Intro:
Welcome to the NSPCC Learning podcast, where we share learning and expertise in child protection from inside and outside of the organisation. We aim to create debate, encourage reflection and share good practice on how we can all work together to keep babies, children and young people safe.
Alexis Golden:
Welcome to the NSPCC Learning Podcast. I'm Alexis Golden, and I'm a Project Development Manager at the NSPCC. I'm leading the development of our Pregnancy in Mind service. Pregnancy in Mind is a preventative service designed to support parents who are at risk of, or experiencing, perinatal mental health difficulties.
NHS England defines perinatal mental health problems as "problems which occurred during pregnancy or in the first year following the birth of a child". Examples include postnatal and antenatal depression; anxiety; OCD; birth trauma and PTSD; and postpartum psychosis.
Perinatal mental health difficulties have the potential to have a big impact on parents and their babies. Persistent problems during the antenatal period can affect the baby's development. And after birth, if parents aren't getting the support they need, this can affect their ability to provide responsive care for their children.
It's estimated that over 25% of new and expectant mothers are affected by some form of perinatal mental health difficulty1, and Black mothers are disproportionately affected. 13% more Black mothers experience postpartum depression than any other group.2 Furthermore, one in five Black mothers reported they did not visit healthcare professionals when they were experiencing low mood.
In this episode of the podcast, recorded in January 2025, we're going to look at why this is the case, what the effect is on babies and young children, and how healthcare professionals can do better to support Black mothers with their mental health. I'm joined by two guests, Chi and Sandra.
Sandra Igwe:
Hi everybody, I am Sandra Igwe and I am the founder and the chief exec at The Motherhood Group. The Motherhood Group is a grassroots organisation and social enterprise that really supports the black maternal experience through a number of way: peer-to-peer support, national campaigns, training, advocacy and research. It's great to be here with you.
Chi Mumbi:
Hello, I'm Chi, I'm a children's services practitioner which is a social worker role for the NSPCC, and I work in the London and South East England team. I help deliver Pregnancy in Mind, Letting the Future In, which is our sexual abuse recovery service, and Domestic Abuse Recovery Together, which is our domestic abuse recovery service.
Alexis:
Thank you both so much for being here with us today. We're going to start with the first question, which is: what is perinatal mental health and why is it important?
Sandra:
From my experience working with and for Black mothers and Black women, perinatal mental health really refers to a mother's emotional and psychological wellbeing during her pregnancy and within the first year after birth.
It's really, really important because this period really involves a significant amount of physical, hormonal and life changes as a whole, and it can really impact any person, especially mothers' mental health during this period.
But good perinatal mental health is really important and essential for both the mother and also her baby's development, when it comes to bonding and looking at the overall long term wellbeing of the family.
Chi:
Just to add on to what Sandra said, perinatal health and infant mental health is obviously very interlinked towards each other as well. So it's hard to separate perinatal mental health and infant mental health, because good positive mental health for the mother means good positive mental health for infant as well.
Alexis:
Just from both your practice perspectives, how can perinatal mental health issues affect babies and children, short term or long term?
Chi:
If mothers are experiencing high levels of anxiety and depression, very often during pregnancy there's a spike of stress hormones, which means that there's more cortisol that is being, kind of, let out — and we do tend to think of cortisol as being the stress hormone, but that's actually not true. It's actually an anti-stress hormone, but it does mean the release of cortisol is often linked with babies having developmental difficulties and there is an impact on infant mental health.
But also there are societal difficulties, not just in terms of just thinking about mental health as something that just exists inside the mind. If there's any trauma, any kind of abuse going on, that is obviously going to impact the baby as well. So it's really important, of course, for mothers to have a really positive mental health experience during their pregnancy because it is linked to better outcomes for infants and children as a whole.
Sandra:
Just to piggyback off what Chi just said, it can really affect the baby and the children in so many different ways. It can even just affect the mother's ability of bonding. I've seen so many mothers in our organisation that come in that have struggled to bond with their baby or respond to their baby when they're struggling with their mental health.
