Midwives' readiness for handling postpartum Perinatal Mental Health (PMH) disorders: a mixed-methods study

Authors

  • Ana Pujianti Harahap Universitas Muhammadiyah Mataram
  • Aulia Amini Universitas Muhammadiyah Mataram https://orcid.org/0000-0003-3190-3424
  • Dina Lusiana Setyowati Universitas Mulawarman
  • Ray Wagiu Basrowi Universitas Indonesia
  • Roma Yuliana Universitas Indonesia Mandiri Lampung

DOI:

https://doi.org/10.31101/jkk.4086
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Keywords:

community health center, midwive readiness, perinatal mental health, PMH disorders, postpartum

Abstract

Perinatal mental health (PMH) disorders affect 15.6–37% of postpartum women, yet midwives report low confidence in detection and management due to inadequate training and protocols. This study evaluated midwives' readiness to handle postpartum PMH disorders in community health centers. A convergent parallel mixed-methods design was used in eight Mataram City health centers (December 2023–January 2024). Quantitatively, 102 purposively sampled midwives completed validated questionnaires on sociodemographics, screening practices, and PMH handling, analyzed via chi-square tests. Qualitatively, thematic analysis of in-depth interviews with six informants (managers, midwives, and mental health nurses) explored referral experiences using N-Vivo. Most midwives (86.27%) did not handle PMH appropriately. The implementation of PMH data assessment (37.25%), screening (37.26%), and classification (22.56%) was low. Handling PMH significance association with screening (p=0.001, OR 14.31), classification (p=0.001, OR 23.22), and data assessment (p=0.009, OR 9.43). Age, education, experience, and training were not associated. Themes emphasized referral collaboration with family consent, consultation with mental health nurses/doctors, and hospitalization for the most serious cases. Midwives are not yet sufficiently prepared to address the perinatal mental health (PMH) needs of postnatal women. Poor screening uptake is a consequence of the absence of protocols and time limitations, and this highlights requirements for training and standardized pathways. Referral dependence is compensatory but inconsistent, mirroring global appeals for inter-professional approaches. Targeted PMH training and referral protocols are crucial in order to assist the development of midwives' skills to provide prompt care and reduce maternal-infant risk. Interventions should be tested in longitudinal studies across a variety of Indonesian contexts.

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Author Biography

Aulia Amini, Universitas Muhammadiyah Mataram

Midwifery Professional Education Study Program, Universitas Muhammadiyah Mataram, Indonesia

References

Abrahams, Z., Schneider, M., Honikman, S., Olckers, P., Boisits, S., Seward, N., & Lund, C. (2022). Health systems strengthening interventions for perinatal common mental disorders and experiences of domestic violence in Cape Town, South Africa: Protocol for a pilot implementation study. Pilot and Feasibility Studies, 8(1). https://doi.org/10.1186/s40814-022-01053-9

ACOG. (2023). Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 4: Obstetrics & Gynecology, 141(6), 1232. https://doi.org/10.1097/AOG.0000000000005200

Al Ahbabi, S., Mubarak, G., Al Khaldi, S., Bin Mousa, A., & Mohammad Baynouna Al Ketbi, L. (2024). Prevalence of Postpartum Depression among Mothers in the Emirates of Abu Dhabi. Maternal and Child Health Journal, 28(10), 1685–1693. https://doi.org/10.1007/s10995-024-03931-5

Al-abri, K., Armitage, C. J., & Edge, D. (2023). Views of healthcare professionals and service users regarding anti-, peri- and post-natal depression in Oman. Journal of Psychiatric and Mental Health Nursing, 30(4), 795–812. https://doi.org/10.1111/jpm.12908

Amer, S. A., Zaitoun, N. A., Abdelsalam, H. A., Abbas, A., Ramadan, M. S., Ayal, H. M., Ba-Gais, S. E. A., Basha, N. M., Allahham, A., Agyenim, E. B., & Al-Shroby, W. A. (2024). Exploring predictors and prevalence of postpartum depression among mothers: Multinational study. BMC Public Health, 24(1), 1–15. https://doi.org/10.1186/s12889-024-18502-0

