15 Apr, 2024
"We have to see families being prioritised in government policies and projects, as we have so much evidence of the significant impact poor early childhood experiences can have on a baby and their continued life; which can impact not just their life but future generations."
Laura Walton Tweet
We were thrilled to catch up with our latest Guest Contributor, Laura Walton, to take a deep dive into the current state of maternity care.
Laura Walton is a Midwife at the Princess Royal University Hospital (PRUH), and she won the Midwife of the Year Nursing Times award this year. Laura won the Midwife of the Year award in recognition of her work to support women and birthing people who have tokophobia, an extreme fear of childbirth, or are experiencing high anxiety about birth. To support women and birthing people, Laura set up the ‘Birth with Confidence’ classes. The classes have reduced anxiety for women and birthing people, and feedback from the classes has shown that fewer women and birthing people request a caesarean section, are more able to enjoy their pregnancy, and think positively about birth after attending the classes. The impact of these sessions has also influenced other NHS Trusts in South East London and from around the UK to run similar classes. Laura has also organised multidisciplinary-led sessions on mental illness in pregnancy with psychologists, psychiatrists, midwives and other healthcare professionals. Alongside this, Laura created and trained sexual trauma champions at King’s, who work together to improve care for those with lived experience of sexual trauma when accessing maternity care.
Please note, all views reflected are the individual’s own, and not representative of their employer.
HUGE congratulations on receiving Midwife of the Year. What specific accomplishments or contributions do you believe led to this recognition?
Thank you so much! I was really blown away to be nominated let alone win and the other nominees were equally amazing. I work with so many incredible midwives that it felt a bit odd to be singled out but I was really thankful for the recognition. The project that was highlighted most in the nomination was my passion and development of trauma informed care within maternity and in particular the workshops I developed for first time mums struggling with significant birth anxiety.
As a midwife, what motivated you to advocate for the recognition and prioritisation of mental health support within the broader framework of maternity care?
Firstly, just the recognition that suicide is and has continued to be for many years; the leading cause of death in women having a baby from 6 weeks to 1 year postnatally. It’s a statistic that is unbearable to read every year the MBRRACE reports are published. Secondly, I feel so passionately about improving mental health care in maternity; mostly because of the women and birthing people I have the honour of caring for. Being able to see the impact that mental health conditions has on their experience of motherhood and attachment to their baby as well as how much their lives can be changed for the better when the appropriate support is offered; this encourages me to keep working hard and speaking out about the need for better perinatal mental health care.
Firstly, just the recognition that suicide is and has continued to be for many years; the leading cause of death in women having a baby from 6 weeks to 1 year postnatally. It’s a statistic that is unbearable to read every year the MBRRACE reports are published. Secondly, I feel so passionately about improving mental health care in maternity; mostly because of the women and birthing people I have the honour of caring for. Being able to see the impact that mental health conditions has on their experience of motherhood and attachment to their baby as well as how much their lives can be changed for the better when the appropriate support is offered; this encourages me to keep working hard and speaking out about the need for better perinatal mental health care.
In your experience, what are some of the most effective strategies or approaches for addressing the mental health needs of expectant parents within the healthcare system?
Continuity of midwifery care is something that has been significantly impacted by the severe midwifery workforce shortage across the country. Yet when it’s able to be provided to families there are numerous benefits for supporting mental health needs of parents. Where a woman is able to develop a trusting relationship with a known midwife/small team of midwives; she is more likely to feel able to be honest about how she’s feeling, to feel listened to and support is therefore more likely to be implemented earlier; which can help reduce the longevity of a mental illness. Sometimes this can also prevent the need for more intensive perinatal mental health support. Raising awareness is also something that can feel like a small thing but the more perinatal mental health is talked about; the less of a stigma it can become and this can reduce the shame that many families feel when they are suffering with a mental illness. When we are able to educate women and their families more on what to expect during pregnancy and the early postnatal journey from an emotional wellbeing point of view; this enables them to be able to feel reassured about what is normal as well as feel empowered to seek support where needed. One example of this is teaching more women and families about intrusive thoughts – they are extremely common to experience after having a baby but very rarely talked about and therefore this can be terrifying for parents when they do experience them.
