Judy Shakespeare

Royal College of General Practitioners | RCGP · CIRC

Background: Perinatal mental health (PMH) problems are a leading cause of maternal death and increase the risk of poor outcomes for women and their families. It is therefore important to identify the barriers and facilitators to implementing and accessing PMH care. Aims: To develop a conceptual framework of barriers and facilitators to PMH care...

Background Ethnic disparities in maternal mortality were first documented in the UK in the early 2000s but are known to be widening. This project aimed to describe the women who died in the UK during or up to a year after the end of pregnancy, to compare the quality of care received by women from different aggregated ethnic groups, and to identify...

Improving diagnosis and treatment of cancer in pregnancy

An exploratory qualitative study exploring GPs’ and psychiatrists’ perceptions of post-traumatic stress disorder in postnatal women using a fictional case vignette Postnatal post-traumatic stress disorder (PTSD) affects 3%-4% of women who give birth. It is underdiagnosed and undertreated. Thus far, no studies have investigated doctors’ perceptions...

The improvement of perinatal mental health formed part of WHO's Millennium Development Goals. Research suggests that the implementation of perinatal mental health care is variable. To ensure successful implementation, barriers and facilitators to implementing perinatal mental health services need to be identified. Therefore, we aimed to identify th...

Objective: The workshop aimed to discuss and develop a statement on the current state of the evidence and opinion in the field of Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide some recommendations for research. Background: A group of international researchers, clinicians and a service user met in 2019 to discuss the state of...

Objective To develop a core outcome set for pre‐eclampsia. Design Consensus development study. Setting International. Population Two hundred and eight‐one healthcare professionals, 41 researchers and 110 patients, representing 56 countries, participated. Methods Modified Delphi method and Modified Nominal Group Technique. Results A long‐list of 116...

Objective To examine the factors associated with receiving surgery for heavy menstrual bleeding (HMB) in England and Wales. Design National cohort study. Setting National Health Service hospitals. Participants Women with HMB aged 18–60 who had a new referral to secondary care. Methods Patient-reported data linked to administrative hospital data...

Objective To examine symptom severity and duration at time of referral to secondary care for heavy menstrual bleeding (HMB) by socioeconomic deprivation, age and ethnicity Design Cohort analysis of data from the National HMB Audit linked to Hospital Episode Statistics data. Setting English and Welsh National Health Services (secondary care): Febr...

Background: Women may not seek help for perinatal psychological distress, despite regular contact with primary care services. Barriers include ignorance of symptoms, inability to disclose distress, others' attitudes, and cultural expectations. Much of the evidence has been obtained from North American populations and may not, therefore, extrapolat...

Background: Up to 20% of women experience anxiety and depression during the perinatal period. In the UK, management of perinatal mental health falls under the remit of GPs. Aim: This review aimed at synthesising the available information from qualitative studies on GPs' attitudes, recognition, and management of perinatal anxiety and depression....

Objectives To identify and prioritise important research questions for miscarriage. Design A priority setting partnership using prospective surveys and consensus meetings following methods advocated by the James Lind Alliance. Setting UK. Participants Women and those affected by miscarriage working alongside healthcare professionals. Results In...

The Confidential Enquiry into Maternal Deaths began in 1952 and has led to major improvements in care for pregnant and postnatal women. Between 2011 and 2013 there were 240 maternal deaths during or up to 6 weeks after pregnancy, giving a maternal death rate of 9 in every 100 000 women, a statistically significant decrease compared with 2009– 2012...

Background: Perinatal anxiety and depression are widespread, with up to 20% of women affected during pregnancy and after birth. In the UK, management of perinatal mental health falls under the remit of general practitioners (GPs). We reviewed the literature on GPs' routine recognition, diagnosis and management of anxiety and depression in the peri...

Background The causes of maternal death are now classified internationally according to ICD-MM. One significant change with the introduction of ICD-MM in 2012 was the reclassification of maternal suicide from the indirect group to the direct group. This has led to concerns about the impact of this reclassification on calculated mortality rates. The...

Should perinatal mental health be everyone’s business? - Volume 16 Issue 4 - Susan Ayers, Judy Shakespeare

Established in 1952, the programme of surveillance and Confidential Enquiries into Maternal Deaths in the UK is the longest running such programme worldwide. Although more recently instituted, surveillance and confidential enquiries into perinatal deaths are also now well established nationally. Recent changes to funding and commissioning of the En...

