What do you do, Nathalie?

Nathalie is a specialist midwife in perinatal mental health at St Thomas’ and tells us about her career as a midwife and why her current role supporting people with mental health conditions is so important.

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May 2023

How long have you been a midwife and what’s your career journey been so far?

I qualified as a midwife in 2014 after training in east London. I had my orientation in a busy east London Hospital and then spent a year at a standalone birthing unit. This was a great experience as we were located 15 minutes from the hospital and assisted with home births in the community too.

I moved to St Thomas’ Hospital in 2016 and worked in the hospital birth centre (labour ward) before joining one of the high-risk teams (Tower team) in 2017. I gained experience in caring for pregnant women and birthing people who are living with epilepsy, sickle cell disease, substance misuse and mental health conditions and those requiring extra care for babies in the womb and in how pregnant women and birthing people experience managing these alongside pregnancy. Whilst in that team, I worked in the antenatal clinic, in the hospital birth centre and in the community doing postnatal visits, so gained valuable experience in a range of settings.

I’m now a mental health specialist midwife. I started this role in November 2022 and love the role!

What does your role involve? 

I am employed as a perinatal mental health midwife and am the only such specialist midwife at Guy’s and St Thomas’. I support pregnant women and birthing people with severe mental health conditions; including schizophrenia, bipolar disorder, or a history of psychosis. I also support people with mild to moderate mental health concerns during pregnancy who require some extra advice, support or signposting on to other services, and do this through one or two appointments. 

I have also recently started a weekly online mental health and wellbeing session for all pregnant women and birthing people, to give information about antenatal and postnatal mental health such as depression, anxiety, obsessive-compulsive disorder and the support available. You can find out more about these, as well as our antenatal classes and our other workshops on the Guy’s and St Thomas’ website

While I’m the only specialist perinatal mental health midwife in the Trust, I’m not the only midwife supporting pregnant women and birthing people with mental health conditions. Women and birthing people with moderate or severe mental health conditions who live in the area receive continuity of care from the Tower team midwives. 

Working with other colleagues is really important. I work closely with the local multi-disciplinary perinatal mental health teams specialising in pregnancy and postnatal care, and the safeguarding teams, along with the link perinatal mental health obstetric consultant, Dr Sonji Clarke. I try to attend weekly ‘huddles’ with colleagues on the maternity wards and provide support on the wards in person, as well as over the phone.

How are the people who need you identified so you can support them?

Most pregnant women and birthing people identify their own needs either during their initial referral or once they have met with the midwife for the first time and gone through their history. Other colleagues, such as doctors, physios and midwives involved in a person’s care may also identify that an individual needs further support due to mental health conditions and they contact me to help. 

Why is it so important to provide mental health support to pregnant women and birthing people? 

I truly believe that the mind and body are totally interlinked, and therefore that mental health is just as important as physical health at any time, but especially during pregnancy when people can feel more vulnerable and isolated. 

We need to provide pregnant people with plenty of information, support and advice, so that they are armed with knowledge and can make informed choices about their own care. 

Having robust mental health support will also help them start their journey into parenthood as well-informed as possible. 

Pregnancy itself can be a trigger for mental health conditions. Sometimes people experience symptoms for the first time in their lives, and sometimes it can exacerbate pre-existing conditions. We know that with the right support and care, we can help reduce risks and support pregnant women and birthing people to be as emotionally supported and safe as possible. 

How do you link in with post-natal services to ensure that pregnant women and birthing people with mental health needs get any additional support they need after giving birth?

Midwives will offer pregnant women and birthing people with certain mental health conditions referrals to specialist health visitors if they are provided in the borough of their home address. This helps ensure a smooth handover of care and helps with providing continuity in health visiting once the person is discharged from their midwifery care. 

We would also advise for enhanced midwifery care in the postnatal period – up to 28 days after birth - to make sure their mental health can continue to be monitored in those critical first few weeks. 

We also liaise with other services such as perinatal mental health teams, Early Help support workers and therapists to provide holistic care to the family. 

What do you most love about being a midwife? 

I love getting to know women and birthing people, alongside their families, and being given the privilege of working with them and supporting them during their pregnancies. I feel I can make a difference by encouraging positive outcomes and helping them to prepare as much as possible for their lives as new parents. 

I also love the colleagues I work alongside, who do invaluable mental health work in the community, in clinics and on the wards. 

What’s the best piece of advice anyone has given you during your midwifery career? 

I’ve been lucky to work with incredible midwives and mentors over the last 12 years and have received lots of helpful advice. 

I think the best advice I was given was as a newly qualified midwife. I was reminded to always trust my gut and go with my initial instinct – if something doesn’t feel ‘right’ then to dig a little deeper and find out why. 

I would encourage all my colleagues to trust their knowledge and their experiences and listen to their own instincts – sometimes asking that one extra question can be the key to supporting people and providing the extra support they may require.

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