Maternity Experience

Month: December 2015

Induction – Cascade – Caesarean Section?

I have great pleasure in introducing a guest blog from Kirsty Sharrock, a.k.a. SouthwarkBelle.  Kirsty is mum to two girls and lives in London. Her other day job involves biological samples, powerful lasers and badly fitting lab coats. When her first child was born in 2009 she became fascinated, and often infuriated, by the amount of misleading information aimed at new parents. Her response was the SouthwarkBelle blog where she tries to make sense of some of the dubious science or at least have a good rant about it.

Thank you so much to Kirsty for writing for us on the topic of Induction of Labour.

Kirsty Sharrock
Kirsty Sharrock – SouthwarkBelle

It’s a well known fact of modern childbirth: Inducing labour sets off a chain of other interventions which often result in an emergency caesarean.

But is this actually true?

Would you be surprised if I said it’s not? I certainly was. The idea goes against so much that I had heard from other women and from midwives, my antenatal teacher and of course the internet.

When I went overdue with my first baby I dreaded being induced. I’d heard nothing but horror stories saying it was entirely awful and unnecessary, it would almost certainly make the birth more painful and complicated and would probably set off a “cascade of interventions” leading, with grim inevitability, to the one thing I was most afraid off – an emergency Caesarean. It would also completely scupper my plans for a natural birth in a midwife led unit. But at the same time I was MASSIVE, it was August, and hot, I was desperate to meet my baby and had had quite enough of being pregnant. So I agreed to book an induction, then did everything I could think of to make that booking unnecessary. In the event I got my wish, sort of.

41 weeks and feeling massive

So was I right to fear the induction?

It seems the answer to that is no.

A 2014 study showed that being induced doesn’t increase the likelihood of having a caesarean. In fact women who were induced at term or when overdue were 12% LESS likely to have a C section than those who hung on for nature to do her thing. Their babies were also less likely to be stillborn or admitted to the NICU.

But can we believe this study?

We often see piles of scientific “evidence” that contradict each other. One minute coffee causes cancer the next it cures it etc. etc. so how reliable is this publication, given that it goes so strongly against the generally accepted view?

In this case the authors of the paper didn’t set up their own experiment or trial. Instead they did what is known as a meta-analysis. This is important because a meta-analysis is far more reliable than most of the scientific studies that make it into the media. The authors took the data from 157 different trials and did some serious number crunching. Looking not just at the results of those trials but at their weaknesses too. For example, many of the individual trials were pretty small, meaning their results are less reliable than bigger studies. Others were quite old or asked slightly different questions to the rest. But this variation is the whole point of a meta-analysis. By putting it all together it’s possible to overcome many of the errors and biases that inevitably influence the results of individual studies and to find a more reliable consensus.

We rarely get perfect answers in anything associated with biology. For obvious ethical and practical reasons we can’t do loads of enormous, randomly controlled trials to answer questions about human childbirth. So a meta-analysis, although still imperfect, is about as good as it gets.

But how can it be true when it contradicts so many people’s experiences?

This is the really tricky part. These results fly in the face of something many of us have learned to be true: In the experience of many women, midwives, etc. inductions tend to end in C sections. As yet I don’t know of any scientific studies to explain this difference, but if we step away from numbers and statistics for a moment, there are a few, very human, possibilities:

Relying on personal experiences is tricky. We’re all inclined to notice and trust things that confirm our existing beliefs. That’s just human nature, and it happens to everyone (I’ve known a few, usually logical, scientists get carried away over flimsy results that fit their current theory). In this case perhaps midwives and doctors who expect inductions to end in c sections are just a little more likely to remember the ones that do. Those births may also stick in the mind more than the less eventful, straight forward ones.

A similar thing can also happen with women’s own experiences. Even with everything seemingly perfect, births don’t always go to plan. Difficult births happen and sometimes they happen after an induction. If a woman has heard many times that inductions cause c sections, then it’s only natural to assume the induction was to blame if she does end up in theatre. Maybe that was the cause, but there is no way to be completely sure that the same things wouldn’t have happened with a spontaneous labour.

