Quality standard
Quality statement 4: Asking about mental health and wellbeing
Quality statement 4: Asking about mental health and wellbeing
Quality statement
Women are asked about their emotional wellbeing at each routine antenatal and postnatal contact.
Rationale
Routine antenatal and postnatal appointments are opportunities for health professionals to discuss emotional wellbeing with women and identify potential mental health problems. It also gives women an opportunity to talk about any concerns they might have, such as fears around childbirth, multiple pregnancy, or past experiences, such as loss of a child or traumatic childbirth. This will help health professionals provide appropriate support.
Quality measures
Structure
Evidence of arrangements for healthcare professionals to ask women about their emotional wellbeing at all routine antenatal and postnatal contacts.
Data source: Local data collection.
Process
The proportion of routine antenatal and postnatal contacts at which woman are asked about their emotional wellbeing by a healthcare professional.
Numerator – the number in the denominator at which women were asked about their emotional wellbeing by a healthcare professional.
Denominator – the number of routine antenatal and postnatal contacts.
Data source: Local data collection.
Outcome
a) Women's satisfaction with being able to discuss any concerns or worries at routine appointments.
Data source: Local data collection. The Care Quality Commission's Maternity services survey asks women whether a midwife or health visitor had asked how they were feeling emotionally at the postnatal stage.
b) Identification of mental health problems.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (antenatal and postnatal care service providers in community, primary and secondary care) have protocols in place to ensure that healthcare professionals ask women about their emotional wellbeing at each routine antenatal and postnatal contact.
Healthcare professionals (GPs, midwives, health visitors and consultant obstetricians) ask women about their emotional wellbeing at each routine antenatal and postnatal contact to support identification and discussion of mental health problems.
Commissioners (NHS England area teams, clinical commissioning groups and local authorities) specify and check that antenatal and postnatal care providers have protocols in place to ensure that healthcare professionals ask women about their emotional wellbeing at each routine antenatal and postnatal contact.
Women who are pregnant or in the first year after giving birth are asked how they are feeling at every routine appointment. This is so that they can talk to their healthcare professional about any concerns they have, and any problems can be identified.
Source guidance
Antenatal and postnatal mental health. NICE guideline CG192 (2014, updated 2020), recommendations 1.5.4 (key priority for implementation) and 1.5.8
Definitions of terms used in this quality statement
Mental health and wellbeing
Healthcare professionals should consider asking the following questions at a woman's booking appointment and at regular contacts in pregnancy, as part of a general discussion about her mental health and wellbeing:
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The depression identification questions:
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During the past month, have you often been bothered by feeling down, depressed or hopeless?
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During the past month, have you often been bothered by having little interest or pleasure in doing things?
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Questions about anxiety using the 2‑item Generalized Anxiety Disorder scale (GAD‑2):
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Over the last 2 weeks, have you been feeling nervous, anxious or on edge?
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Over the last 2 weeks, have you not been able to stop or control worrying?
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[NICE's guideline on antenatal and postnatal mental health, recommendation 1.5.4]
Recommendations 1.5.5–1.5.7 in NICE's guideline on antenatal and postnatal mental health set out additional questions to ask if initial questioning indicates the need for further investigation.
Routine antenatal contacts
Routine antenatal contacts include:
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a pregnant woman's first contact with a midwife or doctor to discuss their pregnancy
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the booking appointment (between 8 and 12 weeks of pregnancy)
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the dating scan (between 8 and 14 weeks of pregnancy)
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the 16‑week check
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the anomaly scan (between 18 and 20 weeks of pregnancy)
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further routine scheduled checks (the frequency of these will vary depending on whether it is the woman's first pregnancy).
Routine postnatal contacts
Women should receive the number of postnatal contacts that are appropriate to their care needs. A routine postnatal contact is a scheduled postnatal appointment that may occur in the woman or baby's home or another setting such as a GP practice, children's centre or a hospital setting if the woman or baby needs extended inpatient care. All women should have a postnatal check about 6 weeks after their baby's birth to make sure that they feel well and are recovering properly. [Expert consensus]
Postnatal period
Up to 1 year after childbirth. [NICE's guideline on antenatal and postnatal mental health]
Equality and diversity considerations
Women with complex social needs may be less likely to access or maintain contact with antenatal and postnatal services. Examples of women with complex social needs include, but are not limited to, women who:
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have a history of substance misuse (alcohol and/or drugs)
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have recently arrived as a migrant, asylum seeker or refugee
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have difficulty speaking or understanding English
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are aged under 20
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have experienced domestic abuse
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are living in poverty
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are homeless.
It is therefore appropriate that localities give special consideration to these groups of women. NICE's guideline on pregnancy and complex social factors has recommendations about how to make antenatal care accessible to women with complex social needs and how to encourage ongoing contact.