Maternal and Infant Mental Wellbeing
Ann Kerr, Team Head NHS Health Scotland
How the work got started
How the work was carried out
What the recommendations are
Next steps
Refreshing the
Maternity Services Framework
2001 Last Maternity Services Framework
2009 Maternity Services Action Group (MSAG)
commenced revision
Health inequalities and health improvement
identified as key gaps
MSAG workshop focus on health improvement
Decision to focus on maternal and infant mental
2010-2011 Short life working group
2011 recommendations to MSAG
Working group
Role and remit agreed with MSAG
 British Psychological Society
 Consultant midwives
 Health Promotion Managers Group
 Health Scotland
 National Childbirth Trust
 NHS Education for Scotland
 Mental Health Improvement Specialists Group
 Royal College of Obstetrics & Gynaecology
 Scottish Government
• Initial brief review of systematic reviews and
current work
• Logic model
• Review of reviews
• Development of recommendations
Appendix 1: Logic Model for Maternal and Infant Mental Wellbeing
Short term outcomes
Intermediate outcomes
Long term outcomes
Decrease in unplanned pregs
Promote healthy relationships
& sexual wellbeing to adolescents
(Link 1)
Parent education,
parenting skills progs & promote
positive relationships with infants
(Link 2)
Increased understanding of
importance of strong
relationships & communication
School students
Education services
Young pregnant women/
Identify and engage
all pregnant women early
in appropriate services
(Link 3)
All pregnant women/
(1st and subsequent)
Wider family
(e.g. partners, grandmothers)
Improve preconception &
antenatal care in
appopriate settings
(Link 4)
Inequalities sensitive practice
from all care providers
(Link 5)
Improve quality and availability of
appropriate post natal support
(incl. peer support)
(Link 6)
Develop key competencies,
incl.awareness of MH problems,
appropriate interventions,
soft skills & modelling
of key behaviours, in NHS &
partner staff who manage
& deliver maternal and
infant care
(Link 7)
Women at social risk
(e.g. domestic abuse,
addictions, previous
mental health problems)
Improved preparation for pregnancy &
childbirth; improved awareness,
understanding & implementation of
techniques/ approaches to promote
bonding & attachment.
Positive/trusting relationships
between mother & caregiver
Women engage early with high
quality services
Women at risk of poor bonding
& consequent poor attachment
of child are identified & engaged
Wider NHS and LA services
with a role in providing
ante and post natal care
(e.g. general practice, specialist
services such as mental
health services, addiction
services, homeless services)
Frontline staff have improved knowlege
and skills to identify and refer
women at risk of mental health problems
'leaders' in NHS,
local authority
and vol sector,
including planners,
Increased parental
Relationships, communication
& transitions between
midwives, HVs, GPs/primary
care team, & specialist
services are improved
Indicators, data collection
systems and records
support the early identification
and ongoing care of women
at risk of poor outcomes
Increased secure
attachment & reduced
disorganised attachment
Increased social
support for
Reduced domestic abuse
& other social risk
(e.g. addictions) during
pregnancy & PN period
Increased amount of
positive experiences
of pregnancy &
All women (including
those at risk of poor
outcomes) receive timely,
tailored support the right support at the
right time
More staff enabled to
deliver compassionate,
caring & competent care
Professionals in maternity care
services provide consistent information
and care, including use of soft skills, &
model/enable appropriate behaviours
Systems, structures and leadership
reflect the importance
of maternal & infant mental health
Coordinate and improve quality
of care and communication
antenatally, intranatally &
(Link 8)
(Both) parents have knowledge
& skills to provide responsive
and consistent care to infant
Dedicated maternity care
profressionals involved in ante,
intra and postnatal care
(midwives, obstericians)
Third sector care
providers and
support groups
Infant receives
responsive and
consistent care from
primary caregiver
Services more responsive,
accessible & appropriate
to the communities they serve:
barriers removed
Improved emotional and
behavioural outcomes for
children and young people
Improved maternal
mental wellbeing & reduced
postnatal depression
Decreased inequalities
in maternal &
infant mental health
Pregnant women choose
healthier behaviours
NHS services value
parenthood and children and
demonstrate this through
service provision
Context: Dyad
Recommendations cont
1. There should be coherence and consistency between
the Parent Education Curriculum and the wellbeing
components of the Curriculum for Excellence.
2. Parent Education and relevant parts of the Curriculum
for Excellence should be integrated into Scottish
Government’s wider parenting strategy
3. The partnership that developed the new Parent
Education Curriculum (HS, NES and HIS) should
ensure that its implementation and effectiveness, in
terms of short and medium term outcomes, is robustly
Recommendations cont
4. The use of equipment that allows physical or
face to face contact between mother and infant
(such as soft baby carriers, and parent facing
buggies) should be promoted.
5. Pre conceptual care should be provided by
sexual health staff, general practice, maternity
care and specialist mental healthcare providers
in order to improve their identification and care
for women who are planning a pregnancy and
are at particular risk of poor mental health
related outcomes.
Recommendations cont
6. All interactions between antenatal service
providers and pregnant women should be used
to promote mental wellbeing using strengths and
asset based approaches, as well as to assess
risk and need.
7. Staff providing postnatal care should be suitably
skilled to be able to identify and respond to signs
of mental health problems, and appropriate
systems and pathways should be in place to
allow appropriate referral where necessary.
Recommendations cont
8. Postnatal social support (which might include peer
support) is anecdotally very important but this is not yet
reflected in highly processed evidence. There is
evidence, however, that new mothers most at risk of
poor outcomes do not access group based support.
9. Interdisciplinary training in maternal and infant mental
health and wellbeing should be available for all staff
providing maternity care, including managers, and
should incorporate shared definitions and guidance, and
focus on the important contribution of maternity care to
promoting and maintaining maternal and infant mental
wellbeing. This should include maternal and infant
Recommendations cont
10. Effective assessment using the GIRFEC
practice model should be integral to maternity
care practice
11. Continuity of carer(s) and the development of
trusting relationships should be provided for all
women and ensured for the safe care of women
with complex health and social care
Recommendations cont
12. The way in which a woman is supported during labour
and childbirth is central to how the woman feels about
her childbirth experience and can have significant
implications for her postnatal mental well-being. Staff
providing intrapartum care should be suitably skilled to
identify and respond to women’s needs during labour
and to provide continuous positive care that enables
women to feel engaged and to have a sense of
control. All women should be given the opportunity to
spend quiet private time with their baby and enabled to
have skin to skin contact with their baby if they choose
as soon as possible after the birth.
Recommendations cont
13. New technologies (e.g. texting, social media)
should be used as mechanisms for improving
continuity of care and ongoing postnatal support.
Next steps
 MSAG endorsed recommendations and wrote to
all relevant agencies for action
 Merger of MSAG and the implementation group
for the new Maternity Care Framework
 Maternity care and public health special interest
 Parenting Strategy
 Antenatal access HEAT target
 Dissemination of evidence reviews and
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Maternal and Infant Mental Wellbeing