There is also the risk of self-fulfilling prophecies. It’s possible that some women are ending up in theatre just a little earlier than they need to because they, or those caring for them, suspected it was inevitable. Perhaps most importantly, there is the issue of fear. It is thought that fear can be a big cause of problems in childbirth. If a women is induced, and terrified of the procedure and what she’s been told it will lead to, then it could be the fear itself which causes the problems.

So should every woman be induced at full term?

What this study doesn’t do is prove that all women should be induced the second they hit 40 weeks.

There are many reasons why a woman may decide to delay or refuse an induction. I went into labour naturally but still ended up having some of the interventions that can be used in an induction and I found them pretty unpleasant. Every woman and every birth is different and each comes with a unique set of considerations. Meta-analysis and big data sets give us a clearer and more objective view of the big picture but they can’t say what is right or wrong for any individual mother. That choice must be hers and to make it women need good, evidence based information and often help from skilled, knowledgeable, health care professionals.

This paper also doesn’t give us is a very clear picture of just how likely it is that an individual induction will prevent a c section, still birth or NICU admission. What I hope we will see in the future is more user friendly data. Every women will have their own tipping point for where the numbers add up to choosing induction.

Looking pretty rough after a labour that started naturally, but still ended in an emergency caesarean

So what now?

Like many pregnant women I was taught to fear induction of labour and the cascade of interventions it would cause. Now it seems that fear was based on a myth. So it’s important that the evidence, challenging though it may feel, gets out to pregnant women and to those giving them advice. Unnecessary fear in childbirth is potentially harmful and certainly unfair. All the more so for those women who feel they have little choice but to be induced for urgent medical reasons.

This study also has implication beyond individual decisions. There is often a binary division of births. On one side the “low risk”, “normal” births that can be handled entirely by midwives and on the other “high risk” births, which are, effectively, everything else. Being induced can push an otherwise low risk woman over that line.

In the hospital where I gave birth this made a big difference. The Midwife led unit didn’t just have lower all round intervention rates, it also housed built in birthing pools and lovely en-suite rooms where mum, dad and baby could recover together after the birth. If I’d been induced I wouldn’t have been allowed on this unit. So, in choosing weather to be induced or not, I wasn’t just weighing up the risks of induction v continued pregnancy. I was also deciding if I should risk higher intervention rates, sacrifice the more welcoming facilities and deny my husband the opportunity to share the first precious hours of his child’s life. Now we have strong evidence that induction can reduce C section rates and in some cases save lives, should it really be the determining factor in where some women can give birth? Or in the standard of care they receive?

For me, spontaneous labour didn’t prevent an emergency C section. Perhaps I’d have stayed out of surgery if I had been induced? I doubt it, although I’ll never know for sure. But I can be glad that when other new mums are overdue, concerned about their baby’s health or just hot, heavy and sick of being pregnant, the myth of induction-cascade-caesarean section will be one less thing to fear.

Kirsty Sharrock / SouthwarkBelle


Kirsty MatExp pals
Kirsty with #MatExp pals Leigh, Louise and Jen

A version of this blog first appeared on the SouthwarkBelle website:

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Welcome to the start of ‘A Catalogue of Maternity Experiences’. Rachel @enduringdelight from This Woman’s Work Blog gets us started with her positive maternity experiences and how they inspired her. We hope this motivates you to share your story too.

Read “An Important Catalogue of Your Maternity Experiences” to find out more about this #MatExp action, and submit your story.

Rachel's Positve MatExp story

I am by no means as eloquent when writing as some of the other members of the #MatExp community, but after seeing this tweet from the inspirational Sheena Byrom and following a suggestion from the lovely Helen Calvert I felt it really important to write this post.  As Fab Obs Flo once told me, outside of my comfort zone is where the magic happens (thanks Flo!).

