From pregnancy, to the birth and beyond - having a positive birthing experience is about more than the actual labour. We chat to one of the UK’s leading midwives, Marley Hall aka Midwife Marley, whose experience spans over 10 years in the NHS and private sector, about emotional support for parents, life after having a baby, and the differences in mortality and morbidity outcomes for Black women and other ethnic minorities.
What are the three most common misconceptions of Maternal Mental Health?
It only happens postnatally
It only really affects people who have had depression in the past
All people who suffer from maternal mental health problems are a danger to their babies.
How can parents-to-be prepare themselves to make their birth journey a more positive one?
I always talk about my 7 steps to an empowered birth!
1. Research choices. Choices on place of birth, environment, support etc
2. Keep as healthy as you can – diet and exercise really matters!
3. Learn relaxation techniques – this can help to keep you calm, confident, comfortable and in control during your birth. Hypnobirthing is a good start and can be beneficial regardless of what type of birth you have.
4. Use your BRAIN – Don’t be afraid to ask questions and understand that you are in control of what happens to your body. If a treatment or intervention is mentioned or offered, use the brain acronym to help you decide the best course of action:
B -what are the benefits?
R – What are the risks?
A - Are there any alternatives?
I – What is your intuition telling you?
N – What happens if we just wait or do nothing?
5. Take a birth preparation class, one that covers all aspects of birth and all eventualities.
6. Try and involve your birth partner as much as possible. They will be your support and advocate throughout your experience.
7. Avoid reading or listening to negative birth stories. If someone starts to tell you their birth story when you are pregnant, you can say something along the lines of “Is this a happy story? If it is, carry on, if not could you tell me after I’ve had my baby?” Keeping your mindset as positive as possible can really make a difference.
BAME maternal healthcare disparities were recently debated in parliament after an e-petition by FiveXMore and other campaigners, but these healthcare inequalities are not a new problem. Marley is on the expert panel for FiveXmore, so we were keen to get her thoughts on these developments.
What are the issues facing BAME mothers and what needs to change?
The petition for change created by FiveXmore has certainly been a driving force in finally getting the topic discussed at Government level, but you’re right, the disparities have been there for a long time.
Using the acronym BAME is difficult as it lumps all ethnic minorities together. We know that there is a huge difference in outcomes for Black women who are 4-5 times more likely to die than White women, in comparison to, let’s say Asian women who are twice as likely.
The experiences both groups have are different, Black women for example often report their pain and concerns which are not listened to. Many women of South Asian heritage report other issues that they face. Traditions, cultures, demographics and access to care are also different within the groups.
There are a lot of things that needs to change, starting with us as health care providers. Looking at medical and reproductive education, traditionally the teachings are based on that of White patients. For example, it’s imperative that a student midwife is taught how to identify jaundice on a darker skinned infants, mastitis in women with dark skin and knowing the difference between a blue grey spot and a bruise. Working with the midwifery and medical students is paramount as they are our future.
An extremely important part in all of this is that as healthcare workers, we need to check our own unconscious or subconscious biases. This means not making assumptions based on a person’s ethnicity and subsequently treating them differently as a result. For example making assumptions about the woman’s ability to understand what’s being said based on language, accent or country of heritage.
I have witnessed situations where a white couple have had their childbirth choices discussed in depth so that they can make an informed decision for themselves. I have witnessed the same care provider with a Black couple whose mother tongue is French (but speak and understand English), be told what they should do rather than discussing options in depth.
There are currently projects working to hear the stories from Black women so that positive action can be taken. Both Birthrights.org and FiveXmore have spearheaded these projects and I’m proud to be on the expert panel for FiveXmore.
Is midwifery continuity of care a solution to ensure all mums receive safe and personal maternity care?
It’s not a solution but it’s a positive step in the right direction. The only thing we can’t guarantee is that the care provider assigned to woman of colour has checked their own biases. If not, continuity of care would be pointless.
In general though, we know that continuity of care improves outcomes for all women and birthing people, regardless of ethnicity. Women generally feel more trust when they see a midwife that they know throughout their pregnancy, so many trusts have started trying to implement CoC.
What advice do you have for mums who weren’t able to have the birth they wanted, or who have experienced negativity over their birth choice?
There are people who will have had a caesarean due to unforeseen circumstances, perhaps unplanned during labour. These women may be grieving the birth they had wanted and that’s ok. There are actually groups of women on Facebook who all share their experience so you may find it helpful to talk with others who are feeling a similar way.
I suspect those who choose to give birth via caesarean possibly feel they are shamed for their choices. We have to remember that as humans we make all kinds of choices in our lives that other people may not feel is best for them – eating meat, veganism, religion, co sleeping, breastfeeding, bottle-feeding, being a working mum, stay at home mum, using disposable nappies etc.
Whatever choice you make around your birth, it’s yours. Own it and own it with pride. As long as you have made an informed decision, have been given evidence based information about any choices you make, that is all that matters.
How can parents support their mental health postpartum?
Understand the parameters of what’s normal, i.e. the ‘day 3 blues’ and what’s more serious. PANDAS have lots of information and are a great support resource.
Preparing antenatally is important. Life with a newborn can be tough, there will be sleep deprivation and support in these early days is vital. If you have friends and family that you can call on, do it!
Prioritise yourself and your baby, decide what can be left for later or for someone else. The early days should be about you bonding with your baby and recovering.
It’s not always easy when you have more than one child, I know this too well! This is why having a supportive family network can really help.
If you don’t have much support, reach out to your health visitor who may be able to put you in touch with some local services. Partners can also help by lightening the load and ensuring that mum is able to recover without having to worry about other things. If there is any concern about their partner's mental health, or indeed their own mental health as partners can also struggle with perinatal mental health problems, they should be able to talk to a health professional too.