Research co-production with Happy Mums: listening to mums and mums-to-be

In the past two years, we have been involved in conversations about maternal mental health and service design in North East England as members of the steering group for a project led by Ways to Wellness. The project aims to develop innovative pathways for supporting maternal mental health in partnership with the voluntary sector. We worked closely with Project Manager Ang Broadbridge who introduced us to Sarah Penn who at the time was the Director and Lead for Engagement at the Happy Mums Foundation – a non-for-profit and peer-led organisation based in North Cumbria that delivers mental health support to people at perinatal stage of pregnancy and parenthood (perinatal phase is defined as the period of time when a person becomes pregnant and up to a year after giving birth).

Early conversation between us highlighted an opportunity for participatory scoping research to engage a diverse group of women and birthing people in co-creation activities to raise awareness and promote listening with communities whose voices may be unheard or excluded from the system. A related aim for us was to explore opportunities and challenges for the design of maternal mental health services in North Cumbria. This research was co-produced from the start involving a large group of organisations including: Maternity Voices Partnership, Maternal Mental Health Service NCIC, Perinatal Mental Health Team CNTW, First Step CNTW, Anti-Racist Cumbria, Together We CiC, Women’s Panah Cumbria, Carlisle College Refugee Support Officer, Healthwatch Cumbria, and digital Midwife NCIC. Since then, more collaborators joined our monthly roundtables where we are discussing follow-up steps and opportunities for disseminating our insights.

In this blog post, we share insights from our engagement so far and reflect on why we think this work has been successful, and what is needed going forward.

What did we do?

We collaboratively organised and facilitated a two-day workshop with 12 participants in the beautiful Holme Head House – a community space specialising in playful education –located by the river in Carlisle. Participants included those who had experienced homelessness, the asylum system, criminal justice system, from LGBTQ+ communities, Black and Brown mums and mums who were neurodivergent.

Over the two days, participants created collages to communicate their experience of motherhood and made small zines (do-it-yourself booklets of personal creations and appropriated images) to represent key or memorable events during their pregnancy journey.  

Each day started with a delicious homemade vegan lunch, which was provided by Holme Head House. Both workshops started with an ‘ice breaker’ (that is, an activity to support getting to know each other), to create a space for building connection, trust and a sense of community between us and participants. Insights and lessons learned from the workshops informed the organisation of ‘MumKind’ - a community event led by Happy Mums, Maternity Voices Partnership and Woman Up! which took place later that month at the same place.

What does an inclusive and participatory approach look like for community engagement?

We worked closely with Happy Mums and Ways to Wellness to co-develop a plan for the workshops. Our community partners drew from their network to invite key representatives early on to help us shape ideas for our study. For instance, we hosted online roundtables for people to feedback on our ethics protocol with particular attention on inclusive language and recruitment of participants with diverse backgrounds. More people joined the conversation and got involved in planning and co-facilitating the workshops. For instance, Mina Banisaeid who is an independent facilitator involved with various communities and Sandra Guise from the Maternity Voices Partnership joined us to co-lead the workshops. We also had support on the day from Healthwatch Cumberland and UK Woman Up. All partners came from different backgrounds and expertise, sharing a common passion for community-based work and improving access to health and social care for women and birthing people from diverse backgrounds.

As a team, we brought different perspectives and expertise to the table, and worked together to collectively make sense of participants’ stories. We reflected on the value of community engagement and importance of nurturing relationships, drawing from best practice:

‘Community engagement, in this context, goes beyond simply 'involving' people. It relies on building ongoing, meaningful relationships between the community and organisations for mutually beneficial outcomes. It is a collaborative process between groups who are brought together as neighbours or through sharing a common interest or concern. It is a powerful vehicle for bringing about environmental and behavioural changes to improve the situation and wellbeing of the community’. (Community Engagement for Social Inclusions, via NIHR Community Engagement Toolkit.

Why is this research needed?