“I’ve learned that people will forget what you said, forget what you did, but people will never forget how you made them feel.” – Maya Angelou

This quote pretty much sums up the story of our children’s births.  I will never forget how the people who cared for us made me feel and how they changed my life.

Rachel at teaI’m Rachel, mama to (almost) 7 year old boy/girl twins and our youngest little boy who is 3½ years old.  I’m also now an NHS Breastfeeding Peer Supporter, MSLC Vice Chair and birth junkie with a particular interest in improving birth experiences for families and the relationship between attachment and neuroscience.

I can’t even remember how I stumbled across #MatExp , but it is an amazing movement; it excites me to know that there are many other people out there as passionate as I am about supporting families to have the maternity experience they crave.  For a long time I thought that my passion for positive birth and all of the issues surrounding it might just be a bit odd!! I don’t contribute to #MatExp as much as many or as much as I would like, but it is a privilege to be part of that community and so I am very grateful to some of #MatExp’s lovely ladies for encouraging me to persevere with writing this when I was struggling.

If you follow #MatExp you will know that, sadly, for a lot of the amazing people contributing to this grass roots movement inadequate care or a negative experience was their catalyst for getting involved.  For me the complete opposite is true, but sometimes that makes things difficult for me because in certain circumstances it’s really hard to talk about having had positive birth experiences as I feel like somehow people may interpret that as me being critical of theirs.

A positive birth experience for me was always going to be a physiological one, but I am not militant about it and I don’t believe that’s what everybody should have.  Moreover I believe that a birth that deviates from a woman’s ideal can still be positive if that woman is consulted, supported and given options rather than dictated to.

Having beautiful birth experiences and successful breastfeeding journeys are what drove me to become involved in movements like #MatExp and peer support.  I’m all too aware that sadly not everybody is as blessed as I am to have had experiences like mine, but I really feel like they should be.  It shouldn’t be a lottery that thankfully I won.  Every woman should be listened to, respected and involved every step of the way in her own and her baby’s care.

“Do the best you can until you know better and when you know better, do better.” –Maya Angelou

My maternity experiences were very different, but positive in their own right.  In hindsight there are things I would change if I could go back and there are things that weren’t ideal and that health care professionals should and could have dealt with differently, but that doesn’t make them a negative experience.  In fact the only reason I know that there are some things I would change and things that could have been done better is because of all of the things I have learned since, but if my birth experiences hadn’t been positive to begin with I wouldn’t have been propelled into the world of positive birth and maternity experience and so would have been none the wiser.  

The birth of our twins involved an induction at 38 weeks and 4 days gestation.   I see so many negative things written about induction that it is important to me to write about this.  I’m not writing about the process of induction and how good/bad this is for women and their babies.  What I want to write about is the fact that, if you have knowledgeable and respectful people caring for you it can be a positive birth experience even if it is not your ideal.  I am so grateful to the midwife who cared for us when our twins were born.  To be honest I think she was the catalyst for my passion for birth and the person who gave me the confidence to decide on a home birth for our youngest son.

Rachel Twins Positive Maternity Experience

I’d had a very straightforward multiple pregnancy and so despite being classed as “high risk” (a label I despise) I hadn’t needed much care at the hospital other than routine appointments and so was quite nervous about how I would gel with midwives caring for me when the time came for our babies to be born in hospital.  I need not have worried; as soon as Carmen walked in the room she came across as so knowledgeable and this gave me complete faith in her from the outset.  It was clear that she had every confidence in my body’s ability to do its job which in turn gave me that very same confidence.  After all, if she thought I could do it then why wouldn’t I?  

Something that particularly stays in my mind is her supporting my decision to not have an epidural. I had never wanted one, but the anaesthetist was fairly insistent on me having one almost as soon as the drip was in my arm and I think I would have given in were it not for Carmen; instead when she could see the conversation was becoming too much for me she delicately stepped in and dealt with it whilst remaining respectful and professional towards her colleague. I remember feeling so grateful to her for that and so relieved to not have to fight for what I wanted.  