The For Baby’s Sake Trust focuses on holistic support for families. How do you integrate mental health support into your practice to align with this mission?
I’ve been so excited to read about the work that For Baby’s Sake is doing as holistic support is vital in order to get better outcomes for families and in particular the early life experiences of children. We know from recent MBRRACE reports that many women who died due to suicide in the perinatal period had experienced trauma either in childhood or adulthood. A high proportion of these women had been exposed to complex trauma such as domestic abuse and substance misuse and many of them had not received a mental health diagnosis. Whilst screening for history of trauma and domestic abuse during pregnancy is still so important; the learning from this report really highlighted the need to ensure trauma informed care is a part of every healthcare professionals practice and it has been and continues to be a passion of mine to see trauma informed approaches being offered to everyone accessing maternity care. Ensuring I am educated in trauma informed care and then sharing this knowledge with trauma champions within the maternity unit I work in has been my first step towards this.
I’ve been so excited to read about the work that For Baby’s Sake is doing as holistic support is vital in order to get better outcomes for families and in particular the early life experiences of children. We know from recent MBRRACE reports that many women who died due to suicide in the perinatal period had experienced trauma either in childhood or adulthood. A high proportion of these women had been exposed to complex trauma such as domestic abuse and substance misuse and many of them had not received a mental health diagnosis. Whilst screening for history of trauma and domestic abuse during pregnancy is still so important; the learning from this report really highlighted the need to ensure trauma informed care is a part of every healthcare professionals practice and it has been and continues to be a passion of mine to see trauma informed approaches being offered to everyone accessing maternity care. Ensuring I am educated in trauma informed care and then sharing this knowledge with trauma champions within the maternity unit I work in has been my first step towards this.
How do you collaborate with other healthcare professionals, such as health visitors or social workers, to ensure comprehensive support for women during pregnancy and childbirth?
I am so thankful to work in an area where we have built a really positive working relationship with other supporting agencies outside of maternity such as Health Visiting and Social Care. We work closely by meeting on a monthly basis to discuss any families which might benefit from enhanced support and also I love when we get to meet with the families together as a team around them. It shows the mother and her family that we are all working together to advocate for the things she needs and gives her a voice and helps her to have more positive outcomes for both her and her baby. It also helps to avoid miscommunication and disjointed care which can be so distressing and frustrating for families.
From a policy perspective, what changes or improvements would you like to see implemented to better support women’s mental health during pregnancy and childbirth?
Thinking outside of just perinatal mental health care; we have to see an improvement in the social difficulties which so many families are facing; particularly with the cost of living crisis. Many women who come to see me and are suffering with mental health difficulties are also battling with poor/unstable housing, financial difficulties and social isolation. It can feel so helpless as a professional as I have no influence over these factors but see how much of the time; these are what are impacting on the mental wellbeing of a mother. Providing mental health support is an important element of care but if they are still left in a home that is unsafe or not suitable for their needs for example; it risks only having a very small impact. We have to see families being prioritised in government policies and projects as we have so much evidence of the significant impact poor early childhood experiences can have on a baby and their continued life; which can impact not just their life but future generations.
Thinking outside of just perinatal mental health care; we have to see an improvement in the social difficulties which so many families are facing; particularly with the cost of living crisis. Many women who come to see me and are suffering with mental health difficulties are also battling with poor/unstable housing, financial difficulties and social isolation. It can feel so helpless as a professional as I have no influence over these factors but see how much of the time; these are what are impacting on the mental wellbeing of a mother. Providing mental health support is an important element of care but if they are still left in a home that is unsafe or not suitable for their needs for example; it risks only having a very small impact. We have to see families being prioritised in government policies and projects as we have so much evidence of the significant impact poor early childhood experiences can have on a baby and their continued life; which can impact not just their life but future generations.
