The dyadic experience of accessing perinatal CMHT
Research type
Research Study
Full title
The dyadic experiences of couples and co-parents accessing community perinatal mental health services
IRAS ID
333583
Contact name
Kirsty Pegg
Contact email
Sponsor organisation
University of East Anglia
Duration of Study in the UK
1 years, 6 months, 30 days
Research summary
Research Summary
Having a baby can cause huge psychological, social and physical changes, which can make mothers and birthing people more vulnerable to mental health difficulties. For some mothers or birthing people, they may receive support from NHS services in the community who are there to support people with their mental health for up to one year after giving birth. Specifically, the Community Perinatal Mental Health Team is there to support mothers or birthing people who are experiencing moderate to severe mental health difficulties.
Within the literature on this topic, parents have often been interviewed about their experiences of these challenges and changes following having a baby, on an individual basis and without their partner or co-parent present. It is less common to see research being completed using interviews with couples, particularly within the context of a mother or birthing person experiencing moderate to severe mental health difficulties.We are looking to bridge the gap and find out more about the couple/co-parent's experience of being a parent whilst accessing a perinatal mental health community service. This will involve the mother/birthing person and their partner/co-parent being interviewed together about their experiences on this topic. Participation in the study, including consent, interview and debrief will last up to 90 minutes. Following the interviews, the transcripts will be analysed to explore themes of experience.
Lay summary of study results:
The purpose of the research study:
Previous research has shown the many impacts that experiencing a perinatal mental health difficulty can have on mothers or birthing people and partners/co-parents. It has also shown the importance of support from each other and from surrounding networks (e.g. friends, family, services) in the transition into parenthood. Previous research has focused primarily on individual experiences, leading to a gap in our understanding of couples’ experiences. This research has been conducted across a range of clinical settings but is limited in understanding these aspects in people accessing perinatal mental health services within the community. With this research, we hoped to bridge these gaps to help develop perinatal research and services, to better understand and support people going through these challenges. We hope this will allow services to be better prepared to support partners and couples together in the future.
This research was approved by an NHS ethics committee (IRAS ID number: 333583).What we did:
Altogether, we interviewed 8 couples across Cambridgeshire, Peterborough and Norfolk where the mother or birthing person accessed a Perinatal Community Mental Health Team. Couples were interviewed together, either face-to-face or online. Interviewing couples together allowed for a shared conversation, giving us a wider understanding of shared experiences beyond individual interview methods. Although we aimed to additionally include co-parents, all of the participants who took part were in a couple.
The information (research data) provided within these interviews was analysed for two separate research studies conducted by Kirsty Pegg and Becky Samuel for their UEA Doctoral Theses. Each of these projects aimed to answer separate but related research questions. The findings for both of these research studies are summarised below.Research study 1 -Transitioning Into Parenthood: The Dyadic Experience of Co-Parents Supported by Community Perinatal Mental Health Teams
Background:
Becoming a parent is a major life change that affects both partners and the wider family. While it can be a joyful time, many parents experience mental health difficulties during pregnancy or after birth (known as perinatal mental health difficulties, or PMHDs). The NHS aims to improve support for families during this time, but some parents still face barriers, such as a lack of partner leave, stigma, and feeling left out by services. Early research shows that mental health difficulties can affect relationships, parenting confidence, and access to support - but supportive relationships can also help recovery. However, most research focuses on either the birthing person or the partner, rather than looking at how couples experience this transition together.
This study aims to explore how couples, where the birthing person is receiving care from an NHS Perinatal Mental Health Team (PMHT), navigate the transition into parenthood together. By understanding their shared experience, we hope to improve support for both parents during this important time.Analysis:
We used thematic discourse analysis to explore how each person described their transition using language and how they shared and made sense of it with their partner. By talking about their experiences, couples create shared understanding, roles, and identities.Results:
Three ‘discursive’ themes were formed – that is, themes about the content of what is discussed. After this, four ‘function and effect’ themes were formed – that is, themes on the function of how things are said and what impact it had on the partner or continuation of the conversation.Discursive Themes
Theme 1. Emotionally Charged
This theme covered couples’ discussions on the strong emotions that they felt whilst transitioning into parenthood, alongside the PMHDs. This was often discussed using strong descriptive language, emphasised words, and pauses before and after discussing difficult subjects.
