King's College London

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:

• 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.

• 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 marvellous 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.

• 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.

While maternal suicide is a relatively rare event with a prevalence of 3.84 per 100,000 live births in the UK, 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.

Research 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. This research (ASPEN) study is supported by NIHR Applied Research (ARC) South London.

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

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.