The For Baby’s Sake Trust emphasises the importance of early intervention and prevention in supporting families. How do you incorporate this preventative approach into your work with expectant mothers experiencing challenges?
I think as I have touched on above; access to information and dispelling myths around perinatal mental health difficulties is a very important starting point to preventing deterioration of mental health difficulties in families. If parents are able to feel empowered to know what mental illness is, where they can seek support if needed and an assurance that they will not be judged or left feeling like a bad parent; it can help to ensure mental health support is accessed at the earliest opportunity. Also working alongside supporting agencies and supporting families to access these is a vital element of early intervention. There are many needs families have that I might not be able to meet in my role as a mental health specialist midwife but there are many organisations that can. Having positive and close working relationships with third sector organisations in my area means I can support families to access peer support such as Befriending services, groups that improve social isolation or address perinatal needs such as Dad mentoring, creative journaling for mental health etc. These third sector organisations are vital for reducing social isolation and enabling parents to realise they are not alone in the difficulties they are facing and there is help available.
In your opinion, what are the most significant barriers or challenges that pregnant women face when accessing appropriate care, and how can these barriers be addressed at both the individual and systemic levels?
I think barriers in accessing holistic support for the many needs that families face in the perinatal period are a huge component as I’ve touched on. If we do not take a holistic view of women’s needs, we can be in danger of trying to only meet one need and expecting this to fix things when all of the barriers being faced impact on her mental and physical wellbeing. It’s why organisations such as For Baby’s Sake are so vital as whilst maternity professionals who usually lead on care in pregnancy are experts in maternity care; we need the expert organisations such as yourselves to support us to provide input and advice for the other elements of care that are vital to a woman’s holistic wellbeing. When talking about barriers; I also can’t not highlight the
disparities in care faced by women from non White backgrounds. We know that Black women for example are 4-5x more likely to die having a baby than White women and Asian women are nearly 2x more likely to die than White women. By working together and listening to organisations such as the amazing Five X More and The Motherhood group and I’m sure there are many more; I am hopeful we can work towards a future where all women receive the same care irrespective of any protected characteristics.
I think barriers in accessing holistic support for the many needs that families face in the perinatal period are a huge component as I’ve touched on. If we do not take a holistic view of women’s needs, we can be in danger of trying to only meet one need and expecting this to fix things when all of the barriers being faced impact on her mental and physical wellbeing. It’s why organisations such as For Baby’s Sake are so vital as whilst maternity professionals who usually lead on care in pregnancy are experts in maternity care; we need the expert organisations such as yourselves to support us to provide input and advice for the other elements of care that are vital to a woman’s holistic wellbeing. When talking about barriers; I also can’t not highlight the
disparities in care faced by women from non White backgrounds. We know that Black women for example are 4-5x more likely to die having a baby than White women and Asian women are nearly 2x more likely to die than White women. By working together and listening to organisations such as the amazing Five X More and The Motherhood group and I’m sure there are many more; I am hopeful we can work towards a future where all women receive the same care irrespective of any protected characteristics.
Looking ahead, what advancements or developments do you anticipate in the field of maternity care, particularly concerning mental health support?
It’s been exciting to see the development in the last year or so of Maternal mental health services which are focused on providing psychological support to families who have experienced the loss of a baby, experienced trauma related to the perinatal experience, Tokophobia and mothers who’ve had their baby removed through care proceedings. It’s been a very much needed source of support to families for so long and I’ve had the pleasure of seeing the enormous impact this psychological support has had on the families who have benefited from it. Many of these services are overwhelmed with referrals so there is still lots of work to be done but I’m excited to see how they develop over the coming months and years and the positive impact this will have on women and their families. I’ve also noticed the growing third sector organisations offering support for women and families in the perinatal period such as The Survivors trust who I’ve had the pleasure of working closely with on improving trauma care and birthing plans, Maternal OCD and Neurodivergent Birth just to name a few. These groups of women have for too long had their voices not heard and therefore the emergence of these incredible charities and organisations really supports our role in maternity to better individualise care and ensure women and birthing people have access to specific support that can address their individual needs and help them feel less alone.
