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Infant Mental Health: every midwife’s business

7 June, 2016

Infant Mental Health: every midwife’s business

“A child’s first relationship, the one with his mother, acts as a template that permanently moulds the individual’s capacity to enter into all later emotional relationships” (Schore, 2000). 

We all need love. The desire for connection, affection and positive relationships with others is there from the moment we are born.  And love at the time of birth is the most crucial.

Together with doulas, doctors, maternity support workers and health visitors, midwives play a pivotal role in influencing the love-bond between a mother and her newborn baby. During pregnancy and childbirth, women go through major physical and psychological change, and are most likely to be receptive to influences in relation to their and their baby’s health and wellbeing (Garrod and Byrom 2007).   The research evidence is clear; a positive mother-infant relationship is crucial for a baby’s social and emotional development, and primarily this means supporting, nurturing and caring for the mother’s emotional  as well as physical wellbeing during the perinatal period (NICE 2012, RCM 2012).  Mental health problems such as post-traumatic stress following childbirth and perinatal depression, domestic abuse, poverty and substance misuse can have a negative impact on the mother-infant attachment, and consequently the physiological and behavioural functioning of the baby (NICE 2012).  In a perfect world, there would be no barriers to midwives using the window of opportunity during the childbirth continuum to ensure each woman is physically and psychologically well, and confident and ready to become a mother. Whilst midwives report time constraints as a barrier to having meaningful, open discussions with women (Gomez 2016), there are things they can do to optimize a new baby’s emotional wellbeing.

As a midwife, what can you do?

·         Use every opportunity to listen to the mothers you care for.  The baby’s wellbeing is influenced by the mother’s emotional health, as well as her clinical condition.  Focus on the woman’s potential in addition to any vulnerability she may have.

·         Understand your public health role (Gomez 2016), and remember it is the women who live in social and economic turmoil, and those with mental health problems who least receive the services they need.

·         Signpost or refer women in need to specialist support; be aware of statutory and voluntary agencies that can help.

·         Even with constrained time frames, treat women with kindness, compassion and respect, it maximizes the potential for enhanced maternal wellbeing. Reassuring, authentic smiling, touch, gentle words, and empathy can turn a difficult situation into an empowering one.  When we nurture and support the mother, we nurture and support the child.

·         Use the Royal College of Midwives Maternal Emotional Wellbeing and Infant Development: A Good Practice Guide for Midwives. It provides a plethora of information and ideas on how to best support mothers during the antenatal, postnatal and intrapartum periods, to promote positive mother-infant attachment.


·         Remember that judgmental attitudes are a barrier to respectful care – if we label or scorn a woman’s lifestyle or choices by the language we use, or the position we take, we may influence her self-belief of ability to parent her child.

·         Read The Lancet Midwifery Series, which provides evidence on how best to support childbearing women, to maximize potential for a positive birth experience to enhance mother- infant attachment, and longer term survival and wellbeing for the infant. http://www.thelancet.com/series/midwifery

·         Be aware of the evidence for close and loving relationships, which underpin the new BFI standards http://www.unicef.org.uk/BabyFriendly/Resources/Guidance-for-Health-Professionals/Writing-policies-and-guidelines/The-evidence-and-rationale-for-the-UNICEF-UK-Baby-Friendly-Initiative-standards/

·         Promote physiological process that aid mother-infant attachment, such as skin-to-skin contact, optimal cord clamping and breastfeeding. Skin-to-skin contact builds social and emotional intelligence, developing the capacity to love https://youtu.be/51xmkaj8dOg

·         Be aware that perinatal mental health problems affect relationships https://youtu.be/NLtY7BN2inI

·         Childbirth matters. What you do, what you say, and how you say it, matters


‘Remember the double vulnerability of childbirth, poverty and despair, and pay particular attention to the poor and dispossessed. Your work takes you to the centre of life itself. Remember that, and your position in the world. Done well, your work will resonate through society and forward into future generations’. (Page 1996: 252)


Garrod D, Byrom S (2007) The midwifery public health agenda: setting the scene. In: (Eds) Edwards G, Byrom S  (2007) Essential Midwifery Practice: public health. Blackwell publishing, London.

Gomez E (2016) Advancing the public health role of  midwives and maternity support workers The Practising Midwife Vol 19, issue 6 Pp 8-11

NICE (2012) Social and emotional wellbeing: early years. October. NICE Public Health Guidance 40 (http://guidance.nice.org.uk/PH40)

Page L (1996) Reclaiming midwifery. Midwives 109 (1304) Pp 248-53

RCM (2012) Maternal Emotional Wellbeing and Infant Development: A Good Practice Guide for Midwives https://www.rcm.org.uk/sites/default/files/Emotional%20Wellbeing_Guide_WEB.pdf

Schore AN (2000) Attachment and the regulation of the right brain. Attachment and Human Development   Vol 2, Issue 1 Pp23-47


Protecting the Mental Health of Mothers and Our Young Can Stop Generational Cycles of Mental Illness in the Future


Public Health England: Giving every child the best start in life


The evidence
and rationale
for the UNICEF UK Baby Friendly Initiative standards http://www.unicef.org.uk/BabyFriendly/Resources/Guidance-for-Health-Professionals/Writing-policies-and-guidelines/The-evidence-and-rationale-for-the-UNICEF-UK-Baby-Friendly-Initiative-standards/

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