Women with or at risk of mental health problems should receive extra support at all stages of pregnancy and beyond, updated NHS guidelines say.
They come a fortnight after the bodies of Charlotte Bevan, 30, and her four-day-old daughter Zaani were found in the Avon Gorge after they went missing from a maternity hospital in Bristol.
NICE hopes its advice will help NHS staff identify mental health problems.
A fifth of women have depression or anxiety in the year after giving birth.

Ms Bevan is believed to have suffered from schizophrenia and depression and had been sleep-deprived after giving birth.
A review into the circumstances that led to her disappearance is being carried out by University Hospitals Bristol NHS Trust.

NICE said the impact on families of mental health problems during and after pregnancy can be long-lasting.

As well as anxiety and depression, there is an increased risk of psychosis in the weeks after giving birth and others may experience obsessive compulsive disorder, post-traumatic stress disorder, tokophobia (an extreme fear of childbirth) and eating disorders.

NICE said that although such problems responded well to treatment, they frequently went unrecognised and untreated.

Under its recommendations, which update the last advice given in 2007:

– Counselling on the potential implications of pregnancy should be given to all women of childbearing age who have a new, existing or past mental health problem
– In early pregnancy, mental health and wellbeing should be talked about at the first booking in appointment as well as specific questions to identify depression
– For any woman with a mental health problem during or after pregnancy, there should be an integrated care plan in place that sets out the treatment and which health professionals are responsible for care
– The guidelines also advise on the most appropriate drugs and treatments that can be offered safely during pregnancy and breastfeeding and supporting women in weighing up the pros and cons
– Women and their partners who have experienced a traumatic event such as a very difficult birth should be offered extra support
– And there are clear recommendations about what should be offered to mothers who have suffered a miscarriage or whose baby is stillborn.

Prof Mark Baker, NICE Centre for Clinical Practice director, said: “Giving women the right treatment at the right time can have a profound effect – not just for the mother, but her family too.

“The effect of getting this right can last for years.”

Expert groups strongly welcomed the guidelines but warned of a dire national shortage of specialist perinatal mental health services.

A recent NCT survey of 186 Clinical Commissioning Groups in England found “huge gaps” with only 3% reporting they had a perinatal mental health strategy.

Royal College of Midwives chief executive Cathy Warwick said: “We desperately need more midwives and maternity support workers to work with these hard-to-reach and vulnerable women.”

Dr Liz MacDonald, who chairs the Royal College of Psychiatrists’ perinatal faculty, agreed there was “gross inequality” in access to perinatal mental health services “which is putting the wellbeing of thousands of mothers, infants and families in jeopardy”.

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