And this can really impact the baby's emotional development, how they grow up, how they form attachments; and as you mentioned, stress response systems as well that can really impact a baby when their mothers go through depression [and] anxiety.
But also research shows that when mother's mental health goes untreated or the issues are left to the wayside, it can really influence children's emotional regulation, their behaviour as an overall sort of standing point, but also their cognitive brain development as well, long term as well.
Alexis:
Thank you both. Moving on to the second question, why are Black mothers more likely to experience perinatal mental health issues, including postnatal depression?
Sandra:
I mean, I'm happy to answer that question. We can really be here all day if I share all that we've heard and learned through our own research over the last eight [or] nine years of running The Motherhood Group. But just to simplify, the, I guess, core main reason is when we experience higher rates of racism within health care settings, that naturally will impact the way we receive care, want to receive care, or also when it comes to accessing culturally appropriate care; it really impacts that.
Also, when you've had previous traumatic experiences, you know, we're more likely to have higher maternal mortality rates, i.e. we're likely to be unalived in pregnancy or maternity care settings, as well as our babies having a higher increase of neonatal death, miscarriages, stillbirth. We're more like to have hypertension, emergency C-sections. All of this, all of these numbers that I've just shared, all this data will obviously impact a mother's rate of postnatal depression.
But also just the cumulative impact of all of this; knowing that you're more likely to have horrible outcomes in maternity care, knowing that you face, sadly, discrimination, whether it's covert discrimination or overt or, you know, preassumptions, misconceptions, preconceptions.
All of this will make you have a higher level of mental health challenges but also make you not want to have treatment because you don't have that trust in the healthcare system and also won't have access for many reasons such as socio-economical pressures as well as concerns not being taken seriously by healthcare providers as we've seen time and time again.
Chi:
Absolutely what Sandra said. I think that when you are racialised in the way that Black women are, which in a very specific way can often be sexualisation, but very often health professionals have historically thought that Black woman can withstand pain more compared to other women, which is obviously not true. But because of that idea, it's meant that when Black women are experiencing pain giving birth or anything related to any symptoms they may be having during their pregnancy, that's often ignored.
There's also, if you are racialised, there is a sense of becoming disconnected from your body, and, of course, being pregnant is a very embodied experience. It's very hard to run away from all the sensations, the feelings, everything. And because of that kind of disconnection, you could end up not wanting to go and get support because you're just in survival mode all the time. And it's very hard to connect to your baby if you're in survival mode.
So I think these things can lead to increased mental health problems which, yeah, there's a very specific way of being racialised in this country as a Black woman.
Alexis:
I think this topic dovetails nicely into the next question, which is about The Motherhood Group. What role does The Motherhood Group play in supporting the Black maternal experience?
Sandra:
Yeah, so we see ourselves as a bridge. A bridge between the community of Black mothers and pregnant women, and then the wider system: healthcare practitioners, maternity services, policy advisors, and just wider stakeholders as a whole. And the reason why we see ourselves as bridges is because for many years, as I mentioned earlier, there has been a breakdown of trust between the community and the system as a whole. So we see ourselves as ways of rebuilding that trust and also ways that mothers— ports that mothers can get, you know, culturally-specific support.
We provide safe spaces where Black mothers can really share their experiences, share resources and ways of accessing information. We do this through our Black Maternal Health Conference, our annual conference that allows Black mothers to finally have a platform to speak about all of the intricate details that matter to us in our maternity care, in our motherhood experience and in our pregnancy as well.
We have our peer-to-peer support and we have our newly launched Black Mums app now, that uses AI to connect Black mothers with similar lived experiences so that you don't have to face this journey alone. You know that isolation can contribute negatively to mental health experiences as a whole.
So we help bridge gaps in traditional health care services by providing this sort of tailored, informed peer support, as well as our training that equips health care staff to really support us and acknowledge the unique challenges that Black mothers face.