Atif, N., Bibi, A., Nisar, A., Zulfiqar, S., Ahmed, I., LeMasters, K., Hagaman, A., Sikander, S., Maselko, J., & Rahman, A. (2019). Delivering maternal mental health through peer volunteers: A 5-year report. International Journal of Mental Health Systems, 13(1), 62. https://doi.org/10.1186/s13033-019-0318-3

Branquinho, M., Shakeel, N., Horsch, A., & Fonseca, A. (2022). Frontline health professionals’ perinatal depression literacy: A systematic review. Midwifery, 111, 103365. https://doi.org/10.1016/j.midw.2022.103365

Cantwell, R. (2021). Mental disorder in pregnancy and the early postpartum. Anaesthesia, 76(S4), 76–83. https://doi.org/10.1111/anae.15424

Carter, M., Russolillo, A., Ou, C., Zusman, E. Z., Hall, W. A., Cheung, I. W., & Jenkins, E. (2025). Models and key elements of integrated perinatal mental health care: A scoping review. PLOS Mental Health, 2(3), e0000164. https://doi.org/10.1371/journal.pmen.0000164

Cena, L., Palumbo, G., Mirabella, F., Gigantesco, A., Stefana, A., Trainini, A., Tralli, N., & Imbasciati, A. (2020). Perspectives on Early Screening and Prompt Intervention to Identify and Treat Maternal Perinatal Mental Health. Protocol for a Prospective Multicenter Study in Italy. Frontiers in Psychology, 11(March), 1–13. https://doi.org/10.3389/fpsyg.2020.00365

Choi, S. K., Park, Y. G., Park, I. Y., Ko, H. S., & Shin, J. C. (2014). Impact of antenatal depression on perinatal outcomes and postpartum depression in Korean women. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences, 19(9), 807–812.

Coates, D., & Foureur, M. (2019). The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review. Health & Social Care in the Community, 27(4), e389–e405. https://doi.org/10.1111/hsc.12740

Cummins, A., Baird, K., Melov, S. J., Melhem, L., Hilsabeck, C., Hook, M., Elhindi, J., & Pasupathy, D. (2023). Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study, from Australia. Women and Birth, 36(2), e270–e275. https://doi.org/10.1016/j.wombi.2022.08.002

Daehn, D., Rudolf, S., Pawils, S., & Renneberg, B. (2022). Perinatal mental health literacy: Knowledge, attitudes, and help-seeking among perinatal women and the public – a systematic review. BMC Pregnancy and Childbirth, 22(1), 1–22. https://doi.org/10.1186/s12884-022-04865-y

De Backer, K., Pali, A., Challacombe, F. L., Hildersley, R., Newburn, M., Silverio, S. A., Sandall, J., Howard, L. M., & Easter, A. (2024). Women’s experiences of attempted suicide in the perinatal period (ASPEN-study) – a qualitative study. BMC Psychiatry, 24(1), 255. https://doi.org/10.1186/s12888-024-05686-3

Dubreucq, M., Dupont, C., Lambregtse-Van den Berg, M. P., Bramer, W. M., Massoubre, C., & Dubreucq, J. (2024). A systematic review of midwives’ training needs in perinatal mental health and related interventions. Frontiers in Psychiatry, 15(April), 1–26. https://doi.org/10.3389/fpsyt.2024.1345738

Grisbrook, M.-A., & Letourneau, N. (2020). Improving maternal postpartum mental health screening guidelines requires assessment of post-traumatic stress disorder. Canadian Journal of Public Health = Revue Canadienne de Santé Publique, 112(2), 240–243. https://doi.org/10.17269/s41997-020-00373-8

Harahap, A. P., Adi, M. S., Sriatmi, A., & Purnami, C. T. (2024). Exploring perinatal mental health in Indonesia: A mixed-method study in Mataram, West Nusa Tenggara. Narra J, 4(1), e667. https://doi.org/10.52225/narra.v4i1.667

