Read standard 10: Mental health and wellbeing

Maternity standards
Healthcare Improvement Scotland

Standard statement

NHS boards ensure women and their babies can access mental health and wellbeing support that is timely, equitable, consistent and trauma informed.

Rationale

Good mental health and emotional wellbeing during pregnancy and birth can improve outcomes for women/birthing people and their babies. Women with a history of mental-ill health or trauma can benefit from early interventions to support their wellbeing during pregnancy in line with national pathways and related guidance. Access to evidence-based advice, information and support enables women to make informed decisions about their care and treatment, including understanding the benefits and risks of continuing or changing mental health medication during pregnancy. Capacity to consent is covered in Criterion 1.6.

Risk of poor perinatal mental health is higher among women from marginalised groups, including those experiencing deprivation, seeking asylum, in prison or police custody or affected by alcohol or substance use.2, 28, 29 Women who have experienced gender-based violence and those who are LGBTQIA+ may also be at increased risk.30, 31 Women who have experienced trauma during pregnancy and birth are also at risk of developing mental health symptoms. Individualised support, ongoing monitoring and opportunities to talk through their experiences are recommended.

Mental health and wellbeing can be affected by the woman’s existing physical health conditions or medical complications that develop during pregnancy. Concerns about the baby’s health or development (for example, following screening or birth), as well as challenges with early postnatal bonding, can also have an impact on a woman’s wellbeing.

NHS boards should provide a range of trauma-informed mental health support services, including clear pathways for timely referral to specialist services, when required. Enhanced access to urgent and unscheduled care at the point of crisis or emergency also improves outcomes.2 The Perinatal Mental Health Network Scotland has established national care pathways for specialist perinatal mental health services. Services should include a dedicated specialist midwife with responsibility for perinatal mental health.28 The Mother and Baby Unit pathway emphasises the importance of keeping the woman and her baby together when specialist inpatient care is needed.

Continuity of carer supports the early identification of mental health concerns and enables timely responses to women who need additional support. Good communication, compassion, practical support and effective pain relief can also contribute positively to women’s mental health and wellbeing.

Infant mental health is supported by positive early relationships between the woman and her baby and secure attachment can have long-term benefits for both.32 Maternity services should be responsive to the individual emotional wellbeing needs of babies and provide a nurturing environment with adequate nutrition and safe sleep opportunities. Positive interactions between women and their babies, including regular communication, appropriate stimulation and responsive care, are important. Support from family members further enhances wellbeing outcomes for women and their babies. All care for babies should be delivered in line with the principles of Getting It Right for Every Child (GIRFEC) and United Nations Convention on the Rights of the Child.

Pregnancy and baby loss is covered in Standard 11.

Criteria

10.1

Women are supported to understand their mental health and wellbeing needs, including recognising changes:

  • throughout their pregnancy and postnatal period
  • following pregnancy and baby loss (see Standard 11).
10.2

Staff ensure women (and, where appropriate, their care partners) know who to contact if they have concerns about their or their baby’s mental health or wellbeing at any point in their care.

10.3

At their first booking appointment, women are offered a comprehensive and holistic assessment of their current and previous mental health and wellbeing. This covers:

  • any relevant existing or previous care and treatment plan, including medication
  • physical health risk factors for the development of mental health problems
  • physical health and medical complications of their baby
  • risk factors associated with multiple pregnancy
  • access to support networks
  • psychosocial factors, such as poverty, homelessness, alcohol or substance use
  • risk of gender-based violence
  • experience of trauma
  • experience of pregnancy or baby loss (see Standard 11).
10.4

Women have their mental health and wellbeing assessed:

  • throughout their antenatal care
  • during and after birth
  • during unscheduled, emergency or critical care (see Standard 9)
  • after transfer of care to the universal health visiting system
  • following pregnancy or baby loss (see Standard 11)
  • when they report a change in their emotional wellbeing.
10.5

Women’s care plans are regularly updated to reflect any changes in their mental health and wellbeing needs.

10.6

A primary midwife undertakes assessments of mental health and wellbeing in line with national pathways and relevant guidance and are enabled to:

  • use validated assessment tools
  • provide positive and supportive care for women with mild to moderate mental health difficulties
  • be responsive to individual needs
  • recognise symptoms and signs of concern and escalate appropriately
  • provide tailored information and signpost to support and resources
  • refer to timely specialist support or intervention, as appropriate.
10.7

NHS boards ensure women who require additional or enhanced mental health care have continuity of primary midwife.

10.8

NHS boards have processes to ensure the early identification of, and response to, the need for additional mental health support for women and their babies.

10.9

NHS boards have clearly defined referral pathways for mental health and wellbeing support throughout the maternity pathway, which include:

  • evidence-based psychological interventions and proactive outreach
  • signposting to community networks and social support, including peer support
  • specialist third sector support
  • specialist perinatal mental health support and support for suicide prevention
  • specialist trauma, female genital mutilation or gender-based violence support.

What does this standard mean for...

What does the standard mean for women and their babies?

  • Your mental health and emotional wellbeing, and that of your baby, will be supported throughout your maternity care and will be based on your needs.
  • You will have the support you need to bond with your baby in your own time.
  • If you need support for your mental health and wellbeing, or your baby’s emotional wellbeing, you will receive this as soon as possible. It will be tailored to what is right for you.
  • You will receive the right information to make decisions that are best for you and your baby.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:

  • undertake holistic and timely mental health and wellbeing assessments
  • support women (and care partners, where appropriate) to prepare for parenthood
  • support women in early attachment and bonding with their babies
  • offer women tailored information and support for their and their baby’s mental health and wellbeing
  • recognise and respond to concerns about deterioration in mental health and wellbeing and make timely referrals for specialist care and support
  • signpost women (and, where appropriate, their care partners) to additional information and support as appropriate.

What does the standard mean for the NHS board?

NHS boards:

  • have referral pathways to a range of perinatal mental health and wellbeing services
  • review services to ensure they are person centred and trauma informed, including information or facilities
  • ensure timely access to specialist perinatal mental health or other support services, for example, specialist trauma or gender-based violence support
  • work in partnership with other organisations and services, including social care and the third sector, to support maternal and infant mental health and wellbeing.

Benchmarking and measuring performance

 

Criteria

Examples of what meeting this standard might look like

Please note this list is not exhaustive and examples may vary according to the size and scale of the service or NHS board or delivery model

10.1

Signposting to (and provision of) national information to women (and, where appropriate, their care partners) about mental health and wellbeing.

10.2

Feedback from women.

10.3

Audit and review of patient records demonstrating quality and consistency of mental health and wellbeing assessments, including use of validated tools.

10.4

Documentation and observations showing timely action when a woman reports a change in their mental health or wellbeing.

10.5

Evidence of care plans being regularly reviewed and updated.

10.6

Evidence of staff using validated assessment tools appropriately.

10.7

Individualised care plans, including a named primary midwife.

10.8

Audit and review of referrals and admissions data and pathways.

10.9

Evidence of access to specialist services, for example, gender-based violence services.

 

Editorial Information

Last reviewed: 23/03/2026

Next review date: 23/03/2031

Author(s): Maternity standards development group.

Author email(s): his.standardsandindicators@nhs.scot.

Approved By: Maternity standards development group

Reviewer name(s): Maternity standards project team.