“Drinking tea intelligently.” –Tricia Anderson

Our twins were born about 8½ hours after my syntocinon drip was started.  I remember Carmen talking me through each stage of the induction; she read my birth plan and made sure that I didn’t remain on the bed and that I got breaks from the CTG trace, she got a rocking chair to allow me to be more upright and off the bed, dimmed the lights and left us to it as much as possible, but without ever being more than a stone’s throw away.  She really did drink tea intelligently!!  Even when she was drinking tea for real on her break I was her priority and she came back when I begged for her to.

Three years later I found myself excitedly planning a homebirth for our third child in our teeny terrace house. There were a couple of little administrative hiccups, but each midwife I came into contact with was positive and enthusiastic about our plans which made me feel really confident about our decision.  

Rachel with newborn Positive MatExp

When the day came for our little boy’s birth I was blessed to have the support of another intelligent tea drinker; familiarizing herself with my birth preferences and facilitating them; Lorraine was a quiet, reassuring and confident companion and exactly what I needed.  Although she hadn’t been my named midwife I had met her at a routine appointment and as soon as she arrived at our home on my son’s birthday I remembered how enthusiastic she had been about my plans for a homebirth when I had seen her all of those weeks before so I immediately felt calmed by her presence.

It was a very straightforward, if a little speedy, birth and with the aid of a tens machine, some hypnotherapy and a little gas and air our son was born in water less then two hours after Lorraine arrived and probably only about 20 minutes after the arrival of the second midwife. They stayed with us for a couple of hours or so after the birth; helping my husband to tidy up and ensuring we got breastfeeding off to a good start, being attentive, but respectful of what was an important time for us.

Rachel with family

The midwifery team’s apparent confidence from the outset in the decision we had made to have our son at home as well as Lorraine’s confidence in her own ability as a midwife and my body’s ability to deliver our baby served to make me more determined to support other women and help them to achieve a birth experience that they were happy with.  This is how I came to become involved in our local MSLC just a few months later; I wanted so much to make a difference.

It goes without saying that when mistakes are made we need to learn from them and make sure that those mistakes never ever happen again; I’ve worked for solicitors on birth injury cases and am all too aware of the devastation that can result from human error.

In addition though it is vitally important that we learn from the positive.

There are many midwives (and other healthcare professionals) who are wonderful at their jobs and passionate about the care they provide.  These people have life changing positive impacts on families every single day and I feel so strongly about the fact that best practice should be shared and celebrated so that it can be replicated by others and that’s what I wanted to do today and to achieve in writing this. I wanted to share my positive experiences and celebrate the midwives who made a difference to me and to my family; I will forever be eternally grateful to you.

“We are like a snowflake; all different in our own beautiful way.” – Unknown

Most of the world faith traditions have stories of the birth of special people. There are signs accompanying the birth. Stars, wise men and phenomena announcing the arrival on earth of someone wonderful. Perhaps these stories are signs of what we should celebrate with each birth. The birth of every single child and every new parent is special.

As we welcome these little ones into our world let us think deeply. What physical environment is most fitting? What psychological and emotional factors should be named and made present? What people and attitudes will build that loving cradle of experience to welcome the newest member of the human race – our race? Every child and every mother are unique – like every snowflake.

Maternity experience is about creating the best for the newest.

I am fortunate that my experiences have been positive. Let’s always put women, children, families at the centre of our care and create experiences that reflect how special birth is.  

Rachel xx

(The content of this post is my story, but a special thank you to John Walsh not only for taking the time to proof read and make some suggestions as to the finer detail, but also for his encouragement. You can read more of John’s wonderful musings here.)

~ How has your maternity experience influenced you? ~

Look out for @HeartMummy Helen’s story next month.