A) Distressing emotions - A variety of negative or distressing emotions were expressed by couples as they transitioned into parenthood. This included expressions of anxiety, anger, guilt, fear, apprehension, isolation, and loneliness. There was also evidence of couples resisting acknowledging the negative emotions associated with transitioning into parenthood.B) Positive despite challenges - Practical and emotional positives were also present despite the acknowledged challenges of having mental health difficulties. For some, this was a clear expression of overt positivity, whereas for others, there was an indication of just how difficult things had been before, and the noticing of a subtle improvement.
Theme 2. Transformative
Although there is a period of transformation for all new parents, the parents in the current study highlighted additional challenges and experiences due to the compounding effect of having a PMHD. Most couples expressed a sense of the transition being transformative despite the difficulties added by the PMHD.
A) Identity change - Identity change was two-fold. It occurred both individually, in response to developing a PMHD or transitioning into parenthood. It also changed through the interaction between having a PMHD and transitioning into parenthood. Participants spoke about the change of identity both as individuals and as a couple. Others discussed what they had learned from each other.
B) Skills development - There were a variety of ways parents transitioned by acquiring skills that helped them cope with parenthood and mental health difficulties. This involved the concepts of learning on the job, developing from previous experiences, preparing and persevering.
C) Open communication – This subtheme included openly communicating with each other and offering support for each other’s well-being. For example, talking to each other about what was working well and what could be improved.
D) With the assistance of others - This subtheme highlighted the severity of the difficulties families were experiencing with their mental health, the variety of support they were receiving, and the importance of support.
Theme 3. Challenging
The transition into parenthood alongside a PMHD was referred to as challenging and complex. It involved:
A) Negative experiences with others – Negative experiences with other people were not uncommon, including friends, family, and healthcare professionals, including the exclusion of the non-birthing parent. This could lead to a worsening of mental health.
B) Expected difficulties – this included an understanding of chronic mental health difficulties that meant that some challenges were pre-empted.
C) Unexpected difficulties – this subtheme referred to surprises about how difficult the transition was with the addition of a PMHD. Even when parents had an awareness of the challenges of parenthood, they were surprised by how much harder this seemed with the addition of a PMHD.Function & Effect Themes
Theme 1. Ways of expressing strong emotion - This theme summarised how strong emotions, such as disbelief, relentlessness, and overwhelm, were communicated. It also included how couples would conclude with a positive remark if they had expressed a negative remark.Theme 2. Disconnection - This theme referred to moments where the couple demonstrated a sense of disconnect within their conversations. We are clear that this theme does not necessarily represent discord in the relationship, but rather a disconnect within the moment. This included times when the sharing of emotional distress resulted in practical responses rather than an attempt to connect with an emotional response; where confrontation with each other has happened; or when there seems to have been a projection of one’s distress onto the other.
Theme 3. Protection of the self and other - This theme encompasses a sense of the fragility of the person with a mental health difficulty, using sarcasm and minimising as a defence mechanism, and thinking things through sequentially to avoid connection to emotion.
Theme 4. Togetherness - Couples also used a way of speaking that represented connection, agreement, and respect for each other. Often, this could be seen in the way that participants spoke in sync, repeating some of the same words and adjectives to describe how things were.
Study recommendations and conclusions
• The findings highlight how the transition into parenthood alongside perinatal mental health difficulties is complex. These complexities should be considered when planning NHS services and perinatal pathways.
• Understanding how couples communicate and cope together can improve therapeutic support. Interventions should consider relational dynamics (e.g. between couples), not just individual symptoms, and family or couple work could be beneficial.
• Clinicians should pay attention to how families talk, as this can reveal protective behaviours or resistance to change. Training may be needed to help clinicians interpret subtle cues and not overlook underlying distress.
