Quality standard
Quality statement 3: Information for pregnant women
Quality statement 3: Information for pregnant women
Quality statement
Pregnant women with a previous severe mental health problem or any current mental health problem are given information at their booking appointment about how their mental health problem and its treatment might affect them or their baby.
Rationale
It is important that pregnant women with a previous severe mental health problem, or any current mental health problem, understand how their mental health problem might affect them during and after pregnancy, and how pregnancy and childbirth might affect their condition, including the risk of relapse. In particular, it is important that the risks of using some medications to treat mental health problems during pregnancy and while breastfeeding are discussed, and alternatives considered to help women make informed decisions about managing their condition. This discussion might happen earlier for some women if they have a discussion with a specialist before their booking appointment.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that women with a previous severe mental health problem or any current mental health problem are given information at their booking appointment about how their mental health problem and its treatment might affect them or their baby.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example care protocols.
Process
Proportion of pregnant women with a previous severe mental health problem or any current mental health problem who are given information at their booking appointment about how their mental health problem and its treatment might affect them or their baby.
Numerator – the number in the denominator who have received information about how their mental health problem and its treatment might affect them or their baby.
Denominator – the number of pregnant women with a previous severe mental health problem or any current mental health problem attending their booking appointment.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers (antenatal care providers) have systems in place to ensure that women with a previous severe mental health problem or any current mental health problem are given information at the booking appointment about how their mental health problem and its treatment might affect them or their baby.
Healthcare professionals (midwives) provide information at the booking appointment to women with a previous severe mental health problem or any current mental health problem about how their mental health problem and its treatment might affect them or their baby.
Commissioners specify and check that booking appointments for women with a previous severe mental health problem or any current mental health problem include midwives giving information to women about how their mental health problem and its treatment might affect them or their baby.
Women who are pregnant and who have had a severe mental health problem in the past or have any current mental health problem are given information at their booking appointment about how their mental health problem might affect them or their baby during pregnancy and after their baby is born. They are also given information about the possible benefits and harms of any treatment they might have for their mental health problem during this time and while breastfeeding, if they choose to breastfeed. This will help them to make decisions about pregnancy and their treatment.
Source guidance
Antenatal and postnatal mental health. NICE guideline CG192 (2014, updated 2020), recommendations 1.4.3, 1.4.4 and 1.4.6 and expert opinion
Definitions of terms used in this quality statement
Information
Ensure that comprehensive information about the nature of, and treatments and services for, their mental health problems is available. Discuss treatment and prevention options and any particular concerns the woman has about the pregnancy or the fetus or baby. Include discussion of the following, depending on individual circumstances:
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the uncertainty about the benefits, risks and harms of treatments for mental health problems in pregnancy and the postnatal period
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the likely benefits of each treatment, taking into account the severity of the mental health problem
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the woman's response to any previous treatment
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the background risk of harm to the woman and the fetus or baby associated with the mental health problem and the risk to mental health and parenting associated with no treatment
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the possibility of the sudden onset of symptoms of mental health problems in pregnancy and the postnatal period, particularly in the first few weeks after childbirth (for example, in bipolar disorder)
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the risks or harms to the woman and the fetus or baby associated with each treatment option
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the need for prompt treatment because of the potential effect of an untreated mental health problem on the fetus or baby
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the risk or harms to the woman and the fetus or baby associated with stopping or changing a treatment.
[NICE's guideline on antenatal and postnatal mental health, recommendations 1.4.3 and 1.4.6]
Healthcare professionals discuss breastfeeding with all women who may need to take psychotropic medication in pregnancy or in the postnatal period. This should include an explanation of the benefits of breastfeeding, the potential risks associated with taking psychotropic medication when breastfeeding and with stopping some medications in order to breastfeed. Healthcare professionals should discuss treatment options that would enable a woman to breastfeed if she wishes and support women who choose not to breastfeed. [NICE's guideline on antenatal and postnatal mental health, recommendation 1.4.4]
Postnatal period
Up to 1 year after childbirth. [NICE's guideline on antenatal and postnatal mental health]
Severe mental health problem
A severe mental health problem includes severe and incapacitating depression, psychosis, schizophrenia, bipolar disorder, schizoaffective disorder or postpartum psychosis. [NICE's guideline on antenatal and postnatal mental health]
Equality and diversity considerations
When information is provided, there must be equal access to information for all women, including those with additional needs, such as physical or learning disabilities, and those who do not speak or read English. Women receiving information should have access to an interpreter or independent advocate if needed.