Development of mental health guidelines to be followed throughout the perinatal period in Zimbabwe

Abstract

This study was carried out as part of efforts to analyse the maternal mental health interventions that are done by midwives on women and then develop mental health guidelines to be followed throughout the perinatal period in Zimbabwe. The objectives were to: analyse the effectiveness of the mental health interventions offered by midwives; measure and analyse the extent to which the levels of the psychosocial markers reflect effectiveness of the mental health interventions; explore and describe the experiences of women, midwives and key informants on the effectiveness of the mental health interventions and to develop mental health guidelines that will direct mental health interventions throughout the perinatal period in Zimbabwe. The sequential explanatory mixed method design comprising both quantitative and qualitative methods was employed. The study was divided into three phases; the quantitative then qualitative and finally the development of guidelines phase. In the quantitative phase, a Quality of Life Enjoyment and Satisfaction Short form (Q-LES-SF) scale was used to measure the psychosocial scores on a purposive sample of 300 women in the third trimester of pregnancy, who had attended at least three antenatal reviews. In the same phase, a document analysis checklist was also used for retrospective analysis of the recordings of the mental health interventions on women’s maternity records from the antenatal period till discharge after childbirth. The population for the document analysis comprised 499 maternity records of women who had attended antenatal reviews and had delivered normally. Interview guides were used to conduct in-depth interviews with women, midwives and key informants. Sixteen (16) women within the age range of 22 to 38 years participated in the study. These were women who had a normal vaginal delivery and were within two months post childbirth. In-depth interviews were also conducted on 17 midwives and nine (9) key informants who participated in the study. Quantitative data for the two instruments were analysed using descriptive statistics on SPSS Version 23 package. Qualitative data were analysed through data reduction, data display and generation of categories and themes. The Q-LES-Q-SF psychosocial scale and the document analysis revealed that women have psychosocial challenges but there was lack of mental health interventions to ameliorate these challenges. The psychosocial scores were generally poor indicating that perinatal interventions are lacking or are not making much impact on the mental and social wellbeing of women in the third trimester of pregnancy. All the demographic variables were not necessarily linked to the quality of life enjoyment and satisfaction of the expectant women. It became apparent that the need for scaling up psychosocial assessments and interventions cannot be overemphasized. Document analysis clearly revealed deficient recording of the mental health attributes of midwifery care which indicates a serious gap in implementation of mental health interventions by midwives. Midwives and key informants concurred with women on several aspects; lack of knowledge and incompetency by midwives, varied attitudes with heavier inclination towards negative attitudes, disempowered midwives with resultant inability to empower women. Poor coverage of mental health in midwifery curricula, lack of standardized mental assessment procedures, heavy workloads were the other findings. Suggested ways of improving mental health were educating midwives, mentorship and preceptor ship, curriculum review, utilization of mental health protocols and validated screening tools. The findings of the study led to the development of mental health guidelines to be followed throughout the perinatal period. It is recommended that the Ministry of Health and Child Care, Zimbabwe adopt the guidelines and provide an enabling environment for their effective implementation. Further research efforts could be directed towards conducting targeted research to support implementation of the mental health guidelines.