• Partners should be offered some level of support or inclusion, even if indirect, to reduce their emotional burden. Understanding the care being provided can help partners feel less isolated and more able to support the birthing person.
• Treatment should have planned and supported endings, as abrupt stops may worsen mental health symptoms. Clear transitions in care are especially important for people with PMHDs.
• Families appreciated staff with lived experience and the support of multidisciplinary teams (MDTs). These roles help build trust and provide wrap-around support.
• Couples in long-term relationships or with experience of chronic mental health difficulties may adapt more easily. Newer couples, those without prior mental health experience, or co-parenting families may need more tailored support to build mutual understanding and effective coping strategies.Research study 2 - Dyadic Coping in Couples Experiencing Perinatal Mental Health Difficulties Within the Community: A Qualitative Study
Background:
Research has traditionally focused on the experiences of the mother or birthing person. However, more recently this has begun to change, with increasing focus on the importance of partners to the wellbeing of mothers and infants, and recognition of paternal perinatal mental health difficulties (Antoniou et al., 2021). Dyadic coping models have developed to understand how stress is communicated and managed within close personal relationships.
Existing research has found that couples experiencing perinatal mental health difficulties engaging in less positive dyadic coping have a lower quality of life and increased depressive symptoms (Alves et al., 2020; Meier et al., 2020). Research also suggests the importance of family and wider social support to coping within the perinatal period (Chen et al., 2022, Sufredini et al., 2022).Systematic Transactional Model (Bodenmann, 1997): stress experienced by one partner is communicated and responded to by the other partner to enhance overall wellbeing and maintain closeness within the relationship.
Positive dyadic coping:
• Supportive dyadic coping: one partner showing coping strategies directed towards the other (e.g. showing compassion towards their partner, supporting them when struggling with their mental health, helping them to solve a problem).
• Delegated dyadic coping: one partner taking over some of the responsibilities of the other (e.g. doing more of the household tasks).
• Common dyadic coping: coping strategies which are engaged in by both members in a symmetrical way (e.g. taking on equal amounts but different household tasks).
Negative dyadic coping
• Hostile: one partner distancing themselves from stress, showing disinterest in the difficulties experienced by their partner or minimising the stress (e.g. avoiding conversations about the stress, saying that there is no problem).
• Ambivalent: one partner showing that support is offered unwillingly to the other (e.g. saying that they don’t want to provide support but feel they have to).
• Superficial: one partner showing surface level attempts to provide support (e.g. talking about how much support they provide without acting on this).Dyadic coping: The process by which members of a couple communicate stress to each other and how this is recognised and responded to, in order to adapt to and manage external stressors together.
This study aimed to understand the experiences of couples coping with perinatal mental health difficulties. It also aimed to understand how experiences of dyadic coping for couples are influenced by surrounding support systems.
Analysis:
The information you provided (research data) was analysed for this research project using thematic analysis. Thematic analysis explores common patterns across the data to create themes of these experiences. During analysis themes were created from patterns in the data and also guided by the Systematic Transactional Model.Summary of findings:
Theme 1. Common dyadic coping
Couples described the life changing transitions and difficulties in meeting the demands of becoming parents. A key aspect of this experience was the shift from individual to shared goals of coping, with the primary focus being on supporting their children.Subtheme 1.1 Shared compassion
An often-unspoken agreement was made that to cope with the demands of the perinatal period both members are unable to experience emotional overwhelm at the same time. This acknowledgement led to shared compassion, where individuals monitor and respond to the emotional state and needs of their partner and provide support when assessed that they have reached a point of being unable to cope.
Subtheme 1. 2 Joint coping with parenting tasks Couples often talked about jointly managing practical tasks and joint problem solving based on individual strengths and emotional capacities. A theme that arose was the process of learning parenting through doing. Couples talked about this process being impacted by avoidance within society of discussing the difficult realities of becoming a parent. Many also described the need for couples to find a level of acceptance in managing unrealistic expectations related to parenting tasks and how couples can support each other to navigate related difficult feelings. This was described as impacted by wider pressures on parenting (e.g. family expectations, conflicting parenting information within media).Theme 2. Partner approaches to dyadic coping For many couples, experiences of perinatal mental health difficulties meant that the mother or birthing person needed more support at points to cope with these difficulties, alongside parenting demands.
