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Background: Anxiety in pregnancy and postpartum is highly prevalent but under-recognized and few women receive adequate support or treatment. Identification and management of perinatal anxiety must be acceptable to women in the perinatal period to ensure that women receive appropriate care when needed. We aimed to understand the acceptability to women of how anxiety was identified and managed by healthcare professionals., Method: We conducted in-depth qualitative interviews with 60 women across England and Scotland approximately 10 months after birth. Women were sampled from an existing systematically recruited cohort of 2,243 women who recorded mental health throughout pregnancy and after birth. All women met criteria for further assessment of their mental health by a healthcare professional. We analyzed the data using a theoretical framework of acceptability of healthcare interventions., Results: Interview data fitted the seven constructs within the theoretical framework of acceptability. Women valued support before professional treatment but were poorly informed about available services. Services which treated women as individuals, which were accessible and in which there was continuity of healthcare professional were endorsed. Experience of poor maternity services increased anxiety and seeing multiple midwives dissuaded women from engaging in conversations about mental health. Having a trusted relationship with a healthcare professional facilitated conversation about and disclosure of mental health problems., Conclusion: Women's experiences would be improved if given the opportunity to form a trusting relationship with a healthcare provider. Interventions offering support before professional treatment may be valued and suitable for some women. Clear information about support services and treatment options available for perinatal mental health problems should be given. Physiological aspects of maternity care impacts women's mental health and trust in services needs to be restored. Findings can be used to inform clinical guidelines and research on acceptable perinatal care pathways in pregnancy and after birth and future research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Meades, Moran, Hutton, Khan, Maxwell, Cheyne, Delicate, Shakespeare, Hollins, Pisavadia, Doungsong, Edwards, Sinesi and Ayers.)

129 mothers referred to specialist psychiatric services in Birmingham and Christchurch were interviewed with the Birmingham Interview. Anxiety disorders were more frequent than depression during pregnancy, and equally frequent after delivery. The focus of pre- and post-partum anxiety may be important for psychological treatment. At a severe level, the most common prepartum theme was fear of foetal death; this was associated with a history of reproductive losses or infertility. After delivery the commonest themes were the pathological fear of cot death and fear of the criticism of mothering skills (which was a clue to a disordered mother-infant relationship). Clinicians should be vigilant for obsessional disorders, querulant (complaining) disorders, post-traumatic stress disorder, conjugal jealousy and dysmorphophobic states, which are all quite common. Patients with “postpartum depression” usually had at least one other (co-morbid) disorder, and 27% had two or more. These findings emphasize the diversity of postpartum psychiatric illness. [ABSTRACT FROM AUTHOR]

Background: Perinatal mental health problems are those that occur during pregnancy or up to 12 months postpartum, and affect up to 20% of women. Perinatal anxiety (PNA) is at least as common as depression during the perinatal phase and can adversely impact on both mother and child. Despite this, research into anxiety has received less attention than depression. The National Institute for Health and Care Excellence guidance on perinatal mental health has identified PNA as a research priority., Aim: To explore the perspectives and experiences of healthcare professionals (HCPs) in the identification and management of PNA., Design and Setting: This was a qualitative study in primary and secondary care set in the West Midlands from February 2017 to December 2017., Method: Semi-structured interviews ( n = 23) with a range of HCPs. Iterative approach to data generation and analysis, using principles of constant comparison. Patient and Public Involvement and Engagement (PPIE) group was involved throughout the study., Results: Twenty-three HCPs interviewed: 10 GPs, seven midwives, five health visitors, and one obstetrician. Four themes were uncovered: PNA as an 'unfamiliar concept'; reliance on clinical intuition and not clinical tools; fragmentation of care; and opportunities to improve care., Conclusion: Awareness and understanding of PNA among HCPs is variable, with debate over what is 'normal' anxiety in pregnancy. HCPs suggested that PNA can be challenging to identify, with mixed views on the use and value of case-finding tools. Opportunistic identification was noted to be significant to aid diagnosis. Care for women diagnosed with PNA was reported to be fragmented and interprofessional communication poor. Potential solutions to improve care were identified., (© British Journal of General Practice 2019.)