Howard, L. M., & Khalifeh, H. (2020). Perinatal mental health: A review of progress and challenges. World Psychiatry, 19(3), 313–327. https://doi.org/10.1002/wps.20769

Johnson, A., Stevenson, E., Moeller, L., & McMillian-Bohler, J. (2021). Systematic Screening for Perinatal Mood and Anxiety Disorders to Promote Onsite Mental Health Consultations: A Quality Improvement Report. Journal of Midwifery & Women’s Health, 66(4), 534–539. https://doi.org/10.1111/jmwh.13215

Li, J., Yin, J., Waqas, A., Huang, Z., Zhang, H., Chen, M., Guo, Y., Rahman, A., Yang, L., & Li, X. (2022). Quality of Life in Mothers With Perinatal Depression: A Systematic Review and Meta-Analysis. Frontiers in Psychiatry, 13, 734836. https://doi.org/10.3389/fpsyt.2022.734836

Manarang, J. K., Bidan, O., & Negara, D. I. (2022). Manarang. Jurnal Kesehatan Manarang, 8, 115–130.

Manjula, R., Badakali, M., Megharaj, P. C., Mallapur, A., & Mutalik, N. (2024). A study on prevalence of postpartum depression: A cross-sectional study using Edinburgh postnatal depression scale. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 13(11), 3284–3290. https://doi.org/10.18203/2320-1770.ijrcog20243191

McNab S, F. J., S, H., L, M., R, L., & Chorwe-Sungani G, et al. (2022). Comment: Silent burden no more: A global call to action to prioritize perinatal mental health. BMC Pregnancy Childbirth. https://doi.org/doi:%252010.1186/s12884-022-04645-8

Mohamed, R. A., Alharbi, M. F. J., Aloufi, R., Abraham, N., Taref, N. N., Bauomy, E. S., Alkalash, S. H., Marzouk, M. M., & Almowafy, A. A. (2024). Perceived clinical competence and its related factors among registered nurses employed at selected outpatient clinics in Egypt. PLOS ONE, 19(12), e0314206. https://doi.org/10.1371/journal.pone.0314206

Noonan, M., Jomeen, J., & Doody, O. (2021). A Review of the Involvement of Partners and Family Members in Psychosocial Interventions for Supporting Women at Risk of or Experiencing Perinatal Depression and Anxiety. International Journal of Environmental Research and Public Health, 18(10), 5396. https://doi.org/10.3390/ijerph18105396

Nwoke, C. N., Awosoga, O. A., McDonald, S., Bonifacio, G. T., & Leung, B. M. Y. (2023). African Immigrant Mothers’ Views of Perinatal Mental Health and Acceptability of Perinatal Mental Health Screening: Quantitative Cross-sectional Survey Study. JMIR Formative Research, 7. https://doi.org/10.2196/40008

Prastyoningsih, A., Rohmah, A. N., Prastika, D. A., Kanita, M. W., Pratiwi, A. M., Umarianti, T., & Andikatyas, Y. R. (2022). Continuing Midwifery Education: Midwifery Encouragements of Continuing Professional Education in Profession Stage in Indonesia: A Qualitative Study. Open Access Macedonian Journal of Medical Sciences, 10(G), 311–317. https://doi.org/10.3889/oamjms.2022.8655

Premji, S. S., Dobson, K. S., Prashad, A., Yamamoto, S., Tao, F., Zhu, B., Wu, X., Lu, M., & Shao, S. (2021). What stakeholders think: Perceptions of perinatal depression and screening in China’s primary care system. BMC Pregnancy and Childbirth, 21(1), 1–10. https://doi.org/10.1186/s12884-020-03473-y

Ravaldi, C., Mosconi, L., Crescioli, G., Lombardo, G., Russo, I., Morese, A., Ricca, V., & Vannacci, A. (2024). Are midwives trained to recognise perinatal depression symptoms? Results of MAMA (MAternal Mood Assessment) cross-sectional survey in Italy. Archives of Women’s Mental Health, 27(4), 567–576. https://doi.org/10.1007/s00737-024-01439-z

