Attempted Suicide in Perinatal Period

The Aspen Themes - A Peer Support Perspective

I was fortunate to attend the Maternal Mental Health Alliance Suicide Prevention for New and Expectant Mothers online event on the 25th of April 2024 at which the launch of The Attempted Suicide in the Perinatal Period (ASPEN) study and the findings of the latest MBRACE-UK 2023 report were presented and discussed, as well as hearing lived experience stories from 2 brave women who had survived.

The findings served to validate and reinforce for me, the undisputable value and hugely important role of 1:1 perinatal mental health peer support and targeted therapeutic perinatal mental health peer support/community group programmes, such as Lifeboat’s Perinatal Comfort Zone, during the perinatal period...

...as safe spaces to disclose thoughts and feelings without barriers, shame, guilt and to enable access to support and intervention and save lives.

The ASPEN study explored the experiences of 11 women who had attempted suicide during the perinatal period and that of their partner, friends, or family members. It reported 3 main THEMES that were described as leading to the suicide attempts.

These all resonated with me as common themes that are often disclosed/discussed in 1:1 peer support sessions or the Perinatal Comfort Zone group programmes

  1. Trauma and Adversity: Psycho-social adversities, a family history of PMH illness (generally of a maternal Mother) which can often remain hidden and undiscussed within families. 1:1 Peer support enables a safe space for discussion and disclosure of this.

  2. Disillusionment with Motherhood: the physical and mental struggle of pregnancy and birth: a very common theme in peer support disclosure with women describing feeling overwhelmed, unable to cope; alongside feeding and sleeping issues, birth trauma, health anxiety (for self and baby, hugely prevalent in pregnancy).. thoughts of I didn’t ever think it would be like this… how will I cope when the baby is born etc

    Invalidation of identity and self-sacrifice, often by maternity health professionals: another common theme that is often discussed.

    “It wasn’t like starry eyed love”: disclosures of feeling scared of the baby, of not wanting to be alone with the baby, of feeling a lack of bond, numb and disconnected, are themes that often come up.

  3. Entrapment and Despair: This is a very common theme discussed during peer support.

    Feeling like a failure: In my experience most women I supported would describe feeling this.

    Intensive intrusive thoughts and abnormal experiences: Many women on some level disclose intrusive thoughts of some sort.

    Feeling alone in this world: most women will describe feeling alone/loneliness (we know it can be particularly felt when a partner returns to work or for single parents) but loneliness is often felt despite support and family around you.

    “Tired and wired”: INSOMNIA is highlighted as a misunderstood and minimised side-effect within the clinical recommendations – this really resonates for me, sleep deprivation and its negative effect on mental health in the perinatal period is such a common theme with women I have supported.

    We need to be aware that sleep deprivation and insomnia can lead to thoughts of being unable to cope and suicidal ideation if not addressed.

    - The irreversibility of Motherhood: the feeling of being trapped with no way out, no going back, feeling utter despair, again a common theme to hear.

    The voices of the 2 brave women who told their stories highlighted further the importance of peer support alongside specialist services. If I can paraphrase their comments…

    ….Someone to listen, peer support, raising awareness , promoting services, feeling you are not on your own…

    ….Peer support would have made a huge difference.. I feel I would have disclosed my thoughts to someone I trusted …we need to keep talking and share

Peer support workers with lived experience really get it, they really get the presentations, the risks and can help health care professionals better understand too.

  • The ASPEN study highlights BARRIERS identified by maternity heath care professionals to responsive care provision and disclosure by women:
  • A lack of recognition of severity of presentation
  • A lack of communication of risk within services
  • A lack of service provision and access to treatments
  • HCPs feeling uncomfortable asking about suicidal ideations
  • A dislike of, finding existing suicide related items on current health questionnaires unhelpful: these are also largely unacceptable to perinatal women in their current form
  • Stigma, fear and shame remain central barriers to disclosure
  • The MBRACE-UK 2023 report into maternal deaths confirms:
  • We are still seeing barriers to accessing support and intervention
  • Lack of referrals
  • Lack of engagement with community specialist services
  • Restrictive referral criteria for access to specialist services
  • Lack of pathways into specialist care for complex adversities (ACES, DVA, Personality Disorder diagnoses, women who have had children removed).

The recent statistics around mental health related maternal deaths from the M-BRACE-UK 2023 report are sobering.

  • 76 suicides/mental health related deaths during 2019-2021
  • Suicide remains the leading cause of maternal death within 6 weeks and 1 year of the end of pregnancy/birth (39%)
  • A high number of suicides are by violent means
  • Suicides antenatally have increased 3-fold
  • Teenage/young women suicides are increasing

Yet despite this, evidence to guide suicide prevention in the perinatal period remains scarce.

Precursor acts of self-harm remain highlighted as red flags and are increasing and we know that children/family being cited as protective factors cannot be taken at face value.

At Lifeboat we aim to raise awareness of perinatal mental health through training and awareness seminars and to enable access to our targeted therapeutic perinatal mental health group programme the Perinatal Comfort Zone, whether within specialist services (run by occupational therapists/peer support workers), children’s centres (run by family support workers or peer support workers) or voluntary sector peer support organisations.

We know that the voluntary sector already fills a huge gap in NHS provision for perinatal mental health; increased funding will enable more awareness raising, targeted 1:1 support provision and targeted therapeutic group programmes to provide safe spaces to disclose thoughts and feelings without barriers, shame, guilt and to enable access to support and intervention and save lives.

For more information on the ASPEN study, you can read the full article here.