I have received more than 30 supportive comments on my article about the death of my father.1 Many people were not surprised by my experiences and described their own sad stories. This suggests that poor basic care for older patients is endemic within the NHS, with mid-Staffs just a scapegoat for a widespread institutional malaise. Food, water, cl...

This is the story of how my father died in a modern British hospital. In late March 2012 he organised his own 90th birthday party, where he stood and delivered an articulate and funny after dinner speech. He was a retired anaesthetist living alone and independently in a small village in the north of England. By the beginning of May he was dead, hav...

Former consultant anaesthetist (b 1922, q Leeds 1944; FFARCS), died from old age and a fractured hip on 4 May 2012.

In the triennium 2006-2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003-2005 to 4.67 per 100,000 maternities in 2006–2008 (p = 0.02). This decline is predominantly due to the reduction in...

Is important but needs to be done earlier in primary care

The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening tool for postpartum depression (PPD). We systematically reviewed the published evidence on its validity in detecting PPD and antepartum depression (APD) up to July 2008. Systematic review of validation studies of the EPDS included 1987-2008. Cut-off points of 9/10 for...

Background: Listening visits are a routine intervention offered to women with postnatal depression. Objectives: To explore the experiences of women who have received listening visits for postnatal depression. Methods: An in‐depth qualitative interview study involving a purposive sample of 39 postnatal women from patients of 22 general practices wit...

to explore how women experience breast-feeding difficulties. This theme emerged unexpectedly during a study of women's experiences of screening with the Edinburgh postnatal depression scale (EPDS) and subsequent care from primary health-care professionals. qualitative in-depth interview study. postnatal women of 22 general practices within Oxford C...

Health professionals are ideally placed to identify domestic violence but cannot do so without training on raising the issue and knowledge of advice and support services.

Screening for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS) has been widely recommended and implemented in primary care, although little is known about how acceptable it is to women. To explore the acceptability to women of postnatal screening by health visitors with the EPDS. Qualitative interview study. Postnatal pati...

This is part of a series of occasional articles on common problems in primary careThe parents of an only child, aged 13 months, are worried about media reports that the MMR (measles, mumps, and rubella) vaccine causes autism. Their son is due for his vaccination and his cousin has an egg allergy. What issues you should cover Evidence—Evidence linki...

The objective of this study was to compare the knowledge, attitudes, responses and levels of detection of domestic violence among a variety of healthcare workers in different specialities.Self-administered questionnaires were sent to community and hospital based healthcare workers in Oxfordshire working in primary care, obstetrics and gynaecology,...

Norethisterone has several indications in gynaecology and primary care. At low dose ( = 5 mg daily) it can be used for menorrhagia, to treat metropathia haemorrhagica, and to postpone menstruation. Norethisterone is not available in a formulation greater than 5 mg. Recent evidence has suggested that at conventional doses (5-10 mg/day) it is not eff...

EDITOR, - Philip M W Bath and colleagues suggested that with the expected increase in patients taking warfarin for non-rheumatic atrial fibrillation the management of long term control with anticoagulants could be devolved into the community.1 Fiona Taylor and colleagues showed that in London few patients taking anticoagulants were managed by their...

A structured sample of mobile elderly patients in a rural community practice was assessed on validated rating scales for depression, dementia and disability. A total of 62% of the sample was abnormal on at least one variable. The overall prevalence of depression was 13%; the overall prevalence of dementia was either 10 or 18% depending on the crite...

Two hundred subjects aged 60-89 were selected for a study aimed at defining a reference range for the erythrocyte sedimentation rate in the elderly. The study extended a previous survey in subjects aged 20-65. The results confirmed that the sedimentation rate increases with age and that women have higher values than men but suggested that over half...

A naturalistic study was set up to screen, identify and treat hypertensive patients aged 20–60 years in a rural general practice. 3,222 patients (92%) of a stable population of 3,489 were screened by 2 nurse research assistants and of these 455 patients (14%) were found to be hypertensive or borderline hypertensive. After careful assessment, 192 of...

A naturalistic study was set up to screen, identify and treat hypertensive patients aged 20-60 years in a rural general practice. 3,222 patients (92%) of a stable population of 3,489 were screened by 2 nurse research assistants and of these 455 patients (14%) were found to be hypertensive or borderline hypertensive. After careful assessment, 192 of...