Suicide is one of the biggest preventable killers of new mums

By Catherine de Lange Suicide has become one of the leading causes of death in pregnant women and those who have recently given birth. According to a report on maternal mortality in the UK, maternity-related deaths are declining, making it safer than ever to give birth in the UK. But an analysis of all women who died between 2009 and 2013, either during pregnancy or up to one year after giving birth, reveals mental health is an important problem. Compared with 2003, the number of direct maternal deaths – those caused by complications during pregnancy, such as bleeding or infection – has fallen. But there was no corresponding fall in deaths with indirect causes – namely pre-existing physical and mental health conditions that pregnancy can make worse. “There’s been no decrease in those deaths over the past 10 years,” says Marian Knight of the University of Oxford, who led the study. Almost a quarter of maternal deaths between 6 weeks and a year after birth had mental health-related causes. Suicide accounted for 1 in 10 of the women who died during pregnancy or up to a year after giving birth. Although this is a lower rate of suicide than is seen in the general population, the finding exposes problems in the mental health services available to women in the UK. The study paid special attention to 101 women who had died by suicide either during pregnancy or in the following year, and found that many of these women did not receive the care they needed. “It was clear that many of them had had symptoms for a long time,” says Knight. Around half of the women who died by suicide had a history of depression, but the study found that they often had not been asked about this by doctors or midwives. The same was true of experience of domestic violence. Both of these areas should be discussed during the first meeting between a pregnant woman and her midwife. “It’s important that everybody is asked so we identify the women who are really at risk,” says Knight. “We think, with improvements in care, we can prevent about half of the suicides in the future.” The team behind the report has identified several warning signs to help pinpoint women at high risk, including thoughts of violent self-harm and persistent feelings of estrangement from their baby. Because perinatal mental illness can get worse very quickly, Knight says people with these symptoms should seek urgent help from a doctor. “It was clear that many women were unwell for a long time and there was evidence that their symptoms were downplayed by both them and their families,” says Knight. “I think it’s really important that we create a safe and trusting environment to allow these issues to be discussed.” Severe mental health problems are very rare during pregnancy. About 15 per cent of women will have a mild depressive illness after birth, but only about 2 in 1000 will have a very severe depressive illness. However, the decline in direct causes of maternal death has highlighted the lack of similar progress in reducing maternal deaths linked to mental health. According to the report, if the same women who died by suicide became ill today, 40 per cent would have no access to specialist perinatal mental healthcare. Only 15 of the 101 women had had any contact with these services. “We must ensure that women with mental illness in the perinatal period, wherever they live, have access to the specialist services they need,” Ian Jones, director of the National Centre for Mental Health at Cardiff University, UK, said in a statement responding to the study. Knight thinks more can be done to identify symptoms and to encourage women and families to get help. There are drugs for mental health that can be safely used by women who are pregnant or breastfeeding. Last month, the government announced increased funding for perinatal mental healthcare in its spending review, which may help meet its target of halving maternal deaths by 2030. Need a listening ear? UK Samaritans: 08457 90 90 90; US National Suicide Prevention Lifeline: 1 800 273 8255 Image credit: Phanie/Alamy Stock Photo Correction: When this article was first published, some of the language describing suicide was inappropriate. This has now been changed. More on these topics:
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