Abstract
Purpose
Pregnancy and the first postnatal year can be a difficult and distressing period for women with mental health problems, particularly if they are not able to access appropriate and timely assessment and treatment. The aim of this systematic review was to synthesise qualitative evidence on experiences of care for women with (or at risk of developing) antenatal or postnatal mental health problems across a range of disorders (including non-psychotic mental disorders).
Methods
Six electronic databases were searched for papers published from 2000 to April 2014. Thirty-nine studies were identified that met the inclusion criteria. Findings were synthesised using secondary framework and thematic analysis approaches.
Results
Seven key themes were identified across mental disorder groups: an unmet need for collaborative and integrated care; stigma and fears about loss of custody; healthcare professionals unable or unwilling to address psychological needs; focus on babies over mothers; importance of non-judgemental and compassionate support; an unmet need for information; importance of service user involvement in treatment decisions.
Conclusions
Women’s experience of accessing and engaging with care for mental health problems could be improved if given the opportunity to develop trusting relationships with healthcare professionals who acknowledge and reinforce the woman’s role in caring for her baby in a non-judgemental and compassionate manner, and foster hope and optimism about treatment. Information for women, their families and healthcare professionals, and the provision of individualised care and treatment, are also crucial to enable full implementation of a person-centred programme of care.
Similar content being viewed by others
References
Antonysamy A, Wieck A, Wittkowski A (2009) Service satisfaction on discharge from a psychiatric mother and baby unit: a representative patient survey. Arch Womens Ment Health 12:359–362. doi:10.1007/s00737-009-0085-2
Ayers S, Eagle A, Waring H (2006) The effects of childbirth-related post-traumatic stress disorder on women and their relationships: a qualitative study. Psychol Health Med 11:389–398
Baumgartner LM (2007) The incorporation of HIV/AIDS into identity over time. Qual Health Res 17:919–931
BMJ (2011) Consolidated criteria for reporting qualitative research., http://bmjopen.bmj.com/content/suppl/2011/02/21/bmjopen-2010-000017.DC1/bmjopen_research_checklist_000017.pdf . Accessed 25 August 2014
Boath E, Bradley E, Henshaw C (2004) Women's views of antidepressants in the treatment of postnatal depression. J Psychosom Obstet Gynecol 25:221–233
Breustedt S, Puckering C (2013) A qualitative evaluation of women's experiences of the mellow bumps antenatal intervention. Br J Midwifery 21:187–194
Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M et al (2003) Evaluating meta ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Soc Sci Med 56:671–684
Carroll C, Booth A, Cooper K (2011) A worked example of “best fit” framework synthesis: a systematic review of views concerning the taking of some potential chemopreventive agents. BMC Med Res Methodol 11:29. doi:10.1186/1471-2288-11-29
CASP: Critical Appraisal Skills Programme (2013) Qualitative checklist., http://media.wix.com/ugd/dded87_951541699e9edc71ce66c9bac4734c69.pdf . Accessed 25 August 2014
Chew-Graham CA, Sharp D, Chamberlain E, Folkes L, Turner KM (2009) Disclosure of symptoms of postnatal depression, the perspectives of health professionals and women: a qualitative study. BMC Fam Pract 10:7. doi:10.1186/1471-2296-10-7
Cooke S, Smith I, Turl E, Arnold E, Msetfi RM (2012) Parent perspectives of clinical psychology access when experiencing distress. Community Pract 85:34–37
de Jonge A (2001) Support for teenage mothers: a qualitative study into the views of women about the support they received as teenage mothers. J Adv Nurs 36:49–57
Dixon-Woods M, Bonas S, Booth A, Jones D, Miller T, Sutton A et al (2006) How can systematic reviews incorporate qualitative research? A critical perspective. Qual Res 6:27–44
Dixon-Woods M, Sutton A, Shaw R, Miller T, Smith J, Young B et al (2007) Appraising qualitative research for inclusion in systematic reviews: a quantitative and qualitative comparison of three methods. J Health Serv Res Policy 12:42–47
Dolman C, Jones I, Howard LM (2013) Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Arch Womens Ment Health 16:173–196. doi:10.1007/s00737-013-0336-0
