In Project 1 we want to identify which health services are offered to women, which services they access, and regional differences. We also want to find out whether all women have access to services to support their needs.

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To do this, we ask all women to complete questionnaires about their anxiety, general health, and health service use 6, 12 and 24 months after giving birth. This will highlight women with perinatal anxiety who do not receive care, as well as help us recommend ways that these women can be better identified and supported in the future.

In Project 2, we will examine medical records of 40 women who have a diagnosis of perinatal anxiety or an associated disorder, to assess the relationship between when anxiety started and health service use. We will also look at whether medical records give us similar information about health service use compared to women's questionnaire responses in Project 1.

In Project 3, we are exploring what support and care is offered to women with anxiety or distress at any point during pregnancy and after giving birth, whether they received that care, and women’s views on that care.

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Women who have completed questionnaires as part of Project 1 and have had anxiety or distress during pregnancy or after birth are being invited to take part in a one-to-one interview. We will interview 60 women who experienced anxiety or distress to get their views of the care they were offered/received and how acceptable they found it.

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In the interview, women will be asked about their experience of anxiety and distress, their journey of telling their GP, midwife, or health visitor about their symptoms, as well as any treatment they might have had or reasons for not accessing any treatment or support. We will also discuss women’s thoughts on ways in which treatment and services can be improved.

Project 4 will explore health service personnel’s views on perinatal anxiety, distress, and depression. We will examine health professional’s role and ability in managing perinatal anxiety, what barriers exist in managing anxiety, and ways in which we can improve women’s care.

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Similarly to Project 3, we will invite healthcare professionals who work with pregnant and/or postnatal women, such as midwives, GPs, health visitors, and psychologists, to take part in an in-depth interview. We will interview 60 health professionals and managers about their role in managing perinatal anxiety, and factors that help or hinder this. In each interview, we will explore how services identify and diagnose anxiety, distress, and depression in pregnancy and after birth, the options of care that are available to women, how confident professionals feel in managing women’s anxiety, as well as what changes are needed in order to provide the best care.

Project 5 will investigate the cost of health service use for women with and without perinatal anxiety.

As part of the previous projects, women have provided information about the health services they have used for themselves and their baby/babies from pregnancy to two years after giving birth. We will use this information to calculate and compare the cost of health service use between women who have had anxiety and women who have not.

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We will also explore the wider societal costs, like whether women’s anxiety has impacted their plans on returning to work or affected their household and family responsibilities.

The results of this project will be used to provide information on the financial and societal cost of perinatal anxiety, the types of services accessed by women, as well as inform health service commissioning and budgets.

Project 6 will investigate the cost of health service use for women with and without postpartum post-traumatic stress disorder (PTSD) or birth-related PTSD. Postpartum PTSD can develop due to traumatic events that occurred prior to birth. In contrast, birth-related PTSD arises as a direct result of birth.

To carry out this project we will use information women provided in Project 1 about their mental health and health service use for themselves and their baby. We will look at the circumstances of women with and without postpartum PTSD and birth-related PTSD to investigate whether there are differences in who gets referred and accesses services. We will calculate the cost of health service use and compare this for women with and without postpartum PTSD and birth-related PTSD. As in Project 5, we will also explore the wider societal costs, such as whether women’s PTSD affected their plans to return to work or their household and family responsibilities.

The results will help policy makers and NHS health service planners and providers understand the costs of services for postpartum and birth-related PTSD, which will influence the way services are provided to women in future.