You can submit your story too; see the second paragraph for more information.

Like what you’ve read? Share far and wide 🙂

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It is time to talk about the ‘perinatal’ aspect of Perinatal Mental Health (PMH): the ‘missing link’ in the national campaign

I am delighted to be able to publish today a guest blog for the #MatExp campaign from Mr Raja Gangopadhyay.  Raja is a Consultant Obstetrician and Gynaecologist with special area of clinical interest in Perinatal Mental Health (PMH) from West Hertfordshire Hospitals NHS Trust. He is a member of the Royal College of Obstetrician and Gynaecologist (RCOG).

Raj capture

I would like to take this opportunity to share my views on why I feel so strongly about the role of the Maternity Services in Perinatal Mental Health (PMH).

Perinatal Mental Health (PMH) has two important components in its terminology: ‘Perinatal’ (period during pregnancy, delivery and post delivery) and ‘Mental Health’. Therefore the care of mums in the Maternity Services during this vital period is of utmost importance in PMH: it should be a no-brainer.

But sadly, PMH is the only one area of Maternal Health where I do not see a strong voice of the Maternity Services in the national campaign.

This has remained ‘Cinderella’ within Maternity Units in spite of the glaring facts:

  • PMH is still one of the leading causes of maternal death in the UK.

  • This is one of the most prevalent conditions mums suffer from during their pregnancy and postpartum period (at least 10% of mums suffering from this).

I strongly believe that without robust ‘perinatal’ care, women would continue to suffer and die from PMH illnesses, no matter how much we spend to expand specialist Mother and Baby Units (MBUs).

Therefore this is the time when we must recognise this important area and raise awareness.

I am trying to address this issue through my campaign on social media and as the Royal College of Obstetrician and Gynaecologist’s (RCOG) Representative to the Maternal Mental Health Alliance (MMHA).

What do I mean by PMH ‘within’ Maternity Services?

Suffering and deaths from PMH illnesses are often preventable if appropriate measures are taken during pregnancy and in the immediate postpartum period.

A prevalent health condition like PMH must be managed with the same readiness as managing other medical conditions in pregnancy such as diabetes, high blood pressure (pre-eclampsia) or heart disease.

The only way to ensure that the women with PMH are appropriately cared for according to the NICE guideline (2014) is to have:

  • A dedicated PMH team within every Maternity Service:

A Consultant Obstetrician, Specialist Midwife, a Perinatal Psychiatrist, a Specialist Psychiatry Nurse and a Paediatrician should jointly lead this service locally. The service should be easily accessible to the mums.

  • A dedicated Obstetric-Psychiatry Antenatal clinic

  • Communication with Community Team:

This Maternity Service should have clear links with GP, Health Visitor (HV), community MH Team, Liaison Psychiatry services, Mental Health Crisis Team, Children and Young People services, Peer Support groups and other charitable organisations.

  • Robust Care Pathway:

There should be a clear pathway for risk assessment (at the booking visit and at every consultation), early identification and treatment. There also should be provision of a multi-professional team meeting on a regular basis.

  • Dedicated specialist service and support:

For conditions such as PTSD / birth trauma, fear of pregnancy and child birth (‘tocophobia’), bereavement and support for mums and dads whose babies are admitted to NICU.

  • Pre-pregnancy advice service:

It is important to have specialist advice and support for women (with PMH illness/ traumatic experience in previous pregnancy) who are considering pregnancy.

  • Patient involvement : ‘Patients first and foremost’

PMH is an area where patients’ opinion must be considered in developing local care pathways. Services must be evaluated on a regular basis based on patient experience.

I firmly believe that all the health conditions should be treated in the same way with professional expertise and kindness and without any prejudice. I am not sure why we still classify health conditions into ‘physical’ and ‘mental’ when there is often an overlap.

Psychological care in pregnancy, delivery and beyond…

It is unfortunate that psychological care has remained a very neglected part within Maternity Services. The reason given for this is ‘the staff are too busy’.