Rezaie-Keikhaie, K., Arbabshastan, M. E., Rafiemanesh, H., Amirshahi, M., Ostadkelayeh, S. M., & Arbabisarjou, A. (2020). Systematic Review and Meta-Analysis of the Prevalence of the Maternity Blues in the Postpartum Period. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(2), 127–136. https://doi.org/10.1016/j.jogn.2020.01.001

Roy, R., Chakraborty, M., Bhattacharya, K., Roychoudhury, T., & Mukherjee, S. (2022). Impact of perinatal maternal depression on child development. Indian Journal of Psychiatry, 64(3), 284–288. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_1318_20

Simanullang, E., & Dioso, R. (2020). The implementation of midwifery competency standards in applying behaviour of normal childbirth care (APN) on BIDAN PRAKTIK MANDIRI PERA. Enfermeria Clinica, 30, 96–98. https://doi.org/10.1016/j.enfcli.2019.11.030

Simcock, G., Kildea, S., Kruske, S., Laplante, D. P., Elgbeili, G., & King, S. (2018). Disaster in pregnancy: Midwifery continuity positively impacts infant neurodevelopment, QF2011 study. BMC Pregnancy and Childbirth, 18(1), 1–9. https://doi.org/10.1186/s12884-018-1944-5

Smith, A., Twynstra, J., & Seabrook, J. A. (2020). Antenatal depression and offspring health outcomes. Obstetric Medicine, 13(2), 55–61. https://doi.org/10.1177/1753495X19843015

Smith, T. E., Haselden, M., Corbeil, T., Tang, F., Radigan, M., Essock, S. M., Wall, M. M., Dixon, L. B., Wang, R., Frimpong, E., Lamberti, S., Schneider, M., & Olfson, M. (2020). Continuity of Care and Discharge Planning for Hospital Psychiatric Admissions. Psychiatric Services (Washington, D.C.), 71(1), 75–78. https://doi.org/10.1176/appi.ps.201900233

Van Niel, M. S., & Payne, J. L. (2020). Perinatal depression: A review. Cleveland Clinic Journal of Medicine, 87(5), 273–277. https://doi.org/10.3949/ccjm.87a.19054

Wang, T. H., Tzeng, Y. L., Teng, Y. K., Pai, L. W., & Yeh, T. P. (2022). Evaluation of psychological training for nurses and midwives to optimise care for women with perinatal depression: A systematic review and meta-analysis. Midwifery, 104. https://doi.org/10.1016/j.midw.2021.103160

Waqas, A., Koukab, A., Meraj, H., Dua, T., Chowdhary, N., Fatima, B., & Rahman, A. (2022). Screening programs for common maternal mental health disorders among perinatal women: Report of the systematic review of evidence. BMC Psychiatry, 22(1), 54. https://doi.org/10.1186/s12888-022-03694-9

WHO. (2022). Guide for integration of perinatal mental health in maternal and child health services.

Xiao, X., Ma, H., Zhu, S., Li, Q., & Chen, Y. (2023). The perceptions and attitudes of obstetric staff and midwives towards perinatal mental health disorders screening: A qualitative exploratory study in Shenzhen, China. BMC Nursing, 22(1), 1–10. https://doi.org/10.1186/s12912-023-01475-7

Yu, H., Shen, Q., Bränn, E., Yang, Y., Oberg, A. S., Valdimarsdóttir, U. A., & Lu, D. (2024). Perinatal Depression and Risk of Suicidal Behavior. JAMA Network Open, 7(1), e2350897. https://doi.org/10.1001/jamanetworkopen.2023.50897


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Published

2025-12-26

How to Cite

Harahap, A. P., Amini, A., Setyowati, D. L., Basrowi, R. W., & Yuliana, R. (2025). Midwives’ readiness for handling postpartum Perinatal Mental Health (PMH) disorders: a mixed-methods study . Jurnal Kebidanan Dan Keperawatan Aisyiyah, 21(2), 99–109. https://doi.org/10.31101/jkk.4086

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Original Research

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