Chi:
Why did you start up The Motherhood Group? Why did you think it was important? I mean, obviously it's important, but I'm just interested in the why.
Sandra:
Yes, no, thank you for that question, Chi. Do you know what? It came out of lived experience. So eight and a half years ago, when I was pregnant with my first daughter, I saw that there was a massive gap in the system and I was quite frustrated because I didn't feel like a lot of my concerns were spoken about as a Black British-born mother, first time mother.
And so I would Google 'Black mum support group' and nothing would pop up on Google, only things maybe in America. And so, I thought, "okay, why can't I see any prominent safe spaces for Black mothers?" Just because when I did go to some of these classes or programmes or mummy and baby groups, I was always the only Black mother in the space.
For many people that might be okay, but actually that exasperated my undiagnosed postnatal depression. I definitely did not go and get any traditional clinical support for that because, like I mentioned, I had, you know, a breakdown in trust where my healthcare practitioner treated me differently because of the colour of my skin and at the time I didn't know the data surrounding Black women.
I just knew that I was treated differently and I had substandard care in my birthing experience. I was sent home five times. I was told that I was exaggerating my pain. I didn't get pain relief after begging and pleading for hours. My daughter passed a meconium stool on the way out. She is fine now, but the trust admitted to a breach of duty.
All of these experiences, using my legal background, I really wanted to stand for change; but also seeing that there were so many mums that looked like me, who were speaking about the exact same thing, so this couldn't just be a coincidence. There obviously was a critical issue that wasn't really being addressed in the mainstream to my knowledge at the time. So that's the reason why I started it.
Chi:
Thank you so much for sharing that. I mean, it sounds like such a difficult experience, I can't imagine. And it must be kind of quite easy — you know, I don't look down at people at all for doing this — but it might be quite easy after those experiences just to not talk about it. You know, just think "this is just something that happens. I want to move on. I want to experience my new baby and move on with life."
But then to use quite a traumatic experience, it sounds like, to then create a group and then also help other women who have had those experiences and also hopefully prevent other Black women having to go through those traumas. I think, yeah, that's such an amazing thing. So thank you.
Sandra:
Thank you so much for acknowledging that, thank you.
Alexis:
The work that The Motherhood Group does is fantastic and we did have a chance to attend your conference last year and it was really great to hear just the sharing of awareness, the spreading of knowledge and information, and just having a shared space with Black mums — so, yeah, The Motherhood Group is wonderful. We're really glad to be in partnership together.
So we've talked about the stats, we've talked about the research; but what can professionals do, working with expectant parents, to support perinatal mental health issues?
Sandra:
Yeah, I think just one thing I would say: professionals should really prioritise understanding, listening to the concerns and recognise that there are biases in care. Maybe five, six, seven years ago, this wasn't really a thing to openly discuss the role that race... how it plays a part in maternal experiences, perinatal mental health experiences.
And so just acknowledging that it exists, but also taking the proactive steps in putting yourself in training. There's so many. We deliver cultural competency training. And then making sure that you provide a judgement-free environment for Black mothers to really share their experiences.
Chi:
Absolutely and I think not having a one-size-fits-all approach to perinatal care is really important. Definitely more awareness around those outdated stereotypical beliefs about Black women, pain, what we can tolerate.
And ensuring that there's, kind of, a presence inside perinatal services so that Black women, and other women from different ethnic minority groups, can feel like they're supported, feel like there's a space they can go to.
I know that in some hospitals they have now started doing antenatal classes that are only for Black and mixed race mums, which I think is a really positive step, but also for those, it's a bit of a postcode lottery. So for those mums who are in perhaps majority white areas, it is really important even in those spaces to make sure that professionals keep it a safe space, have those difficult conversations at time, and really make expectant mothers and partners feel like it's a safe space for them and they're safe to give birth. It's a really stressful time. I think that's definitely number one.
Alexis:
Thinking about Pregnancy in Mind (PiM) in particular — Chi, how do you think Pregnancy in Mind can help new mothers, or just new parents in general?
