One of the peer researchers evaluating the pilot service describes the impact this ‘life-changing’ but overwhelmed service had on women, staff, and beyond.
Sorcha Mahony
In 2020, in response to the need for increased mental health support for women during the maternity period, the NHS embarked on an ambitious programme of improving local services.
It recognised a gap in service provision for those who have experienced birth trauma, loss, tokophobia1 and removal of children for safeguarding reasons.
From this, the new Maternal Mental Health Service (MMHS) was designed to provide timely, person-centred care for women whose maternity journeys had left them struggling.
This new MMHS began with a pilot phase, and McPin undertook the evaluation of the pilot services in the London region. We launched our evaluation report a few weeks ago.
I shared a little of my own lived experience, and in return they gifted theirs with an openness that made our findings rich and honest in their complexity.
What did we learn from conducting this evaluation research?
I’m Sorcha, a research manager at McPin. I was the lead evaluator on this project – a peer researcher with my own lived experience of maternity loss, and of birth trauma arising from an emergency caesarean and neo-natal crisis.
The lessons I learned on this project are like coins – each with two sides; a front and a back, an object and its shadow.
The first lesson I learned was that doing peer research can be a profoundly moving experience. The women and staff who told their stories, of struggle and deep psychological pain but also of recovery and joy, shared a depth of detail unparalleled in my 20+ years of doing social research.
I shared a little of my own lived experience, and in return they gifted theirs with an openness that made our findings rich and honest in their complexity.
And yet, through this, I was moved to re-enter my own (unresolved) trauma and learned first-hand the way that triggering can come out of the blue, in unexpected ways; for me, in the form of post-interview somatic shut down – an extreme version of the ‘freeze’ response to threat.
The second lesson I learned was how hard it was for women to share their stories of maternal ill health – they were still so raw, so close to the surface.
The women’s voices quivered, they paused often to breathe deep, and they had to bite their tongues to hold back tears so they could get from beginning to end and recount vivid details along the way.
And yet, telling their stories was both the means and the end goal of their recovery; through the telling and re-telling they were becoming the authors of their stories, rather than characters stuck in a saga about them, penned and narrated by others.
Staff reported being burned out and ‘on their knees’, and likened their services to a ‘capsizing boat’ – desperately in need of ballast if they are to continue.
A tale of two halves
The third lesson I learned was how effective the MMHS pilot services were, not just by enabling women to process and better handle emotional distress and acquire tools for navigating life beyond the service, but mostly on account of the skill and ‘professional kindness’ (as one woman put it) of MMHS staff – the therapists, specialist midwives, peer support workers and back office staff.
And yet, these staff reported being burned out and ‘on their knees’, and likened their services to a ‘capsizing boat’ – desperately in need of ballast if they are to continue.
The fourth lesson I learned was how large an appetite there is among healthcare professionals in the maternity sector, for using the evidence from evaluations like ours, and thinking deeply about how to embed its implications for their decision-making and work practices.
Even so, at the launch event for our findings report in early February, despite a packed (online) room, it was difficult to determine the presence of those most relevant for one of our key recommendations; that these services be funded adequately so they can grow and develop in line with local need.
Without services like MMHS, those roots, those difficulties, can come to cast such long shadows in the present, and into the potential futures of the women and families they have visited.
The far-reaching roots of maternal mental health
The fifth, final, and perhaps most profound lesson I learned doing this evaluation was how deep the roots of maternal mental health difficulties often run; deep into the past, into childhood, and more specifically into adverse childhood experiences and childhood trauma.
And I learned that without services like MMHS, those roots, those difficulties, can come to cast such long shadows in the present, and into the potential futures of the women and families they have visited.
These are some of the lessons we learned conducting this evaluation research. For a more detailed account, please visit the project page, and read our report.