Subtheme 2.1 Supportive and delegated dyadic coping Some couples described the support that partners provided in helping with emotional self-reflection and validation of difficult feelings. Many couples also described how important partners were to providing support at times where they were struggling more acutely with perinatal mental health difficulties. Many couples also described partners taking on greater parenting tasks to support the mother or birthing person to engage in individual coping strategies, for example self-care. However, some couples also alluded to the difficult feelings that this dynamic can create for the mother or birthing person, for example guilt about accepting support.
Subtheme 2.2 Protective buffering
A common theme was partner’s experiences of perinatal mental health difficulties and birth trauma. However, alongside this was the experience of partners finding it difficult to communicate their feelings. To support coping as a couple, partners often avoided communicating their own difficulties due to beliefs that this would be burdensome for their partner and cause further difficulties for the couple. Lots of partners talked about feeling that they needed to be “strong” as a strategy to provide support.Theme 3. Disparities in care experiences A theme that was shown across the data was the differences that couples experienced in the support they received in differing areas of their care and the impact that this had on coping.
Subtheme 3.1 Person-centred perinatal mental health care Couples commonly described support received from specialist perinatal mental health teams holistic, tailored to the needs of the mother or birthing person. They described this support helping them to show more compassion towards themselves. However, lots of couples talked about feeling that this support should be a standard level of care for all couples having a baby.
Subtheme 3.2 Adverse maternity care experiences Although not all descriptions of maternity care were negative, there were common themes of unhelpful interactions with staff which caused greater difficulties in how couples coped. Couples described experiences of not feeling listened to and the insensitivity of approaches of some maternity staff. Couples also described how difficult it can be to recognise perinatal mental health difficulties and how interactions with maternity care are gateways for mental health information and receiving support from specialist services.Theme 4. Where individualised models of care fall short A common theme was the sense of the limitations of support focused solely on mothers or birthing people, with minimal support available for partners and at a couple level.
Subtheme 4.1 Insufficient couple focused support Couples talked about the lack of support focused on the couple relationship and talked about the potential benefits of having a safe space facilitated by services to work through difficulties together as a couple.
Subtheme 4.2 Support as a supporter
Couples commonly talked about partner’s lack of involvement in perinatal care and the lack of contact from services towards partners. Couples described this as a barrier to partner’s receiving support for their own difficulties. Other couples also talked about how the focus of the support that partners did receive focused on support for partners as a supporter rather than on how partners cope as individuals.Theme 5. Engaging with family support
A common factor of support discussed by couples was the benefits and complexities in engaging with family support. Many couples talked about the emotional and practical support that families provided, which allowed them to have more time to do things together as a couple outside of being parents. However, they also described the guilt that couples may have to navigate in accepting support offered by family members. They also described barriers to accessing support from family such as a lack of understanding of perinatal mental health difficulties, geographical distance and not feeling emotionally close to family.Study recommendations and conclusions
• Findings show the importance of partners in how mothers and birthing people cope with perinatal mental health difficulties and how mothers and birthing people support their partners to cope within this period.
• Services should provide more support at a couple level and seek to communicate a lot more with partners to gain their perspective and hear their experiences.
• These findings also suggest an increased focus on perinatal mental health support for partners, aimed at supporting them to recognise and cope with their own mental health needs, rather than their needs solely as a supporter.
• Further research is needed to consider how to effectively expand support to the couple and partner level.
• This also suggests the need to review and develop greater levels of person-centred and trauma-informed care within maternity services, focusing on
awareness and screening of maternal and paternal perinatal mental health difficulties.
• This also highlights more thinking that is needed about the ways in which couples receive information on perinatal mental health difficulties and how we can better support people within this period to recognise that they may be in need of support.REC name
East of England - Cambridge East Research Ethics Committee
REC reference
24/EE/0063
Date of REC Opinion
11 Apr 2024
REC opinion
Further Information Favourable Opinion