Maternal Mental Health

Sarah Olney Excerpts

Wednesday 10th March 2021 Westminster Hall

[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.

--- Later in debate ---

[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.