Barriers and facilitators of accessing perinatal mental health services: The perspectives of women receiving continuity of care midwifery

Objective: To explore what factors midwifery care recipients perceive to prevent or facilitate access to mental health care in the perinatal period. Design: A qualitative descriptive study based on semi-structured individual interviews and focus groups. Setting: Ottawa, Ontario, Canada. Participants: Sixteen mothers who had received or were currently receiving midwifery care. Eligibility criteria were being 18 or older and self-identifying as having experienced or experiencing perinatal mental health concerns. Findings: Five salient themes emerged from the data: cultural values, knowledge, relationships, flexibility, and system gaps. Barriers and facilitators to accessing perinatal mental health services are grouped under each theme. Stigma and fear, broken referral pathways, distant service location, lack of number/capacity of specialised services, baby-centredness, discharge from midwifery care at six weeks postpartum, and cost were barriers to accessing care. Information and midwives' knowledge/experience were context-specific factors that could hinder or facilitate access. Continuity, community, and advocacy were facilitators to accessing care. Many of these facilitators are an inherent part of the Ontario midwifery model of care. Conversely, some aspects of midwives' scope of practice in Ontario impeded access to perinatal mental health care, including inability to make direct referrals to psychiatrists and discharge from care at six weeks postpartum. Key conclusion: Midwifery care based on the principles of continuity of care, woman-centred care, informed choice, and advocacy may help to enhance the uptake of perinatal mental health care, but access to such care also remains dependent on the characteristics of mental health services themselves. Implications for practice: Midwives can enhance access to perinatal mental health services by developing relationships that create safe conditions for disclosure; providing information about symptoms of perinatal mental health concerns, treatment, and services to clients and their social support network; being knowledgeable about existing resources and referral pathways; and identifying when women need additional support to seek care and facilitating connections to available services.