Quality standard

Quality statement 3: Information for pregnant women

Quality statement 3: Information for pregnant women

Quality statement

Pregnant women with a previous severe mental health problem or any current mental health problem are given information at their booking appointment about how their mental health problem and its treatment might affect them or their baby.

Rationale

It is important that pregnant women with a previous severe mental health problem, or any current mental health problem, understand how their mental health problem might affect them during and after pregnancy, and how pregnancy and childbirth might affect their condition, including the risk of relapse. In particular, it is important that the risks of using some medications to treat mental health problems during pregnancy and while breastfeeding are discussed, and alternatives considered to help women make informed decisions about managing their condition. This discussion might happen earlier for some women if they have a discussion with a specialist before their booking appointment.

Quality measures

Structure

Evidence of local arrangements to ensure that women with a previous severe mental health problem or any current mental health problem are given information at their booking appointment about how their mental health problem and its treatment might affect them or their baby.

Data source: Local data collection.

Process

Proportion of pregnant women with a previous severe mental health problem or any current mental health problem who are given information at their booking appointment about how their mental health problem and its treatment might affect them or their baby.

Numerator – the number in the denominator who have received information about how their mental health problem and its treatment might affect them or their baby.

Denominator – the number of pregnant women with a previous severe mental health problem or any current mental health problem attending their booking appointment.

What the quality statement means for different audiences

Service providers (antenatal care providers) have systems in place to ensure that women with a previous severe mental health problem or any current mental health problem are given information at the booking appointment about how their mental health problem and its treatment might affect them or their baby.

Healthcare professionals (midwives) provide information at the booking appointment to women with a previous severe mental health problem or any current mental health problem about how their mental health problem and its treatment might affect them or their baby.

Commissioners (clinical commissioning groups) specify and check that booking appointments for women with a previous severe mental health problem or any current mental health problem include midwives giving information to women about how their mental health problem and its treatment might affect them or their baby.

Women who are pregnant and who have had a severe mental health problem in the past or have any current mental health problem are given information at their booking appointment about how their mental health problem might affect them or their baby during pregnancy and after their baby is born. They are also given information about the possible benefits and harms of any treatment they might have for their mental health problem during this time and while breastfeeding, if they choose to breastfeed. This will help them to make decisions about pregnancy and their treatment.

Source guidance

Antenatal and postnatal mental health. NICE guideline CG192 (2014, updated 2020), recommendations 1.4.3 and 1.4.4 and expert opinion

Definitions of terms used in this quality statement

Information

Discuss treatment and prevention options and any particular concerns the woman has about the pregnancy or the fetus or baby. Provide information to the woman and, if she agrees, her partner, family or carer, about:

  • the potential benefits of psychological interventions and psychotropic medication

  • the possible consequences of no treatment

  • the possible harms associated with treatment

  • what might happen if treatment is changed or stopped, particularly if psychotropic medication is stopped abruptly.

[NICE's guideline on antenatal and postnatal mental health, recommendation 1.4.3]

Healthcare professionals discuss breastfeeding with all women who may need to take psychotropic medication in pregnancy or in the postnatal period. This should include an explanation of the benefits of breastfeeding, the potential risks associated with taking psychotropic medication when breastfeeding and with stopping some medications in order to breastfeed. Healthcare professionals should discuss treatment options that would enable a woman to breastfeed if she wishes and support women who choose not to breastfeed. [NICE's guideline on antenatal and postnatal mental health, recommendation 1.4.4]

Postnatal period

Up to 1 year after childbirth. [NICE's guideline on antenatal and postnatal mental health]

Severe mental health problem

A severe mental health problem includes severe and incapacitating depression, psychosis, schizophrenia, bipolar disorder, schizoaffective disorder or postpartum psychosis. [NICE's guideline on antenatal and postnatal mental health]

Equality and diversity considerations

When information is provided, there must be equal access to information for all women, including those with additional needs, such as physical or learning disabilities, and those who do not speak or read English. Women receiving information should have access to an interpreter or independent advocate if needed.