Maternal Mental Health Services Project Manager Ang Broadbridge (Ways to Wellness) highlighted:

As many as one in five women will experience maternal mental health issues in the perinatal period, as well as the life changing costs to families of not being able to access the right support at the right time there is evidence of the economic costs this has to society.  A report by the London School of Economics and Centre for Mental Health report on The costs of perinatal mental health problems in the UK found that  maternal mental health problems carry a total economic cost to society of about £8.1 billion for each one-year birth cohort.

‘1 in 5 women develop a mental illness during pregnancy or in the first year after birth... In fact, 70% of those experiencing it will hide or underplay maternal mental health difficulties. But when communities come together to tell parents that they are not alone and that we stand with them as their ‘village’ then we can make a difference’, (nalc - It takes a village to raise a child)

For some communities, accessing maternal mental health care can be difficult, there are additional barriers for women experiencing complex social factors and health inequalities and deprivation.  Listening deeply to the seldom heard voices of women facing these challenges, understanding these barriers, learning about stories of hope and exploring gaps and opportunities to meet their needs helps us to champion the rights of all women, think differently about how services are designed and offered, and community engagement of this nature builds community as a vehicle for change.

Did Happy Mums have experience of working with researchers before?  

Sarah Penn Health Partnerships Support Officer at Cumbria CVS and former Director and Lead for Engagement at the Happy Mums Foundation reflected:

Previously Happy Mums’ involvement with research had been limited to that of passive participant or conduit of information. We had taken part in studies as either formal participants or informal contributors to reports/reviews. We had also been asked on several occasions to promote research recruitment for studies through our social media accounts or with group members. This project represented a radical departure from the kind of interactions we had with researchers as we were truly collaborative, equal partners who were able to drive the direction, content and essence of the research. We felt ownership and as such were able to pass this sense of empowerment and control onto the group members who took part. Even though only some of the participants were Happy Mums members, they were able to inadvertently role-model the kind of sharing which makes peer support so powerful, and as such gave other participants permission to share their stories, even where they might otherwise have felt shame, stigma and judgement.

What was it like for participants to take part in the workshops?

“This is just a collage to stop and breathe. Happy Mums gave me hope. They saved my life. I had intentions of not living, anymore. They really helped build me again”. (One participant describing her collage and the critical role of peer support and community-based organisations).  

The workshops provided a safe space for participants to share about their experiences across different stages of their mothering journey. The discussion was scaffolded by creative activities and centred around women’s experiences with care services at perinatal stage of pregnancy and parenthood. Key themes from our discussions included trauma related to life experiences such as prison, abusive relationships and homelessness. Four participants shared about their traumatic births with two of them reporting on near-death experiences when giving birth. Mental health was a key theme in our discussion with pregnancy being described as a catalyst for the diagnosis of mental health conditions.

Feelings of isolation and post-natal depression were also reported as a result of pregnancy. In their journey, all participants described the critical role of peers and community-based organisations as lifesaving. Overall, being listened to and having agency were important qualities of care with discussions highlighting further considerations for informed consent, patient empowerment and human rights.

As scoping research, the workshops helped us surface relevant themes that were explored more in-depth in a follow-up community event ‘MumKind’ led by Happy Mums. A zine was created to communicate insights from the workshops and more analysis will follow. You can view the zine here.

What are the future plans?  

In February 2024, we ran a hands-on session at the Boost conference hosted in Newcastle: ‘Embedding Personalised Care – A system approach to improving lives’. Our session was attended by around 50 participants, including patients and people working in healthcare and community-based organisations. We introduced trust-building techniques and creative methods used in our workshops, and facilitated discussion on co-production with the aim of addressing the following question: how a structured system can listen and learn from intersectional, and complex lived experience?

We are currently working on finding the best ways to disseminate insights to key stakeholders across health and social care.

Blog post written by Caro Claisse and Abi Durrant (Open Lab, Newcastle University) with contributions from Sarah Penn (Cumbria CVS, Happy Mums); Ang Broadbridge (Ways to Wellness); Sandra Guise (Carlisle & Eden Maternity & Neonatal Voices Partnership Group); Mina Banisaeid (Independent Facilitator); Sam Massey (UK Woman Up); Chloe Wallace (Healthwatch Cumberland); Lucinda Bray (Happy Mums).