However pregnancy is probably a period of life where psychological support from the HCPs is needed the most.

It is especially important when mums could potentially have severe stress during pregnancy and the postpartum period due to the following factors:

  • Previous history of miscarriage, ectopic pregnancy, IVF, traumatic childbirth.

  • Any other family member or friend has had complicated childbirth experience.

  • Sudden life event such as breakdown in family relation/divorce, loss of employment, bereavement in the family or loved one, relocation/migration and domestic violence.

  • Sexual abuse in childhood or pregnancy as a result of sexual violence.

  • Associated pregnancy complications (for example premature rupture of membrane, high blood pressure, diabetes, concerns on baby’s growth or SPD).

PMH is not only PND and Puerperal Psychosis (PP)…

Many believe that PMH is a term equivalent to the care of Postnatal Depression (PND) and PP.

PMH includes specialised care for women (during pregnancy and one year after the childbirth) with any mental health condition (such as anxiety, depression, bipolar illness, schizophrenia, OCD, eating disorder, and personality disorders).

PMH must include bereavement care (miscarriage, still birth and neonatal death), traumatic birth experience/PTSD, support services for mums and dads whose babies are admitted to NICU and tocophobia (fear of pregnancy and childbirth).

Another important component should be the psychological care of mums and dads throughout the journey of pregnancy, delivery and postpartum period.

PMH, in my view, must be recognised as a separate subspecialty in the training of Obstetricians and Midwives.


Why is identification in pregnancy and immediate postpartum period so important?

  • Effects of psychological stress in pregnancy:

There are now plenty of research results, which indicate the long-term impact of stress during pregnancy on the brain development of the baby while it is in mum’s womb. Prof Vivette Glover, an eminent Professor of Perinatal Psychology from Imperial College London, explains this:

Therefore timely intervention and adequate support during pregnancy can prevent long-term effects on the child.

  • Care Planning to prevent serious illness:

All pregnant women with risk factors to develop worsening mental health conditions should have a plan of care during delivery and postpartum period.

Confidential Enquiries into Maternal Deaths have repeatedly pointed out that in the majority of cases of deaths from suicide, there is a lack of care planning during pregnancy.

This is only possible through appropriate care within the Maternity Services and multiagency communication.

  • Enjoying the journey of pregnancy:

Experience of pregnancy and birth creates a lasting memory for the mums and dads for the years to come. Therefore this should be an enjoyable experience for the woman and her family to cherish in happiness in the future.

As HCPs our role is to ensure we support and empower women to make informed choices for the safety of her and the baby and most important of all a very positive birth experience.

  • Helping mums to make informed decision regarding medications:

Mums should get proper advice regarding the use of medication in pregnancy and after delivery.

Pregnancy is a short window but an excellent opportunity to address health conditions.

  • Bonding and attachment:

PMH conditions can adversely affect the bonding with the baby and the mum.

‘A stitch in time saves nine’: Prevention of serious PMH illnesses is only possible through good care in Maternity Services.

Guardian capture

Having discussed the importance of the role of Maternity Services in PMH, now let us find out what is happening in the Maternity Units……

A journey of revelations…

I contacted many Maternity Units across the country to find out the provision of PMH services within their Units. What I found was extraordinary.

I raised my concerns in a letter published in The Guardian: .

I raised this issue with the Maternity Review Team, during my meeting in September (2015).

Although there are examples of good service, the overall structure within the Maternity Units is very poor:

  • Often there is no dedicated Lead Obstetrician and/or Specialist PMH midwife

  • Many Units do not have formal debriefing services (for traumatic birth experience), specialist bereavement midwives and support system for parents with babies admitted to NICU.

  • There are hardly any dedicated services for women with fear of childbirth.

Delving deep into the challenges….

