7. Debate on the Children, Young People and Education Committee report on Perinatal Mental Health in Wales

Part of the debate – in the Senedd at 5:51 pm on 31 January 2018.

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Photo of Jenny Rathbone Jenny Rathbone Labour 5:51, 31 January 2018

Llyr just stole my line. Of course, it's great timing: we are talking about this report on the eve, I think, of Time to Talk Day, because obviously you produced your report in October and then the Government responded in November. So, well done to the leader of the house that she timetabled this discussion for today. 

Having a baby is a messy business. One minute you're a booted, suited woman with a job to go to, and the next minute you're a sleep-deprived milk machine entirely dependent on other people to enable you to begin the lifelong journey of motherhood. And that's assuming you have those support mechanisms, because if you don't, or the support is given to you conditionally or grudgingly or resentfully, the journey is much more challenging. 

So, I think this is a really important subject. I think nobody's mentioned so far that you are, of course, at increased risk of domestic violence if you are pregnant. Those who've been previously abused are four times more likely to be abused during pregnancy than women with no history of violence. Other risk factors of single mothers are lower education, lower socioeconomic status, alcohol abuse and unintended pregnancy. Perinatal mental illness—there's a strong association with domestic violence, both perinatally and during your whole lifetime. They're not necessarily always present. You can obviously have postnatal depression without having an abusive partner. The reasons you've got your depression can be completely unrelated to anything like that. But we have to be aware that there are these risks, and that mothers are really, really vulnerable when they first have a baby. 

So, I think your recommendation 19, continuity of care from a midwife or a health visitor, is absolutely essential. In my day, you had up to 10 days of visiting at home, unless you agreed collectively that you didn't need it because you had good support mechanisms. But these days I know it's not that consistent, and parenting doesn't come with instructions. Mothers desperately need independent professional advice without the emotional baggage you often get from other family members. 

Recommendation 16 feels a bit like groundhog day to me. I'm pleased to hear that Llyr thinks that this is going to be a ground-breaking report, and that we're really, really going to change things, but I can remember discussing this, I'm afraid, a very long time ago. The Edinburgh postnatal depression scale has been around for at least 30 years and it's a really, really simple tool for asking women how they're feeling, which enables you to assess the potential risk; obviously, not losing sight of your ability to observe the woman and ensure that you've understood—. You already know the person, so you're able to also observe whether or not you think there may be depression going on.

But I find it really depressing that we're still talking about the need for midwives and health visitors and GPs and any other health professional who comes into touch with postnatal women to have these skills, and also to actually ask the question, because it is completely essential for safeguarding of the mother and the child that we are asking these questions. Lynne Neagle asked if we can afford not to provide these services, and the answer is that we absolutely cannot afford not to, because of not just the impact on the mother but the impact on the baby. The baby starts communicating the minute it's out of the womb, and, if the mother, who's the main person that the baby's in touch with, is not communicating with the baby, the impact is absolutely devastating. Why would the baby bother to communicate if they're getting no response from the adult? If the adult is utterly depressed, they won't be responding.

So, it's completely essential that we have professionals involved, as well as family members, to ensure that, if the person is perinatally depressed, there are other people around to talk to the baby, because the consequences otherwise are lifelong: the failure to secure attachments, the impact on the infant's social, emotional, cognitive and language development, facilitating development of good mental health in childhood and adulthood—as you heard in your evidence.

I'd be very interested to hear from the Cabinet Secretary about the family resilience assessment tool as a way of complementing the Edinburgh postnatal depression scale, because we absolutely have to ensure that the inverse care law doesn't apply here and that those who most need the services of professionals are getting them. One in five women—that means everybody needs this service and everybody needs to understand that we need to talk to women about their perinatal mental health.