What does a mental health midwife do ?

[koalakate99]

I'm 23 weeks pregnant.

My midwife has offerred to refer me to a MH midwife as my mum ( unexpectedly), died 2 and a half weeks ago following a short hospital admission.

I'm really worried about being referred , and this highlighting or causing unwanted involvement/ attention from SS. The appointment is on Friday.

I am back to work on Monday, ( I have been given three weeks off due to the bereament), and am worried it could be stressful and anxiety inducing before going back to work.

I was under the care of the mental health team due to severe anxiety and had regular sessions with a mental health professional (not sure she was a midwife) throughout my pregnancy. They advocated for me to get an early c section date booked in, and be first on the list for my c section on the day.

Social services weren't involved at all, I didn't even think of it. The goal was to prevent me developing post-natal depression, as I was high risk.

I meant to say - I'm so sorry about your mum. Take all the counselling they offer you, it can only help.

Thank you.

I think i'm just so worried about everything right now.

I’m sorry to hear about your mum. Unless you were showing signs that your mental health will be effecting your ability to care for your child then there would not be a cause for social services involvement. They will just be able to support you, check in on you, ensure you have a safety net for afterwards postnatally when your mood may take a nosedive. It’s just an extra support, nothing scary I promise! And you can always decline/withdraw if you feel they aren’t necessary

The peri natal mental health team are there to provide extra support to anyone who may for any reason have vulnerable mental health .

So sorry for your loss

This is not a bad thing , you are not labelled or judged unfavourably
It's really for early identification of things becoming unmanageable which could affect the pregnancy
Be honest with them , take any support offered and be kind to yourself 💐

What kind of support could be offerred ?

Hey OP,

So sorry for your loss!

I had/have a MH midwife due to a previous mental episode and high risk of developing it again after birth.

I too was worried but they have been fantastic! It’s just another person to advocate for you and an additional resource you can draw upon.

Mine came to meet me, find out about my current MH and previous episode. Explain all available help and routes if I became unwell. Come up with a birth plan to reduce likelihood of relapse - ways to reduce stress of labour and unexpected (I opted for a planned c), more partner support (outside visiting hours), own hospital room to ensure maximum sleep, access to psychiatrists, psychologists etc if I wanted them. Supported me in not wanting to take medication preemptively but organised a preemptive prescription just in case I do become unwell.

She now checks in on me once weekly to see how I am doing. This sounds really intrusive and I previously would have hated the thought of that but I really like her and feel she is only here to support so quite like having a chat with her. You can decline this if you want.

There has been no social services at all even though my risk was very high for post partum psychosis.

She will probably just come and have a chat and see if you need or want any support. Even if they don’t offer anything now, I think they like to have a baseline of knowing you so they can know after birth what you are like and offer more help if your struggling.

Please don’t worry OP, it’s only a good thing and it shouldn’t have to be but it’s a really good trump card for pregnancy care which you can use if your not getting the care you require - ie. I had a battle for the planned c until I mentioned the MH and they said yes within 30 seconds!

And congratulations on the pregnancy 🥰

Oh @koalakate99 I'm so so sorry. To reassure you, the perinatal health team have no more cause to get SS involved than any other team. I don't know how to phrase this without being alarmist but if any team had concerns for your baby they would contact SS, normal midwife or perinatal health midwife, I'm not at all suggesting there will be any concerns though! Just that you should look into the support that's offered as SS isn't a factor at all.

I was under the PNH team and I was told it meant the team looking after me in hospital would have an interest in mental health as well as midwifery, so they would be able to help me work through my anxiety in a way another midwife may not (although most midwives have seen everything!)

It's not a weakness to take all the help offered to you as you go through a difficult time. I really do wish you all the best

Thanks, the only thing I can think of asking is I am at slightly higher risk of C-Section, ( spinal surgery when I was 15, I am now 30), and have a consultant appointment booked to discuss that on 30th June.

Some more info about the likelihood of needing a C-section/ ability to access epidural due to metal in my back may be helpful...

A mental health midwife isn't necessarily part of the perinatal mental health team. It is normal to have mental health midwives as a subset of the more generic midwifery service. They support pregnant women who may have additional mental health need but don't meet the criteria for the perinatal team, which normally has quite a high threshold of moderate-severe mental health need.

Are you struggling in particular with your mental health? Perhaps your midwife thought she was being helpful by offering but you are actually just grieving and dont need additional mental health support but could maybe do with some help like counselling etc to help with the bereavement?

I am so sorry for your loss.

I had my first appointment with a mental health midwife this week due to generalised anxiety made worse in pregnancy due to past traumatic experiences in previous pregnancies. She discussed support available to me. Also supported me to understand all the medical implications of my maternity care (I have a high risk pregnancy and see a consultant fornightly). I have her mobile and email so following my medical appointments I can contact her to clarify information. I also have anxiety regarding theatre due the previous traumatic experiences but I am having a planned c section so she said she can be there with me during the section and discussed things they can put into place to reduce my anxiety. The idea as well is I see this midwife more regularly than a community midwife so can build a better relationship during my pregnancy. It was left up to me to decide if I wanted to see her again or not. And no implications to social services at all. I think it might be worth having an appointment and seeing if some of the support they can offer is what you want or not.

