Six-week postnatal checks are failing many new mothers

As part of their review of maternal mental health care, Healthwatch England has 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.

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.

• 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.

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.

Healthwatch England undertook the research between October and December of 2022 to find out to what extent mental health support has improved during and after pregnancy. Their analysis also found the following:

• 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.

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.

Louise Ansari, National Director at Healthwatch England said:

“With mental ill health affecting up to a third of new and expectant mums, six-week postnatal checks are key to assessing their wellbeing after the birth. If left untreated, poor mental health can have a devastating impact on new parents and their families. “Unfortunately, our findings show that although most new mothers and birthing parents are likely to be invited to a postnatal consultation, these are frequently carried out as a tick-box exercise, where mental health is not treated as a priority or not assessed at all.

 “Monitoring the delivery of six-week checks should be the first step to ensuring there’s a consistent approach to offering quality mental health support to all new mothers. NHS England should consider what additional support and guidance it can provide to GPs so that the help new parents get is of the best quality.

“We also need to ensure that maternal mental health and peri-natal services continue to remain on the government’s agenda and a priority in workforce planning and funding budgets.”

Annie Belasco, Head of Pandas Foundation, said:

“The findings of Healthwatch England’s new research, alongside our own work, tell us that people are still struggling to access the right support at the right time. The NHS is not making the most of opportunities to support women with the quality, timely mental health interventions which we know can save lives. That’s why we need to ensure the experiences of those women who were let down by the system contribute to eliminating barriers and improving support for others.”

Healthwatch England 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 should monitor the delivery of six- week postnatal consultations as part of their primary care commissioning responsibilities.
• NHS England should update the GP contract to make clear that mental health reviews at the six-week postnatal check should be part of an open-ended discussion.
• NHS England should update the GP contract to include mention of signposting to specialist and community mental health support services at the six-week week check.
• 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-week postnatal check.
• Deliver the Long-Term Plan commitments on improving access to perinatal mental health services, including through more perinatal mental health outreach clinics around the country.

• Nine had a stillbirth.
• First birth experience was discussed by 1886 of our respondents; 803 had given birth at least once previously. 
• Over three in ten (816) of respondents had a mental health condition prior to becoming pregnant.  
• The majority of our participants (2635) were aged between 25 and 49 years old. 43 participants were aged 18-24, and three were aged 50-64.  
• The majority of participants identified as women (2662), with three participants identified as nonbinary, and one as a transman.  
• Over one in five (22%) respondents had a diagnosed mental health condition prior to becoming pregnant.