Edge D (2007) Perinatal depression and Black Caribbean women: lessons for primary care. Prim Health Care 17:32–35
Edge D (2008) 'We don't see Black women here': an exploration of the absence of Black Caribbean women from clinical and epidemiological data on perinatal depression in the UK. Midwifery 24:379–389
Edge D (2011) 'It's leaflet, leaflet, leaflet then, "see you later"': black Caribbean women's perceptions of perinatal mental health care. Br J Gen Pract 61:256–262. doi:10.3399/bjgp11X567063
Edge D, Rogers A (2005) Dealing with it: Black Caribbean women's response to adversity and psychological distress associated with pregnancy, childbirth, and early motherhood. Soc Sci Med 61:15–25
Edwards E, Timmons S (2005) A qualitative study of stigma among women suffering postnatal illness. J Ment Health 14:471–481
Einarson A, Selby P, Koren G (2001) Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling. J Psychiatry Neurosci 26:44–48
Hall P (2006) Mothers' experiences of postnatal depression: an interpretative phenomenological analysis. Community Pract 79:256–260
Hanley J, Long B (2006) A study of Welsh mothers' experiences of postnatal depression. Midwifery 22:147–157
Heron J, Gilbert N, Dolman C, Shah S, Beare I, Dearden S et al (2012) Information and support needs during recovery from postpartum psychosis. Arch Womens Ment Health 15:155–165. doi:10.1007/s00737-012-0267-1
Howard LM, Molyneaux E, Dennis C-L, Rochat T, Stein A et al (2014) Non-psychotic mental disorders in the perinatal period. Lancet 384:1775–1788. doi:10.1016/S0140-6736(14)61276-9
Hunt K, France E, Ziebland S, Field K, Wyke S (2009) 'My brain couldn't move from planning a birth to planning a funeral': a qualitative study of parents' experiences of decisions after ending a pregnancy for fetal abnormality. Int J Nurs Stud 46:1111–1121. doi:10.1016/j.ijnurstu.2008.12.004
Jones I, Chandra PS, Dazzan P, Howard LM (2014) Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet 384:1789–1799. doi:10.1016/S0140-6736(14)61278-2
Lawton J, Rankin D, Peel E, Douglas M (2009) Patients’ perceptions and experiences of transitions in diabetes care: a longitudinal qualitative study. Health Expect 12:138–148. doi:10.1111/j.1369-7625.2009.00537.x
Mapp T (2005) Feelings and fears post obstetric emergencies, part 2. Br J Midwifery 13:36–40
Mapp T, Hudson K (2005) Feelings and fears during obstetric emergencies, part 1. Br J Midwifery 13:30–35
McCreight BS (2008) Perinatal loss: a qualitative study in Northern Ireland. Omega 57:1–19
McGrath L, Peters S, Wieck A, Wittkowski A (2013) The process of recovery in women who experienced psychosis following childbirth. BMC Psychiatry 13:341. doi:10.1186/1471-244X-13-341
NCCMH (2012) Service User Experience in Adult Mental Health: Improving the experience of Care for People Using Adult NHS Mental Health Services. Clinical guideline 136 [Full guideline]. The British Psychological Society and the Royal College of Psychiatrists, Leicester and London
NCGC (2012) Patient Experience in Adult NHS Services: Improving the Experience of Care for People Using Adult NHS Services. Clinical guideline 138 [Full guideline]. Royal College of Physicians, London
NICE (2011) Service User Experience in Adult Mental Health: Improving the Experience of Care for People Using Adult NHS Mental Health Services. NICE Clinical Guideline 136. NICE, London, http://www.nice.org.uk/guidance/cg136
NICE (2012) Patient Experience in Adult NHS Services: Improving the Experience of Care for People Using Adult NHS Services. NICE, London, http://www.nice.org.uk/guidance/cg138
NICE (2014) Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance. NICE Clinical Guideline 192. NICE, London, http://www.nice.org.uk/guidance/cg192
Nicholls K, Ayers S (2007) Childbirth-related post-traumatic stress disorder in couples: a qualitative study. Br J Health Psychol 12:491–509
Parvin A, Jones CE, Hull SA (2004) Experiences and understandings of social and emotional distress in the postnatal period among Bangladeshi women living in Tower Hamlets. Fam Pract 21:254–260
Patel S, Wittkowski A, Fox JR, Wieck A (2013) An exploration of illness beliefs in mothers with postnatal depression. Midwifery 29:682–689. doi:10.1016/j.midw.2012.06.012
Peel E, Douglas M, Lawton J (2007) Self-monitoring of blood glucose in type 2 diabetes: longitudinal qualitative study of patients’ perspectives. BMJ 335:493–498
