# Health care across the first year postpartum and experiences of women with anxiety/depressive symptoms: A longitudinal cohort of first-time mothers in Ireland (MAMMI)

## TL;DR

This study finds that postpartum mental health is often overlooked in Ireland, with women experiencing anxiety or depression receiving less support and facing barriers to discussing their concerns with healthcare providers.

## Contribution

The study provides new insights into the gaps in postpartum mental health care and women's experiences in Ireland, emphasizing the need for expanded and more supportive care pathways.

## Key findings

- Approximately 50–70% of women reported being asked about mental health at three months postpartum, but this decreased over time.
- Women with anxiety/depressive symptoms had more healthcare visits but felt uncomfortable discussing sensitive topics.
- Many women felt postpartum care was too infant-focused and ended too soon, advocating for extended and dedicated maternal support.

## Abstract

Women’s increased contact with healthcare professionals during pregnancy and the early postpartum make it an opportune time to identify any physical or mental health problems that emerge during this period, yet mental health problems are under-identified in clinical settings. This study uses quantitative and qualitative survey data from a large prospective study of first-time mothers in Ireland to investigate contacts with healthcare professionals, enquiry about mental health, and women’s satisfaction with the support they received.

Quantitative and qualitative data were collected during pregnancy and at 3, 6, 9 and 12 months postpartum. The sample comprised 2572 mothers reporting on postpartum anxiety/depressive symptoms using the Depression, Anxiety and Stress Scale.

Approximately 50–70% of women reported that a healthcare professional asked about their mental health at three months postpartum. Contact with healthcare professionals and enquiries about maternal health decreased significantly over the course of the first 12 months. Women felt that postpartum care was concluded too soon, and that appointments were often hurried and infant-focused. Women reporting anxiety/depressive symptoms had more frequent appointments for their own and their baby’s health than women who did not report symptoms. Women with symptoms were more likely to indicate they felt uncomfortable addressing sensitive topics and worried about the consequences of disclosure. Many women described positive and supportive interactions with professionals; others reported that their disclosures were dismissed, while some feared that disclosures may lead to judgment, labelling or being recommended psychotropic medication as a solution.

The findings support the need for an expansion of the postpartum care currently provided in Ireland. Greater support for health professionals regarding asking and responding to women’s needs across the postpartum period is required to address mothers’ hesitancy to share concerns and to broaden access and pathways of care.

The online version contains supplementary material available at 10.1007/s00737-025-01670-2.

Although provided as a standard and free part of Irish postpartum maternity care, this research found that a significant percentage of women did not receive or attend a postpartum health check with a GP for themselves (n=583, 23.9%) or their baby (n= 311, 12.95%) in the first three months postpartum.

This research found a correlational association between reporting anxiety/depressive symptoms and the number of visits to a Healthcare Professional (HCP). Women who reported anxiety/depressive symptoms attended more GP visits for their own health at six (OR=3.6, 95%CI 2.4 -5.4), nine (OR=4.6, 95%CI2.7 -7.5), and 12 (OR=3.3, 95%CI 1.9 -5.5) months.

Medical and child development appointments in the postpartum period are opportunities for healthcare professionals to enquire about mothers’ physical and mental wellbeing and provide appropriate care or referral. However, only 51.7% of women reported that their GP enquired if they were feeling depressed or low in the postpartum period.

Women who reported anxiety/depressive symptoms were less likely to perceive their HCPs as easy to talk to about concerns, and more likely to endorse statements indicating fears of being judged or facing undesirable repercussions following disclosure, than women who did not report mental health symptoms.

Women reported that postnatal care is predominately baby-focused, and advocate for additional postnatal care pathways that extend beyond three months postpartum and that provide an opportunity for greater emotional support for mothers. Women indicated that having access to a healthcare professional, dedicated maternal/baby healthcare spaces, more frequent appointments and/or call lines would be beneficial to women in the postpartum period.

The online version contains supplementary material available at 10.1007/s00737-025-01670-2.