“Every care conversation with every new and expecting parent needs to include two critical questions: Are you OK? Are you safe?”
Perinatal mental health screening is recommended in Australia, yet expecting and new parents may not always feel comfortable talking about their mental health and wellbeing concerns with a healthcare provider.
Common barriers to having an open and honest conversation include feelings of shame, fear of judgement, or fear of child removal.
Primary healthcare providers are key to addressing these barriers by providing a space of trust, care, and safety that encourages people to share their concerns, feelings, and experiences.
Callers to PANDA’s Helpline often share that they’ve been managing by themselves for weeks, or months, just wishing someone would ask how they’re feeling.
You can help parents in your care by asking how they are feeling, taking the time to listen, and exploring what might help someone feel less alone, and more supported.
Building trust and rapport
It’s helpful to build trust early with parents in your care to help them feel comfortable to share what’s on their mind.
You can do this by:
- Letting them know that your role is to care for their mental health and wellbeing too, not only for their baby
- Allowing enough time for your client to share any concerns without feeling rushed
- Using plain, non-judgemental language when talking about mental health and wellbeing
- Using inclusive language and offering appropriate resources
- Showing understanding and empathy
- Encouraging them to book a follow up appointment so that you can continue discussing it further, particularly if time is limited
“The healthcare providers that helped me the most were the ones who normalised how I was feeling, gave me positive encouragement and offered a lived experience perspective. It was as simple as “I can see how hard this is for you. I can understand feeling like you’re failing - I remember feeling that too. You are doing a great job even if you don’t feel like you are. You don’t have to be perfect, just good enough.””
“I will never ever forget the midwife who was on shift for my first night with Will. In the morning at handover, she said I was the best first-time mum she’d ever seen. Now, whether or not she said this to all the mums I have no idea, but it was so genuine and just really stuck with me through those early months.”
Helpful Information
Secondary Consultation service: Support for healthcare providers
Practice tips: Conversation starters
Individuals and families that you support may not know that you can provide mental health support, treatment and/or referral. You can begin a conversation by explaining your role and asking about wellbeing and safety during each contact (e.g. appointment, inpatient stay, home visit).
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Conversation starters during pregnancy
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Conversations starters after birth
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Conversation starters during the first year
“One doctor said to me “I can see baby is well looked after, loved and cared for, you’re doing a great job at that… but how are you going mum?” That hit home to actually be asked that when I was really struggling but trying to hold it together for everyone.”
Respond with empathy and manage your own responses to encourage sharing and honesty
Many people find it hard to talk about what they are experiencing. This includes intrusive thoughts of harm, suicidal ideation and other thoughts and feelings that people may find very difficult to share with you, or anyone else.
If someone in your care chooses to trust you with their experience and story, it's important to listen closely and respond without judgement.
This can encourage an honest conversation. As a healthcare provider, a more complete picture of what’s going on is important when you are working together on a personalised treatment or care plan.
“You listened, you didn't freak out, you said it was okay not to love my baby straight away. You recognised my needs alongside, not secondary to my baby's needs.”
Provide information and resources
Health care providers play a key role in ensuring people have access to evidence-based information about perinatal mental health challenges.
Ideally, discussions about mental health should happen as early as possible. It could be during conversations about conception, prenatal health, or during pregnancy. This helps to prepare parents to find and access support when and if they need it.
These resources can also be shared with parents who may be experiencing challenges with their mental health and can help them reflect on how they are feelings and find the right help.
Sharing resources that address people’s diverse circumstances, needs, and preferences can help them feel understood, less alone, and support them to access appropriate services.
Some of these include:
More helpful resources
Watch and listen
Often expecting and new parents will present a strong “mask of coping” with their family, friends and healthcare providers. It’s important to be attuned to the signs that someone may not be coping as well as usual or adapting to pregnancy or parenthood as well as they’d hoped.
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What to look for: Signs of perinatal mental health and wellbeing changes
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What to listen for: Signs of perinatal mental health and wellbeing changes
PANDA Practice tips: Watching and listening
It’s important to note that expecting and new parents may feel exhausted and stressed, and for many, self-care has shifted in meaning or priority. Likewise, many people present ‘well’ during healthcare provider interactions but are feeling overwhelmed underneath a put-together exterior.
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Gently explore all signs of change
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Be inclusive
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Be direct
“Listen for statements that suggest they’re having a hard time – I don’t know what I’m doing, I didn’t think it would be like this, I’m doing it wrong.”
Signs of hopelessness or possible suicide ideation
Suicide remains one of the leading causes of maternal death during the perinatal period in Australia. Mental health can also shift rapidly during pregnancy and early parenthood – feelings of hopelessness and despair can quickly change into thoughts of suicide and self-harm.
Even if you ask directly if someone is having thoughts of suicide and they answer no, you may hear some of the statements below in your care conversations.
If someone in your care expresses sentiments like these, it’s vital that you explore their wellbeing and safety.
This may include asking again about suicide in your conversation. Sometimes people take a while to trust that they can share how they truly feel with healthcare providers. If you’re having a respectful, curious, non-judgemental discussion, you may find people choose to trust you with their experience as your care conversation progresses.
Verbal signs of hopeless, despair, possible suicide ideation:
- “I feel helpless, I feel hopeless"
- “Nothing will change, no one can help me. I’m beyond help.”
- “I just want to sleep all day… and not wake up.”
- “I feel like running away or disappearing.”
- “I can’t ever see things changing. I can’t do this anymore.”
- “I’m such a burden. They would be better off without me.”
- “I just want this to end."
PANDA Practice tips: hopeless or possible suicidal ideation
Asking if someone is having thoughts of suicide or hurting themselves doesn’t increase the risk they will act on those thoughts. It’s often a relief to be asked about thoughts of suicide in a caring, curious and non-judgemental way.
Asking about someone’s wellbeing and safety is the foundation of effective, meaningful perinatal mental health care. It really is that simple.
Focus on being present with the person you’re supporting. Together, you can explore what they need to keep themself and their baby safe. Keep providing calm assurance that help is available.
It’s always a good idea to involve other support people in any risk management care plan:
- You can try calling the person’s supports and specialist mental health services if you are together, in person or online.
- If it’s between appointments or sessions and you have concerns, we encourage you to reach out directly to the person to provide support if time permits, and seek supervision and/or a secondary consultation as appropriate (e.g. PANDA, local mental health triage services).
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PANDA National Helpline
Find someone to talk to, Monday to Saturday.
1300 726 306
Call 000 for police and ambulance if you or someone else are in immediate danger
Talk with friends or family
Consider talking about how you are feeling with someone you trust. This might be a friend or family member. Once you starting talking you might be surprised at how many others have had similar experiences and the support they can provide you.
Talk with your doctor
Talking with your doctor can be an important step to getting the help you need. They should be able to give you non-judgemental support, assessment, diagnosis, and ongoing care and treatment. They can also refer you to specialists such as a counsellor, psychologist or psychiatrist.
Get help now
If you are having suicidal thoughts or are feeling disorientated it’s important to get help immediately. PANDA is not a crisis service, if you need immediate support call Lifeline 13 11 14 (24/7).
Helpful Information