Chi:
Yeah, I think it helps that it isn't a one-size-fits-all kind of approach and it isn't manualised. So we really do look at the group of women that we have and who are working one-to-one and think "what will help this group of women in particular?" And we do focus as well on neurodivergence now, but also how are we going to adjust the content to be as inclusive as possible to all expectant parents.
I think it's also unique in that we do include partners; other perinatal mental health services don't always do that, but it's helpful to have a holistic idea of the family but also to show how important partners are for expectant mums. And if they don't have that support identifying what support they can have, so we can also include who we call 'supporters', who could be expectant parents' grandmothers or sisters or friends that can come on the group, because it's really all about community.
There is of course lots of conversations around the loneliness epidemic that affect all different groups of people across the UK, but in particular, being a lonely mother is extremely difficult. It takes a village to raise a child and that's absolutely true. Having different sources of support, both professional, but also personal, is really important for mothers. And I think PiM helps provide that space so they feel that "actually, we're not alone."
We had this really wonderful moment in one of the PiM groups where they all each quite naturally opened up saying that they had had experiences of anxiety and depression. I spoke to one of the mums afterwards and she was talking about how the taboo was kind of over and she felt like, "oh, I'm not alone actually. What I'm feeling isn't strange. It isn't— it doesn't make me a terrible mum. It's just actually something that I'm experiencing, I'm getting support with, and yeah, I'm not the only person in the world [experiencing this]."
Which I think in the age of social media, which is helpful in so many ways, but I can imagine as an expectant parent looking at all these seemingly perfect images and videos of ideal motherhood can be really, really difficult.
So yeah, I think we try to keep it an open, inclusive space for everyone and really try to think about people's individual experiences, adverse experiences, as well as empowering parents to feel like they can do this and they're an expert on their body and their babies; which I think is especially important when working with Black women, because I think that... there can be that idea of not being an expert in your own body and not taking ownership of your own body, which we try to promote as much as possible in PiM.
Alexis:
Chi, what are the next steps for Pregnancy in Mind as a service across the UK?
Chi:
Yes, so we're expanding. So we're currently active in West Sussex [and] Slough, and the hope is that we're going to expand into two London boroughs as well. So our reach is extending.
But also the NSPCC has scale-up, where we will sell programmes — so programmes like DART (Domestic Abuse, Recovering Together) for example, but now it'll be PiM (Pregnancy in Mind) — and that will mean that PiM can go to different organisations, different places all over the country, so it won't just be concentrated inside our area in London and the South East, which is really exciting as well to see how it's gonna blossom and develop.
Alexis:
Is Pregnancy in Mind being delivered across the NSPCC in other areas as well?
Chi:
So yeah, PiM is currently being delivered in several different areas. But if you look on the NSPCC website for Pregnancy in Mind, you can check to see if it's being delivered anywhere near you.
Alexis:
We'll be sure to leave a link underneath the podcast so that you can see where we're being delivered right now. Sandra, what are the interesting projects coming up for The Motherhood Group in 2025 and beyond?
Sandra:
Yeah, so we have quite a few. We have, as I mentioned, our launch of our new digital app called Black mums. The title literally is what it says it is. It's a safe space for Blackmums to connect virtually. We often have a lot of these wonderful platforms — you know, like Peanut, Netmums, Bounty — these are wonderful online digital spaces that connects mums, but none of it really addresses the unique needs that Black women face. And so we've created our own version of that, where we can speak about all the challenges that matter to us, but also connect us with like-minded mums locally and nearby.
We also have the launch of our Black Maternal Mental Health Project in collaboration with Maternal Mental Health Alliance and Centre for Mental Health. And so looking at the last eight years of our engagement, what are the common themes that are important or crucial or essential to make the mental health of Black mothers thrive. What do good spaces look like? What does good communication look like? So we'll be launching that at our Black maternal health conference in March.
