Six-week postnatal checks are failing many new mothers
Healthwatch England (HWE) have warned that six-week postnatal checks – required of GPs in England - are failing many new mothers.
As part of a review of maternal mental health care, HWE have analysed experiences of pregnancy and post-natal care shared by 2,693 new mothers and birthing parents since April 2020. Whilst the survey participants were self-selected, their views are likely to reflect those of a significant group of recently pregnant people.
50 local women across Cambridgeshire and Peterborough took part in the survey, 90% of whom were offered a six-week postnatal check-up. Of those who were offered a check-up, 83% reported they felt that the GP involved didn’t spend enough time discussing their wellbeing or mental health.
One respondent said:
I felt that my GP did not want to spend time discussing my postpartum recovery in any depth, and just asked if I was ‘feeling ok’ which was neither specific nor encouraged me to be detailed about my concerns.
The analysis suggests that not all GP practices comply with the requirement to provide six to eight-week postnatal checks. And where those checks take place, it is not clear that GP practices are aware of NICE guidance which tells them in detail how to spot mental health problems and provide help.
Key findings
- Over one in 10 (16%) of new mothers and birthing parents who shared their experiences said they hadn’t received the six to eight-week check.
- Of those who said they had been offered the postnatal check, only one in five, 22%, were satisfied with the time their GP spent talking to them about their mental health.
- Nearly half, 44%, of respondents felt that the GP did not spend enough time talking to them about their mental health, while a third, 30%, said that their GP didn’t mention this during the check.
- One in seven, 15%, said they had had their six-week check over the phone, with many new parents finding it hard to verbalise their mental health struggles and discuss physical issues. In the worst cases, respondents felt the way their mental health issues were discussed was inappropriate and potentially harmful.
Six-week postnatal checks
In April 2020, the Government introduced the six to eight-week postnatal check after Healthwatch England shared the experiences of almost 1,800 women on mental health during their journey to parenthood.
General practitioners in England have since been contractually obliged and paid to assess new mothers’ mental health and wellbeing, providing an opportunity for referral to specialist services and additional support. Crucially, the checks must take place separately from a postnatal check focused on the health of the baby.
We undertook the latest research between October and December of 2022 to find out to what extent mental health support has improved during and after pregnancy.
Experiences of mental health support during and post-pregnancy
- Two-thirds, 1800, of the women and birthing parents who shared their experiences had struggled with their mental health during and after pregnancy.
- Nearly half of those, 41%, received no support to help with their mental health during and post-pregnancy.
- Delays in accessing mental health support can have a devastating impact on new parents, with some reporting they had struggled to leave the house, bond with their child and maintain relationships.
- First-time mothers are particularly vulnerable to developing mental health problems and are less likely to access timely care.
Other research
The findings come after the Care Quality Commission warned of a “concerning decline” in women’s experiences with maternity services due to a shortage of frontline staff.
Also, last year, a report by MBRRACE highlighted that in 2020, women were three times more likely to die by suicide during or up to six weeks after the end of pregnancy, compared to 2017-19. This is equivalent to 1.5 women per 100,000 giving birth.
Amanda's story: “I didn’t know about a GP six-week check”
Amanda’s daughter was born in July 2020. The single mother from Hampshire said that while her baby girl received a GP check, she was never invited to the six-week postnatal check to assess her mental health and wellbeing: “I didn’t know there was a GP six-week check available for new mums.”
Amanda suffered from anxiety and developed sleep and eating problems. She didn’t get any support from her family who lives abroad. She felt that a lack of guidance with practical things eg. bathing the baby, added to her mental health problems.
Her healthcare journey was long and tiring, with inconsistent support from health and care services. Eventually, an asthma consultant at her local hospital recognised that she might have suffered from postnatal depression and helped secure mental health support for her. Amanda started therapy, 18 months after her daughter was born.
“The therapy has helped me, and I am slowly coming out of the low feeling. I have talked about my feelings towards my daughter, I have learnt what to do with them. My eating has picked up and my sleep is slowly getting better.”
“When I was pregnant, I received all the instructions I needed. But once the baby was born, I felt on my own. When you are a single parent, you don't have your own support network and don't get adequate support, it can be very hard. I felt like I was underwater and couldn’t escape."
"If I had had more support at the right time, my mental health would be better."
We need action
HWE have made five recommendations to help ensure every new mother and birthing parent receive the six-week check, and that it is of the highest quality:
- Integrated Care Systems (ICSs) should monitor the delivery of six to eight-week postnatal consultations as part of their primary care commissioning responsibilities.
- The Medical Licensing Assessment being introduced from 2024 should check understanding of the importance of postnatal mental health and the mental health element of postnatal checks.
- The section of the GP contract on delivery of postnatal consultations should be updated to include mention of signposting to specialist and community mental health services and point to best practice guidance around carrying out open-ended discussions.
- As part of its Maternity Transformation Programme, NHS England should consider what additional support and guidance it can provide for GPs to have quality conversations about mental health at the six to eight-week postnatal consultation.
- Deliver the Long-Term Plan commitments on improving access to specialist community perinatal mental health services.
