Childbirth-related Post-traumatic Stress Disorder

My Lords, we take the findings of this study seriously and recognise the significant impact that PTSD after childbirth can have on women and families. Postnatal appointments provide opportunities for identification of PTSD and specialist perinatal mental health services are available nationwide to support diagnosis, treatment and professional training. The national maternity and neonatal action plan will provide further opportunities to strengthen prevention and postnatal support for those affected by birth trauma.

My Lords, I thank my noble friend for her reply and her ongoing commitment to improving women’s health and mental health. This new evidence highlights that thousands of women with post-traumatic stress disorder following childbirth may be going undiagnosed. Will the Government use this evidence to raise awareness about childbirth-related post-traumatic stress disorder and work with NICE and other stakeholders to implement screening tools for diagnosis and a pathway for specialist referral in primary care so that women can receive timely diagnosis and treatment?

The key thing here is identification, because without that we cannot have treatment. Prevention of PTSD is really our starting point. I certainly agree with my noble friend that early identification is crucial and that women should be routinely asked about their mental health and birth experiences during postnatal contact. That is why training resources have been developed to support this. I can assure my noble friend that I am very keen that we continue to work with clinicians, charities and, crucially, women with lived experience, because further improvements are needed, including on how women can be identified earlier and referred for appropriate support.

Can the Minister share the access rates to perinatal mental health services for Black, Asian and minority-ethnic women during and after pregnancy, and what actions are being taken to help them overcome barriers that they may face? One area that needs attention, for example, is cultural attitudes towards mental health.

While I cannot give the specifics here and now, I will be pleased to get that information to the noble Baroness. She is right to highlight the need to make sure that all women have access and that all women who have PTSD or experience of birth trauma are identified. Record numbers of women are now accessing specialist perinatal mental health services—66,500 women last year in England alone. The figures I can get the noble Baroness will, however, give a much better flavour of how we are reaching groups who may well be marginalised in the way that she describes.

My Lords, given that six out of 10 maternity units have been assessed as unsafe by the Care Quality Commission, it is not surprising that this research identifies thousands of women experiencing birth trauma. Will the Government now guarantee one-to-one midwifery care during labour and a consultant on every maternity ward 24/7 to support women giving birth?

Safety is key, and so are the experiences of women and their families. The noble Baroness and the House will be well aware of the national maternity and neonatal plan, which will drive proper, sustained improvement across the system. This is what I believe we have been lacking for years, and it is why we asked the noble Baroness, Lady Amos, to conduct an independent review. She has reported on that and the maternity and neonatal plan will be announced by the end of this year. I certainly look forward to that; it is being worked on as we speak, involving both clinicians and those with lived experience, as well as campaigning organisations and all those with an interest. I am feeling positive about how we move forward, and the point made by the noble Baroness about staffing and ratios will of course be part of that.

My Lords, one of the stresses for mothers, and indeed parents, and their mental health post traumatic birth is having a child in NICU. I understand that hospitals such as Alder Hey have piloted schemes where parents have been involved with the care of their child in NICU. Organisations such as the First 1001 Days Movement and Ei SMART have seen that this can have a huge benefit both for the mental health and longer-term care of the child and for parents. What can the Minister do to ensure that NICU units beyond Alder Hey are encouraged to involve parents, and even have them staying overnight within their units?

The noble Baroness is absolutely right about the involvement of parents being key, and it is variable across the country. This is not least because of the estate and the ability to do it. This is why we have invested £187 million in the maternity and neonatal estate since April of last year. I think that is a step forward; I do not think it will resolve the whole issue, but I hope it gives an indication to the noble Baroness that the point she is raising is well heard and being responded to, and that we will continue to respond to it.

My Lords, I think the noble Baroness is referring to a paper by Susan Ayers, who has studied this for many years. It is certainly not a new problem. In the literature, there are over 700 papers on post-traumatic stress disorder in childbirth and another 1,700 papers on it during or in childbirth. This is a long-standing problem. It is not always serious, but when it is then it needs to be taken very seriously. Most cases are relatively trivial and the national incidence is about 3.17% of women in childbirth. This is something we can handle. As the paper by Susan Ayers correctly points out, we could do something much better in primary care in this situation. I hope the Minister will take this on board.

I certainly will take that on board. I completely agree that this is not a new issue, but the report shines another light on the situation. I can confirm to my noble friend that I have specifically said that early identification of issues is crucial. Yes, there is a six-week to eight-week follow-up point, but I know—and many noble Lords will be aware from their own experience in their communities and families—that it is very variable how appropriate, good and effective that is. It is not acceptable that we have such a wide range, so I will focus very much on making those improvements.

My Lords, I will focus on two concerns. The first is that GPs often mistake PTSD for postnatal depression, meaning that mothers do not get the appropriate treatment. The second is that at the six-week postnatal check-up, to which the noble Baroness referred, there is no approved framework for assessing women’s risk of having PTSD. As the responsible Minister, what conversations is she having with NHS England and GP organisations to make sure that these two issues are addressed?

As the noble Lord heard in my response to my noble friend, that is exactly one of the points of focus. He is aware that, following portfolio changes, I am very specifically the Minister for Women’s Health and Maternity—there is a very special reason for that: to give that area focus—but I am also responsible for early years. The combination of all those things will be crucial. I emphasise that there are several touch points at which women vulnerable to and experiencing PTSD can be helped, supported and assessed, but we are not necessarily using them correctly. That is where I will be focusing.

My Lords, I would like to ask the Minister about two issues. First, has any research been done on the effect of early discharge on the subsequent development of PTSD after a traumatic birth? Mothers are now routinely sent home from hospital within hours of giving birth, which leaves them very little recovery time, particularly when they are going home to difficult family circumstances. The second issue is the wider context of education. When mothers have a baby and are having things such as flashbacks about the birth, they can be afraid that they are going mad. If they are afraid to declare these things and are unable to articulate them, they will continue to try to work with them, and we will end up with a situation in which very tragic events can occur. There is a need, even today, for wider education for women about the fact that, when you go home with your new baby, particularly your first baby, you do not necessarily have to find that you can do everything perfectly and that, where you have serious mental health issues, you must be able to seek help.

The noble Baroness is right to say that, and that there is no shame in seeking mental health support. The most recent CQC maternity survey showed an upward trend in women accessing mental health services, which may reassure her. Just last year, there was an upward trend in respondents being offered mental health support. Some 90% were offered it, so the offer is there. I also feel it is being offered in a way that normalises it, which is important. It is also important to reduce the situations in which a traumatic birth may take place. We must hang on to that. As the noble Baroness said, education is part of that more positive way forward in supporting mothers and babies.