Suicide is one of the most common causes of death for Australian women after pregnancy. This fact should shock our community. Advances in obstetric care have made pregnancy and birth so safe it now is rare for women to die from complications such as haemorrhage, pre-eclampsia, or infection. Unfortunately, suicide is the cause of more than 10 per cent of all pregnancy-related deaths in this country.
Specialised mother-baby units are fundamental to the safe care of new mothers who experience severe mental health problems. The current dispute between public hospital psychiatrists and the NSW government, with hundreds of psychiatrists having submitted their resignations, is extremely serious for tens of thousands of mental health patients. For new mothers with severe psychiatric problems – and their babies – the situation is potentially catastrophic.
The Royal Australian and New Zealand College of Psychiatrists states: “The effects of maternal mental disorders can be devastating on the mother, baby and surrounding community. Without adequate management, symptoms and associated impairment of functioning can sometimes persist for years.”
Mother-baby units are fundamental to safe modern care of perinatal mental health conditions during and after pregnancy. The college of psychiatrists recommends that one such eight-bed unit should be available for every 15,000 births in an Australian setting.
With around 95,000 births in NSW each year this would demand about 50 mother-baby unit beds to meet the need safely: the state has only 16 beds and these are under threat from the current dispute. Australia should have about 160 mother-baby unit beds but there are only half that number.
The chronic under-resourcing of psychiatric care for mothers and babies by state and territory governments should already be considered a national scandal. The aftermath of mental health problems remains an area of deep concern for everyone involved in pregnancy care. Mental health problems now are the most common pregnancy complications seen in our healthcare system.
As many as one woman in five will have some mental health issues during or after pregnancy. Fortunately, most of these conditions are relatively mild and resolve quickly with care and love. For some new mothers, though, the situation is more serious and potentially deadly.
Severe mental health conditions put women and their babies at high risk of harm at a time of great vulnerability in the lives of both. Their occurrence can come as a shock to new fathers and other family members. Such mental health problems also can be difficult to recognise until they are advanced and severe. This is a setting where the lives of mothers and their babies are at risk.
About one mother in 500 will need hospital care for a severe mental health issue such as postpartum depression. An adult psychiatric ward is the worst place for a woman to be managed for these serious mental health issues. Admission to such a unit means taking a newborn from its mother. To make matters worse, Australia has a chronic and severe shortage of adult mental health hospital beds.
The staff of general psychiatric wards – hardworking mental health nurses, psychologists, and other therapists – commonly do not have specialist perinatal expertise. The multidisciplinary teams staffing mother-baby units are trained and experienced in the complex treatment of perinatal mental health problems.
Separation of mother and baby in the critical newborn period can have severe and lifelong consequences. It has enormous potential to worsen the mental distress of mothers and harm their baby at a vulnerable time. Keeping mother and baby together is an essential principle of care.
Maintaining the bond between mother and baby, however, requires specialised resources combining psychiatrist-led mental health care for the mother, along with maternity care, plus newborn care. All in a setting where mother and baby are safe and protected.
An enormous amount of effort goes into the screening of women’s mental health during pregnancy and after birth. New mums will be very familiar with completing questionnaires such as the Edinburgh Postnatal Depression Scale with their midwife, GP or obstetrician.
Unfortunately, if it becomes clear that a woman is affected by a mental health condition, the pathways for her care are severely constrained. Securing appropriate psychiatric care for a mentally ill new mother can be like the proverbial camel passing through the eye of a needle. That was then and this is now.
The dispute between psychiatrists and the NSW government is disastrous for our community. For new mums with severe mental health problems – and their babies – it is diabolical. The national disaster of access to mother-baby units is about to be turned into a deadly hell that our community must not accept.
Professor Steve Robson is an obstetrician and gynaecologist and one of Australia’s most highly qualified surgical specialists, researchers and teachers. He works at the Australian National University Medical School.
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