To have a better understanding of the need, I embarked on a journey to meet professionals from all the relevant Royal Colleges (RCOG, RCM, RCPsych, RCGP), Health Visitor organisations, Maternal Mental Health Alliance (MMHA), MPs and All Party Parliamentary Group (APPG), NHS England, CCGs and other national Campaign Groups.

It was revealed that overall there is very little understanding of the vital role of the Maternity Services in PMH.

Thankfully RCM is campaigning for a Specialist Midwife in every Maternity Unit.

But the main barriers are the following:

  • Lack of Mapping of the existing services in PMH within Maternity Units (such as the MMHA map of the available Perinatal Psychiatry services).

  • Lack of a national standard of the service provision within Maternity Units (according to the number of deliveries and complexity of cases).

  • Poor collaborative work among HCPs: as often the Maternity Electronic record system is not accessible to other HCPs and vice versa.

  • Lack of standard Training programme for the Obstetricians and the Midwives.

  • Lack of adequate focus on PMH illnesses in Antenatal Education.

I have concerns that unless these issues are resolved appropriately, we cannot provide the best quality of care for women with PMH illnesses.

With the best of my abilities, I am currently working closely with other national organisations to address these areas.

Maternity HCPs: Please, please do something and don’t wait for things to happen….

Charles Dickens

It is true that funding is necessary to set up specialised PMH services and Mother and Baby Units (MBU). However Maternity Units should not wait for the approval of their business cases.

In my humble opinion, funding is not everything. Our professional values are the most important factors in patient care:

  • Kindness:

Simple measures such as a smile, empathy and a willingness to listen to the concerns of the mums and dads could make a huge difference in patient experience.

  • Communication:

Take every opportunity to explain the situation and ensure that appropriate wording is used during communication.

  • Continuity of care:

Try to ensure continuity whenever possible or communicate adequately with the rest of your team.

  • Local Alliance:

Please try to develop Local Alliances with Community Midwives, Health Visitors, GPs, all available community mental health services, Peer Support groups and children’s services.

This could significantly improve communication among the multi-agency teams in caring for mums with PMH illnesses.

  • Listen to concerns:

Please create opportunities to listen to the concerns of the user group. This may be in the form of promoting your local Maternity Service Liaison Committee (MSLC) or Patient Panels.

If possible, please read the real life stories of the Lived Experiences on the Internet: it would help you to think ‘outside the box’, have a better insight into the PMH illnesses and give you inspiration.

  • Raise awareness:

Arrange patient engagement events, Road shows or Community Events with local CCGs.

Participate in Social Media support, such as #PNDHour (Wednesday 8-9pm) and #BirthTraumaChat (Monday 8-9pm):

This would help to raise awareness, remove stigma and give mums and dads a ray of hope.

  • Arrange training on PMH:

Please ensure all staff are adequately trained in your local Units.

  • Get involved in your Regional PMH network:

Many regions now have regional PMH Networks. This could be an important place for information sharing among the Maternity Units.

  • Please do not forget dads:

There is now good evidence to support that dads can suffer from PTSD/PND. Please take every opportunity to support and communicate with dads.

  • Keep yourself updated:

PMH is a rapidly evolving area; therefore HCPs must keep their knowledge and skills up-to-date through continuous professional development.

If unsure, please seek help and escalate to your senior colleagues: an unsafe advice from a HCP could endanger an invaluable life.

Working together to make a difference…

We ALL need to work together to prevent suffering and death from PMH illnesses.

If you have any suggestions for improving PMH services within Maternity Units, I would be very keen to know (Twitter: @RajaGangopadhyay3).

If you are involved in good projects locally or are aware of any good practice, please share with everyone through #MatExp.


I am grateful to #MatExp for giving me this opportunity to write this blog.

I am immensely grateful to all the Lived Experiences for sharing their stories, which have enriched my knowledge on PMH much more than any textbook and journal article.

My thoughts are with all the bereaved families who have lost their loved ones due to this dreadful illness.

Raja Gangopadhyay



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