And then of course, September, our annual Black Maternal Mental Health Week, which Chi spoke at last year — she was fantastic. And we look at common themes relating to, you know, helping to bridge the gap, but also looking at some of the barriers that Black mother's face in mental health or maternal mental health but sometimes also wonderful solutions and recommendations for improvement; such as the role that stigma plays, how to connect with grassroots community-led organisations, the role that, you know, faith and religion, how that can be a bridge, but also a barrier in seeking support. So please do get involved in our daily webinars during that week as well.
Alexis:
Sounds like there's a lot of things coming up. I've run out of questions, but I'm just coming up with this one off the cuff. If either of you had to give three big takeaways to our listeners today, what would they be?
Sandra:
I'd say one: if you are a professional working with expectant parents that are from Black or Brown communities, really, as I mentioned, listen; it sounds so simple, but it's very, very rarely done quite well. So actively listen to all the concerns, but also recognise again that some of these barriers that might not be relevant to you, they are really important for a mother that wants to receive good quality, adequate care.
Then make a mother feel safe. So provide safe spaces, bring on diverse staff to support them, make sure that you're able to offer support or care that helps to bridge the traditional health services by providing those relevant support networks and culturally relevant resources so that a mother can receive that as well.
And then finally, three: recognise that not everybody has the right language to articulate that they are struggling with perinatal mental health issues. In some languages and some cultures, there is no word for perinatal mental health or postpartum depression. And so being open to exploring what that might look like for each community and what might be the better word. Is it wellbeing? Is it care? How do you feel? Just make sure that you are looking at that person as an individual and not seeing them as a monolithic group.
Alexis:
Wonderful, thank you so much, Sandra. Chi, anything to add?
Chi:
I absolutely agree with Sandra. I would say that number one for professionals for me would be to be curious and to continue to be curious about expectant mothers' experiences, and really taking a non-judgmental stance. So when you're hearing a woman talk about her difficulties, or you feel like something else is going on, instead of becoming judgmental, really trying to unpick that with her in a caring, thoughtful way that will not make her turn away and make her feel like, "I'm feeling judged, I need to leave", and not actually being able to get that support later on.
I would say number two is recognise the importance of community. I mean as Sandra was talking about The Motherhood Group, I mean it's so amazing — the power of community and having other people around you who maybe won't have exactly the same experiences as you but will understand and can listen to you and can help care for you. I think recognising the importance of community, and as a professional asking parents, "okay, what support do you have?" And if they don't have any support and they're lonely, what support can we provide or can we help you with? And I do understand the pressures on NHS staff and all over the caring sector, but I think it is really important to recognise and to identify lonely mums and ways that you can support them.
And I would say third: to not lose sight of the mental health of the infant as well. I know the concept of... To me anyway, the concept of pregnancy is quite abstract and when we're working with participants, we do a lot of connecting to your baby exercises. And for some parents, it's the first time they really thought about questions like, "what music do you think your baby would like?" Or "what food you think you baby would enjoy?"
And they are quite abstract questions but it does help you connect more with your baby. The purpose of those connecting to you baby exercises is so that we're thinking about the baby and bringing the baby into the room, but also thinking about the potential mental health of the baby and linking the mental health of the parents to their child as well.
Alexis:
Wonderful. Well, thank you both for those key takeaways. I think you've given our listeners a lot to take in. I'll close here, but I just wanted to say a big thank you to both Chi and Sandra for your time today and for sharing your experiences. We have a lot of information to share with our audience.
If you want to learn more about Pregnancy in Mind or The Motherhood Group, we will be sure to put those in our podcast notes. Chi and Sandra, thank you so much for your time.
Chi:
Thank you so much.
Sandra:
Thank you for having us. Thank You.
Outro:
Thanks for listening to this NSPCC Learning podcast. At the time of recording, this episode’s content was up to date but the world of safeguarding and child protection is ever changing – so, if you're looking for the most current safeguarding and child protection training, information or resources, please visit our website for professionals at nspcc.org.uk/learning.
