in saying it is central to mothers’ mental health to know that they have economic stability. I thank her for raising that.
I want to pick up on the Minister’s comments. I am really pleased to hear about the call for evidence. As I say, I am looking forward to the early years review. I want to push her on the point about not allowing digital and telephone consultations to become the norm in perinatal mental health, because those face-to-face visits are so important to mothers everywhere, and I really hope that can be embedded. I thank everyone for their time this afternoon, and thank you, Sir Edward, for your chairing.
Sir Edward Leigh (in the Chair)
Speaking as a grandfather, it has been a very interesting debate.
Question put and agreed to.
Resolved,
That this House has considered maternal mental health.