How do you ensure that your practice remains up-to-date with the latest research and best practices in maternal mental health, and how do you envision incorporating future advancements into your work?
I follow as many organisations as I can on social media and am always really excited to read new research which can help change our practice and make things better. I’m also really privileged to have had the opportunity to both attend and present at conferences where networking with other professionals with the same passions can help me to grow and develop as a maternal mental health midwife. I have a close relationship with all the other mental health midwives that work in neighbouring trusts and we are always sharing new ideas and pieces of research we have found as well as my local perinatal mental health team who are amazing and constantly inspire me. Mostly though, I find any changes I support to make in practice come from feedback from the women and families I care for. I am constantly in awe of how women sacrifice their own needs in order to provide the best care to their babies despite the most challenging circumstances and it is their journeys and experiences that usually grow new ideas for better practice. One group of women I haven’t touched on much so far and would love to see improvements in care for are our population of young mothers. We know again from MBRRACE that their risk of suicide in the perinatal period is growing and yet those who are under 18 years old mostly do not have access to the amazing specialist care provided by perinatal mental health teams. I’d love to see this change as I have seen first hand the life changing differences these teams can offer and believe that being a younger mum shouldn’t be an exclusion to accessing this specialist support.
I follow as many organisations as I can on social media and am always really excited to read new research which can help change our practice and make things better. I’m also really privileged to have had the opportunity to both attend and present at conferences where networking with other professionals with the same passions can help me to grow and develop as a maternal mental health midwife. I have a close relationship with all the other mental health midwives that work in neighbouring trusts and we are always sharing new ideas and pieces of research we have found as well as my local perinatal mental health team who are amazing and constantly inspire me. Mostly though, I find any changes I support to make in practice come from feedback from the women and families I care for. I am constantly in awe of how women sacrifice their own needs in order to provide the best care to their babies despite the most challenging circumstances and it is their journeys and experiences that usually grow new ideas for better practice. One group of women I haven’t touched on much so far and would love to see improvements in care for are our population of young mothers. We know again from MBRRACE that their risk of suicide in the perinatal period is growing and yet those who are under 18 years old mostly do not have access to the amazing specialist care provided by perinatal mental health teams. I’d love to see this change as I have seen first hand the life changing differences these teams can offer and believe that being a younger mum shouldn’t be an exclusion to accessing this specialist support.
Reflecting on your journey to becoming Midwife of the Year, what advice would you offer to aspiring midwives?
I think from all the things I have learnt throughout my career I would have 2 pieces of advice. Firstly, it can feel overwhelming sometimes when you feel really passionate about making positive change but face barriers related to difficulties within the NHS system and it can feel like you’re not making much of a difference. But you are, even when you might not see it. Women and their families remember their midwives for life and even if they don’t remember your name or what you looked like; they will remember how you made them feel. Finally; individualised care is so so important and the best way to provide this is to listen to the woman and her partner or family. We can quite often make the mistake of grouping women into their circumstances and assuming that for example; all women facing domestic abuse will have the same wants and needs for theirs and their babies life. But everyone is different and what works for one family might not work for another. Therefore if we as midwives can just take the time to listen and hear from the women themselves about what they need to help them thrive as mothers; it not only makes our job easier but ensures the care we are giving is meaningful and actually going to help make a difference. Being an advocate for a woman and ensuring her voice is heard is one of the most rewarding parts of my role!
Thank you for sharing, Laura!
If you’d like to be involved in our Guest Contributor series, please email daisyobrien@forbabyssake.org.uk
