Caring in action: Midwives' approaches to supporting perinatal mental health in Aotearoa New Zealand

Background: Pregnancy and the postnatal period are particularly vulnerable times for mothers’ mental health, with an increased risk of women experiencing depression and anxiety. In Aotearoa New Zealand, midwives are uniquely positioned to provide support to women during this critical time, often filling gaps in mental health services. Aim: The qualitative study, based on a select sample of midwives, aimed to explore the tools and resources that these lead maternity care (LMC) midwives find most helpful in supporting women experiencing mental distress during the perinatal period. Method: Using a strengths-based approach, the study recruited seven Aotearoa midwives with a particular interest in mental health. These midwives participated in semi-structured online interviews to share their experiences and insights regarding the practices they find most helpful and the barriers they encounter. Data were analysed using inductive thematic analysis. Findings: Five key themes emerged from the analysis: (1) Screening: “Sometimes we have to sit and unpack it”; (2) Being with: “A listening ear” and beyond; (3) Connecting: “A wraparound type of approach”; (4) Up-skilling: “It should be there for all of us”; and (5) Barriers: “You have to be at the bottom of the scale”. The midwives’ stories revealed their deep empathy and care, as well as the complexity of referrals and challenges in accessing mental health services, which were central to the midwives’ frustration around their ability to fully support mothers. Conclusion: The study highlights midwives’ relational continuity of care as a key strength for supporting perinatal mental health. Their deep empathy and trust built with women underpin their role in mental health screening, advocacy and referral. Enhancing midwives’ capacity, through targeted education, culturally appropriate resources and greater access to mental health services and resources, will help address existing gaps and build on these strengths.