Raymond JE (2009) 'Creating a safety net': women's experiences of antenatal depression and their identification of helpful community support and services during pregnancy. Midwifery 25:39–49
Robertson E, Lyons A (2003) Living with puerperal psychosis: a qualitative analysis. Psychol Psychother 76:411–431
Ryninks K, Roberts-Collins C, McKenzie-McHarg K, Horsch A (2014) Mothers’ experience of their contact with their stillborn infant: an interpretative phenomenological analysis. BMC Pregnancy Childbirth 14:203. doi:10.1186/1471-2393-14-203
Shakespeare J, Blake F, Garcia J (2003) A qualitative study of the acceptability of routine screening of postnatal women using the Edinburgh Postnatal Depression Scale. Br J Gen Pract 53:614–619
Shakespeare J, Blake F, Garcia J (2006) How do women with postnatal depression experience listening visits in primary care? A qualitative interview study. J Reprod Infant Psychol 24:149–162
Simmons RK, Singh G, Maconochie N, Doyle P, Green J (2006) Experience of miscarriage in the UK: qualitative findings from the National Women's Health Study. Soc Sci Med 63:1934–1946
Slade P, Morrell CJ, Rigby A, Ricci K, Spittlehouse J, Brugha TS (2010) Postnatal women's experiences of management of depressive symptoms: a qualitative study. Br J Gen Pract 60:e440–e448. doi:10.3399/bjgp10X532611
Smith L, Gibb S (2007) Postnatal support for drug users: evaluation of a specialist health visiting service. Community Pract 80:24–29
Snowdon C, Elbourne D, Forsey M, Alfirevic Z (2012) Information-hungry and disempowered: a qualitative study of women and their partners' experiences of severe postpartum haemorrhage. Midwifery 28:791–799. doi:10.1016/j.midw.2011.12.012
Stanley N, Borthwick R, Macleod A (2006) Antenatal depression: mothers' awareness and professional responses. Prim Health Care Res Dev 7:257–268
Stapleton H, Fielder A, Kirkham M (2008) Breast or bottle? eating disordered childbearing women and infant-feeding decisions. Matern Child Nutr 4:106–120. doi:10.1111/j.1740-8709.2007.00121.x
Templeton L, Velleman R, Persaud A, Milner P (2003) The experiences of postnatal depression in women from black and minority ethnic communities in Wiltshire, UK. Ethn Health 8:207–221
Thomas J, Harden A (2008) Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 8:45. doi:10.1186/1471-2288-8-45
Thomson G, Downe S (2008) Widening the trauma discourse: the link between childbirth and experiences of abuse. J Psychosom Obstet Gynecol 29:268–273. doi:10.1080/01674820802545453
Thomson G, Downe S (2013) A hero's tale of childbirth. Midwifery 29:765–771. doi:10.1016/j.midw.2012.07.008
Thurtle V (2003) First time mothers' perceptions of motherhood and PND. Community Pract 76:261–265
Tsartsara E, Johnson MP (2002) Women’s experience of care at a specialised miscarriage unit: an interpretive phenomenological study. Clin Eff Nurs 6:55–65
Turner KM, Sharp D, Folkes L, Chew-Graham C (2008) Women's views and experiences of antidepressants as a treatment for postnatal depression: a qualitative study. Fam Pract 25:450–455. doi:10.1093/fampra/cmn056
Turner KM, Chew-Graham C, Folkes L, Sharp D (2010) Women's experiences of health visitor delivered listening visits as a treatment for postnatal depression: a qualitative study. Patient Educ Couns 78:234–239. doi:10.1016/j.pec.2009.05.022
Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF et al (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 65:805–815. doi:10.1001/archpsyc.65.7.805
Whitehead L (2006) Towards a trajectory of identity reconstruction in chronic fatigue syndrome/myalgic encephalomyelitis: a longitudinal qualitative study. Int J Nurs Stud 43:1023–1031
Wittkowski A, Zumla A, Glendenning S, Fox JRE (2011) The experience of postnatal depression in South Asian mothers living in Great Britain: a qualitative study. J Reprod Infant Psychol 29:480–492
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(DOCX 22 kb)
Rights and permissions
About this article
Cite this article
Megnin-Viggars, O., Symington, I., Howard, L.M. et al. Experience of care for mental health problems in the antenatal or postnatal period for women in the UK: a systematic review and meta-synthesis of qualitative research. Arch Womens Ment Health 18, 745–759 (2015). https://doi.org/10.1007/s00737-015-0548-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-015-0548-6