Thrive: Developing a New Service for People Who Have Experienced Birth Trauma or Loss 

Task 

It is estimated that birth trauma occurs for around 1 in 3 women during or after childbirth and around 1 in 4 women experience mental health problems during the perinatal period. Childbirth-related mental health problems are thought to cost the NHS approximately £10,000 per birth. When mental health conditions occur during the perinatal period, there is a more pressing need for prompt access to care to improve outcomes for the woman, and to minimise the negative impacts on the child and wider family. The NHS Long Term Plan renewed the commitment to transform specialist perinatal mental health services by developing and implementing maternal mental health services in every area of the country by 2023/24. These services will combine maternity, reproductive health, and psychological therapy for women experiencing moderate to severe or complex mental health difficulties directly arising from, or related to, their maternity experience. As an early implementer, Kent and Medway NHS and Social Care Partnership Trust and the East Kent Hospitals University NHS Foundation Trust began running the pilot project ‘Thrive’ in East Kent from January 2021. Alongside the pilot project and corresponding evaluation, TONIC were asked to conduct a scoping activity to inform the future roll out of additional maternal mental health services across the rest of Kent and Medway. The aim of this was to gather the thoughts of those with lived experiences of birth trauma or loss on how services should run and how they can be set up to ensure women and their families are supported as effectively as possible. The scope of this work was also to examine inequalities within Kent and Medway and explore barriers to accessing support services, particularly for those living in areas of deprivation. The overall objective was to make evidence-based recommendations to promote equity and break down existing barriers.  

Our Approach 

Initially, TONIC conducted a review of existing research, surveying and synthesising both national and international literature, to provide insight into the current knowledge and understanding around perinatal mental health. The literature review was conducted in order to establish ‘what works’ according to the latest research, provide examples of best practice, discover the impact of inequalities on perinatal mental health, how these may affect help-seeking behaviour, and what can be done to tackle such inequalities. Additionally, the literature review was used to explore existing surveys of maternal mental health to inform the development of the surveys and interview materials used within this consultation, as well as to identify benchmarks to allow comparisons to past research.  

TONIC then engaged a total of 393 women with lived experiences and 25 birthing partners via anonymous online surveys. In-depth confidential interviews were conducted with 38 women and 6 birthing partners, all of whom felt they had experienced some kind of birth trauma or loss and subsequent issues with their mental health as a result of their pregnancy and/or birth experience. The sample provided insight into a range of experiences, including, traumatic births, neonatal death, stillbirth, miscarriages, failed and ongoing fertility treatment, terminations due to medical reasons, postnatal depression, post-traumatic stress disorder, fear of childbirth, and more. Of those interviewed, 5 women (including 1 birthing partner) also wrote a detailed case study about their experience.  

As well as gathering the opinions of those with lived experience, the TONIC research team spoke with 16 key stakeholders during the process of this consultation, these included consultant midwives, bereavement midwives, specialist mental health midwives, perinatal mental health midwives, mental health nurses, and those involved in running and managing the Thrive pilot project. TONIC spoke to representatives from all care partnerships across Kent and Medway, and the purpose of these discussions was to compare and contrast the similarities and differences in opinions from healthcare professionals and those with lived experiences, to establish whether any key considerations need to be made based on the areas for the Thrive roll out, and to ensure recommendations within this report are realistic.  

In addition to this, TONIC consulted with the Association of South Asian Midwives (ASAM) in an attempt to fully understand experiences, support, and specific barriers in perinatal mental health for Black, Asian, and ethnically diverse communities. ASAM then produced a reflective report based on their practice and experience as midwives, as well as survey responses from a further 11 service users and midwives.  

Finally, a TONIC representative remained in regular contact with the Thrive Project Lead and attended monthly Perinatal Mental Health NHS LTP – Communications Working Group meetings and monthly LTP – Steering Group meetings to provide updates on the progress of the consultation.  

Outcome 

TONIC produced a detailed report, presented the findings to the commissioners, and developed an action plan with 17 recommendations to be taken forward during the roll out of maternal mental health services across the whole of Kent and Medway. Recommendations were split between wider system changes around improved monitoring and data collection, awareness raising, staff supervision, assertive outreach to minoritised ethnic communities, and Thrive-specific suggestions such as establishing clear eligibility criteria and referral pathways, providing a flexible approach to counselling and psychotherapy, having support for those suffering from Tokophobia or past trauma, creating a network of peer support workers, and offering support to birthing partners. TONIC also provided the Thrive Project Team with contact details for a total of 74 people with lived experience (including 3 birthing partners) who agreed to be contacted in the future to provide ongoing feedback.