Sorry to hear about your mum. I was under the perinatal mental health team until I moved trusts at 34 weeks pregnant. They were invaluable but I had no care in my new trust because my anxiety wasn’t severe enough (different criteria). I really missed the support and the last few weeks of pregnancy was really tough.

Social services do not get involved just because you see a mental health professional!! Can you imagine the consequences if they actually did do that???

Please don't sorry. I am a social worker and really struggled with anxiety earlier in pregnancy pregnancy (constantly worrying that baby had died and other irrational thoughts) - my midwife and I discussed a potential referral to the MH team but some other stuff I tried helped and it wasn't needed. Honestly if it was needed then I would take any support I could have regardless of my job!! Social care do not get involved with a family because they are open to mental health services (lots and lots of people are), they get involved if there is a risk of harm to the child/if there are additional support needs. Don't worry and get any support that you want to xx

@koalakate99 so sorry to hear about your mum 💐
I see the mental health team (nurse and psychiatrist) and also mental health midwife. The mental health midwife I’ve seen three times at 16 weeks, 24 weeks and 28 weeks - now 34 weeks. We made a mental health birth plan at 28 weeks which basically goes into how staff can support my mental health needs at birth and at appointments (for example, not asking me about previous births). She also went through previous notes and has been a sounding board over text/phone about different decisions I’ve had to make. She’s also put me in contact with other teams like infant feeding.
I now only see the nurse and psychiatrist but have this midwifes phone number if I need it.

Social services have never been mentioned/involved if that reassured you!

OP here.

So I'm now more confused.

I went to the appointment and was obviously quite upset about what's happened with my mum.

The MH midwife said she could refer me to the perinatal psychiatry/ mental health team, but when I asked what they did, she just said " I don't know , it's hard for me to describe really, you just have to accept the referral on trust if that's what they want."

When pressed, she kept saying, " well I don't know exactly what they do, perhaps they could offer you a nursery nurse to support with the baby once it's born, I don't really know" That obviously left me paranoid that they would think I wouldn't be a "good enough," mum, as why else would I be offerred a nursery nurse, unless they thought I wouldn't be good enough...

So, I said "no thank you," to the referral, and she said, "sure, just call me if you change your mind."

But how can I agree to a referral if she can't tell me what a perinatal psychology team does ? And surely there's not much point in a MH midwife if they can't tell you what they do ?

How can I take a referral "on trust" when she can't say/ doesn't seem to know what they do / offer ? What does a MH midwife actually do ?

It's just, I'm a bit disappointed the Mental health midwife can't tell me what the perinatal mental health team actually do....

Anyone ? tried ringing the MH midwife back on her phone for further clarification but her phone is switched off.

Hi OP, I posted earlier. I was with the perinatal mental health team. It’s a more equipped team so I would definitely say yes.

You will likely see a psychiatrist first who will talk to you and write a summary of your current state of mind and any increased risks they foresee (ie. post natal depression) to add to your notes. They may suggest options you can have if they think you might benefit. They can access psychologists (gold dust on the NHS), therapy, cbt, you name it. They have the full range of treatments at there finger tips and are much more powerful at accessing resources than the MH nurses.

Having had a dislike of psychiatrists from my previous contact with MH services I have to say all of the maternity mental health people were absolutely lovely. They will not jump to diagnose or label you with anything and everything is very softly and sensitively discussed. They also seem very understanding of emotions, worries, anxieties and thoughts as normal and part of life/ new motherhood as opposed to trying to say it’s a problem to think in any specific way. Very refreshing and polar opposite to my previous experiences.

I would go back and say yes. I too was worried but I have found it really supportive through pregnancy and post partum. You can always change your mind.

It sounds like the MH Midwife doesn’t know much about the perinatal MH team, which is disappointing.

I think you should accept the referral though and then you can speak directly to the perinatal team about what they offer and if you think it will be useful for you. You won’t be pressured into anything, but at least you’ll know what is available.

And to put your mind at ease I was referred because at really high risk of post partum psychosis. That’s something super serious and within 24hrs you go from normal to completely insane. Thankfully I havent had it so don’t know how it would present in me - but some think their baby is the devil or possessed and do horrific things in response. What I am trying to say is if anyone was going to get referred to social services it would have been me with that prognosis. Haven’t had any contact.

Hey in the end I phoned her back today and said "yes, refer me."

Tbh she, ( the MH midwife), has an incredibly patronizing manner and that didn't help much.

She just said "well it's not my job to know what the perinatal MH team do, it's my job to refer people to them !"

Well done 😊 If you don’t like it you can always opt out again but you might find it really good.

Nothing ventured nothing gained after all.

Goodluck with the pregnancy OP and your wee one.

If I were you I would be making a complaint about the midwife. How can she possibly assess you as in need of a service she doesn't understand? Her explanation is not adequate and the way she spoke to you is inappropriate

As a mental health professional, I would not think someone in the early stages of grief after a close relative bereavement was mentally ill or in need of additional services. In my experience the perinatal mental health team has an extremely high threshold and not for people experiencing appropriate emotions to a sad situation

This doesn't sound like an issue with you OP, rather than professionals doing a poor job