'I can't do another day': Research spotlights women's experiences of maternal suicide attempts

Researchers at King's College London conducted extensive interviews with women who attempted suicide during pregnancy or shortly after giving birth. They found three key themes in women's experiences that could help to identify and support those at risk of a maternal suicide.

Suicide is a leading cause of maternal death during pregnancy and the year after birth (the perinatal period). This study was the first of its kind to focus on suicide attempts during this time and nearly half of participants undertook a suicide attempt during pregnancy.

During the interviews, women talked about a myriad of factors which affected their mental health during the perinatal period. One participant, Lauren, discussed her experience with domestic abuse, saying, "It was a punishment actually that I dared to be pregnant even though he knew I wasn't on any contraception or anything."

Another, Marie, talked about her fear after experiencing post-partum psychosis with her first child: "I remember sort of going to the 12-week scan with [second pregnancy] and getting the picture and thinking like shit, it's really real now and it could all happen again."

From looking at all the interviews, researchers identified three key themes that contributed to the perinatal suicide attempt:

1. Trauma and adversities—captures the traumatic events and life adversities with which participants started their pregnancy journeys

"I think there was something about the anxiousness of doing it all again, because I think I had some prenatal depression with my first, that wasn't picked up, and then postnatal anxiety through the roof, that was also never picked up, and was told that was normal."—Sam.

2. Disillusionment with motherhood—brings together a range of sub-themes highlighting various challenges related to pregnancy, birth and motherhood resulting in a decline in women's mental health

"There's all this thing about pregnancy you're supposed to be glowing and it's all marvelous and you've got these wonderful hormones, but I was just beached on the sofa feeling hot and sweaty thinking when is this baby going to come out, when's it going to come out?"—Simone.

3. Entrapment and despair—presents a range of factors that leads to a significant deterioration of women's mental health, marked by feelings of failure, hopelessness and losing control.

"I don't know how to explain it. I was feeling like all the things that I had to do were like water in my hands. I could see it. I could feel it. I could hold it. But it was coming through my fingers and I couldn't do anything about it."—Liv.

"We are incredibly grateful to the women who shared their experiences as part of this research study. We hope the findings highlighted will lead to increased awareness and support during the perinatal period and help prevent future maternal suicides," said Dr. Abigail Easter, reader in perinatal mental health at King's College London, and lead investigator on the study.

While maternal suicide is a relatively rare event with a prevalence of 3.84 per 100,000 live births in the U.K., the impact on the mother, her children, family and wider society is profound and long-lasting. Qualitative research into perinatal suicide attempts is crucial to understand the experiences and the circumstances surrounding these events, but this has largely been unexplored until now.

The research, now published in BMC Psychiatry, aimed to explore the experiences of women and birthing people who had a suicide attempt in the perinatal period and to understand the context and contributing factors surrounding it.

Researchers recruited 11 women and birthing people in the U.K. who self-reported as having undertaken a suicide attempt. Interviews were conducted virtually, recorded and transcribed.

"As a midwife, I have witnessed how hopeless some women felt during pregnancy or after they gave birth. With this study, we wanted to give women a voice to help us understand how their care can be improved.

"We hope the findings from our study will inform strategies and recommendations to help identify women at risk of suicide during the perinatal period and ultimately improve the care and support that women and families receive," said Kaat De Backer, research associate, King's College London and lead author.

The research team worked closely throughout with a group of women with lived experience of perinatal mental health difficulties, key stakeholders, and voluntary sector partners, to shape the design and delivery of the research.

This unique research demonstrates the critical importance of health care professionals discussing mental health with new and expectant mothers.

"Every contact is a chance for sensitive enquiry and to create positive change by ensuring those who need it get compassionate, potentially lifesaving support.

"The clear recommendations from ASPEN and MBRRACE and the welcome inclusion of pregnant women and new mothers within the recent National Suicide Prevention Strategy provide an opportunity for collective action and targeted interventions, which we hope will save women's lives," said Karen Middleton, head of campaigns and policy at the Maternal Mental Health Alliance.