Advice to Policymakers
We asked women for advice they would like to offer decision-makers and policymakers about perinatal mental health care. The following five themes emerged from their comments:
- Make maternal mental health a policy and funding priority
- Create specialized mother and child support services
- Enhance professional training
- Provide more mental health services – before and after birth
- Address stigma and increase awareness
By sharing their observations and experiences, the women that we spoke with provided actionable insights to inform policies and enhance services for better maternal mental health.
Make Maternal Mental Health a Priority and Fund It
Women encouraged policymakers to provide resources and create responsive policies and services based on the data already available on maternal mental health outcomes such as depression and suicide rates. Several of the women that we spoke with commented on how under-resourced services for mental health were in the healthcare system. While it was noted that there are some services for women with low incomes or very high needs, Joan said that gaps in services left many women without care: “There’s not a lot of supports out there for people who don’t need the basic needs met, but need that kind of secondary emotional sort of support”.
Tara advises that policymakers look at rates of women who die by suicide after birth.
Transcript
My advice would be for those who decided that mental health – maternal mental health wasn’t important enough to fund. You know? Like, I’d probably give them a little – a piece of my mind. You know? [Laughter] I wouldn’t give them advice first. I’d just, you know? But no, […]
Leah says that more resources and funds are needed for mental health.
Transcript
More resources and funds need to be put into mental health. And I know, our healthcare system is very much in crisis and strained to the max as it is. I mean, I’m glad that there’s more public awareness about mental health, but we still have a long, long, long […]
Christine says that the system is under-resourced when one staff member's illness can shut down a whole service.
Transcript
I think my individual circumstance, I think they had to cancel because the person was sick, and they didn’t have a replacement. And then I didn’t get rescheduled. I think that was a fault within the system and not any individual professional. I think there’s people to, they’re gonna get […]
Create Specialized Support Spaces
Several women described the need for dedicated spaces where mothers can get mental health support from well-trained staff, without having to be separated from their newborn babies. These places could women to be together with other women with similar struggles, offering peer support as well as professionally–led support groups. Andrea would ”love to see a beautiful ward created for this specific purpose. I would love to see half of it devoted to prepartum issues and half of it devoted to postpartum issues”. Andrea also thought “running support groups during pregnancy is really important. I think having a place to go when you’re pregnant and you’re depressed is really important. If people create a weekly session for women who are pregnant to go to, with a psychiatrist there, that would be unbelievable. Again, I think support is everything, I really do”.
Andrea describes the need for a safe space for moms to get mental health care and support.
Transcript
That’s another thing, when women talk about how scary it is with a baby with no sleep in front of a pregnant woman, it makes it worse. But if you could somehow have the same place with nurses who are specialized in it – I mean the nurses who work […]
Caroline speaks about a postpartum mental health centre for mom and baby.
Transcript
Je ne le sais pas… T’sais c’est sûr une baguette magique, t’sais je pense que ça… Un centre pour les femmes avec leur bébé, le temps de se remettre sur pied, parce que moi, souvent je me suis dit : « Il faut que j’aille à l’hôpital. », tellement je me sentais pas […]
Tara says that formal systems need to take the lead.
Transcript
I’m just so disappointed. Like, I’m so – that women have to find Facebook groups and go through Facebook groups to find resources, to find groups. Like, it’s – it shouldn’t be up to, like, a random – it’s great. It’s great that women come together and they just do […]
Enhance Professional Training
Women highlighted the need for enhanced perinatal mental health training for nurses, doctors and other healthcare staff. Specifically, some women advocated the use of trauma-informed care approaches since the birth experience can be both mentally and physically traumatic. Emma said: “I would definitely say that doctors and healthcare professionals that come into any contact with a pregnant woman or a birthing woman or person, they need trauma counseling, they need to hold accountability for their contribution to trauma, and support. And also, I think that there’s more services needed for postpartum.” Both Canadian and American medical guidelines encourage screening and assessment for perinatal mental health disorders, but Kalli questioned whether they were being implemented by physicians adequately:
Why is there not anything for mothers who are pretty much embarking on one of the most significant life changes that is set to come upon her when she has a child that they do – that – that you’re basically just leaving it for the doctor’s discretion to assess whether or not this woman, this person, is at risk or might end up with postpartum depression or anxiety or whatever? Like, there’s other stuff. There’s the psychosis as well. Like, it – it falls so short of meeting that individual’s needs. There are so many gaps….
– Like, why don’t you have it as part of your guidelines to assess the woman’s mental health properly? Not just ask, hey, how are you feeling? Like, well, that’s such an open-ended question. Where are the detailed questions to kind of to make sure and rule out anything is happening? Like, mental health wise. Again, it could be, like, something gets screened, something gets flagged. Then the OB knows where to go. And refer that individual to get, you know, proper assistance and care. Right?
Karmin suggests that professionals reach out and ask women how their birth experience was.
Transcript
Yeah, so like I had mentioned, like, with my postpartum care it would have been good if they have some type of birth trauma informed care and, I don’t know, even just like asking them how would you – how would you classify your birth experience? Because I’ve had friends […]
Offer More Support – Before and After Birth
The need for a more holistic approach to maternal care – one that considers the well-being of mothers, beyond caregiver to baby, was mentioned by several women. Julie advocated for earlier education: “And that’s where I think it could be a very easy, quick win for us to completely change how we do discharge and education training. That I think it should be done way in advance. You know? With parents and birthing parents, like, when, you know, they have multiple weeks to process information prior to actual game time, they can ask questions in a calm way because they’ve had time to – when they’re not dealing with, you know, post injury issues as well as mental health potential challenges. To me that’s just, like, such a simple, easy thing that could be done and could be a game changer”.
Others suggested more frequent and comprehensive postpartum care that considers physiotherapy and mental health checks. Kalli wondered why the 6 week follow–up visit ignored her mental health and focused on “contraceptives because, you know, apparently there’ll be the things that will be the first thing you want to do is have sex after you have a kid?” Karmin thought policy should include “reaching out to the moms”.
Emma wanted more postpartum visits and follow-up physio after caesarean section surgery.
Transcript
Also, I think that there’s more services needed for postpartum. That six-week bonus check, we see the doctor how many times through our pregnancies, I think there’s 15 times you see a doctor to check on you and the baby. And then the second the baby’s born, you get one. […]
Address Stigma and Increase Awareness
Julie offered this perspective:
Written testimony
And then I think, like, best piece advice for the health system more at large is that we need to be supporting women and their families or birthing people to be more inclusive. Birthing people through this journey. From a very, very psychosocial perspective, and really removing the medicalization of childbirth and postpartum – even pregnancy experiences. You know? Even, like, and I often tell women who are older to push back against these geriatric labels, to trust their bodies. Obviously they have to, you know, we need to be mindful of, like, there’s clear medical indications for things. But to not be, like, labelled and then streamlined just by virtue of the fact that you are a certain age. And I think that’s really doing women and birthing people and their babies a disservice by applying these labels. So my advice to the system would be really being mindful about applying labels and biases onto the care that’s being provided to birthing people.
Karmin also wanted a system that rejects labels and mental health stigma, by “letting people know it’s not a weakness. And like having care providers remind their patients it’s not a weakness”.