Mother and Baby Units (MBUs)

An even smaller number (around 2 to 4 per 1000 women who have a baby) will need admission to hospital for their mental health problems.⁴ These women will usually be admitted to a Mother and Baby Unit (MBU)⁵  

Mental illness at this crucial time can affect a mother’s relationship with her baby. It can undermine a woman’s confidence and belief in her ability to be a good mother. MBUs are designed to keep mothers and their babies together. Specialist staff nurture and support the mother infant relationship on the ward at the same time as the mother has treatment for her mental illness.

MBUs can admit women in late pregnancy and at any point until their baby is one year old. They are calm welcoming places that are more homely than other wards. Each mum has their own bedroom, with a cot for the baby. The entrance to the unit is controlled by staff to ensure the safety of mothers and babies. 

MBUs work closely with community perinatal mental health teams, maternity services and health visitors.

Any MBU will usually offer a visit to you and your partner, or other family member, before you come in, although this may not be possible if you have to come in as an emergency.

Professionals with specialist knowledge and skills in caring for women with mental health problems in pregnancy and the postnatal period, and their babies. They work closely together as a team, so they can, together, develop a clear understanding of each mum’s unique experience and circumstances. They can advise you about which treatments will best help you recover. Staff include:

Perinatal mental health nurses: On an MBU, each mum has a named specialist mental health nurse. This nurse will be the staff member they have most contact with during their stay on the ward and they will get to know them very well. The nurse manager is in charge of the ward.

Nursery nurses: Each mum and baby will also have a named nursery nurse, who will get to know their baby well. They provide advice and support to help mums care for their babies.

Perinatal psychiatrist: A consultant psychiatrist who specialises in working with women with mental health problems in pregnancy, and after birth. They are usually the most senior professional on the team and have particular expertise in the use of medication in pregnancy and breastfeeding. There may also be junior doctors who work closely with the consultant and the rest of the team.

Psychologists: The psychologists provide talking therapies (see below). 

Occupational therapists (OT): Provide activities to help mothers spend their time in a therapeutic and creative way, to help their recovery.

Pharmacist: Advises the clinical team about medicines prescribed on the ward and when women are discharged.

Ward clerk/receptionist: Runs the administration of the ward. 

You may have an existing mental health problem that has got worse either during pregnancy or after birth.

Or, you might develop mental health problems for the first time in pregnancy or the first postnatal year. 

MBUs specialise in treating severe mental health problems.

These include Bipolar Affective Disorder, Schizophrenia, Postpartum Psychosis and other psychotic illnesses. A mother can also be admitted for treatment of severe Depression or Anxiety Disorders, such as Obsessive-Compulsive Disorder.

Any health professional can refer you to an MBU. You, or your partner or another family member, can speak to your GP, psychiatrist, midwife or health visitor if you think you might need admission. You will usually see a mental health professional before admission, to make sure that an MBU is the best place for your treatment. 

Your health professionals will complete a referral form. This will include information about you, your family and the current concerns. It will also include other important information, for example about your current and past mental health problems and treatment.

• Women with severe personality disorder, learning disability or substance misuse, unless they also have a serious mental illness.
• Women who have very aggressive behaviour that might pose a risk of harm or injury to their own or other babies.
• Women who are unlikely to be able to care for a baby independently, even with reasonable support (for example, some women who need to live in supported accommodation).
• Women who just need an assessment of their ability to parent, but who do not need treatment for a serious or complex mental illness.

• Admission to an MBU further away from home. Some partners and other relatives may not want this, as it can make it hard for them to visit you.
• Admission to an MBU closer to where other family members live. MBU beds are run as a national network. This means you can request admission to an MBU close to your relatives even if a bed is available close to home.
• Temporary admission to a general psychiatric ward close to your home until a bed is available in your nearest MBU. This means your partner, a family member or friend would need to look after your baby (alternative care can be arranged if you have no suitable carer for your baby).
• Staying at home with another family member with intensive support from the mental health Home Treatment Team who can visit at least once each day. The safety of this option will need to be considered for each mother. Some women are too unwell for staying at home to be a safe option.

Medication

This includes antidepressants, antipsychotics and medicine to help with anxiety and sleep. A psychiatrist will talk to you about the different medicines which may help you. They will explain the side effects, how the medicines might help you and how long they might take to work.

They will also help you weigh up the risks and benefits of using medication in pregnancy and/or while breastfeeding. You can decide together on the best option for you and your baby. The team will review your medication and any side effects every week.

Psychological therapies 

Talking therapies, such as CBT (cognitive behavioural therapy), are available on MBUs. Different units may offer different types of therapy. Many talking therapies are provided by psychologists, but sometimes other professionals are be trained to provide these. 

Therapies can help with managing symptoms and thinking about any previous traumatic experiences or relationship difficulties. They can look at any problems in your relationship with your baby and help improve your confidence as a mum. 

Group therapies may also be available. These can help everyone realise that they are not alone in what they are experiencing.

For example, new mums commonly have anxious thoughts and feelings – but these may be worse if you have a mental health problem.

These worries are often about your baby, or about whether you are a good mum. It can help to know that other women have similar symptoms, or worries. The therapist can teach you ways to reduce your anxiety and develop your confidence.

Individual MBUs vary, but there is always something to do, to help your recovery and support your relationship with your baby. Activities in the MBU are optional. Examples include cooking, baby massage, relaxation and Mindfulness.

Arts and crafts are often available and might include baby hand and footprint painting, collage work, crocheting, scrapbooking or photography. There are plenty of opportunities for exercise and fitness, from gentle walks to sessions in the gym. 

They also have support and information for partners and families.

Staff are on the ward 24 hours a day, 7 days a week. They will understand your mental health problems and will be there to give you help and support. There will always be someone to talk to, at any time of the day or night, and staff will make sure that you and your baby are looked after. They will help you to care for your baby yourself as much as possible.  

Your baby will usually sleep in your room with you. If you need more sleep to help you recover, staff can take care of your baby through the night. 

Staff will support you to feed your baby whether you have chosen breastfeeding, bottle feeding or a combination of the two.

MBU’s have private gardens which you and your baby can use at any time during the day. Although you will be encouraged to use communal spaces and get to know the other mums, there are also quiet spaces. There are also private spaces for individual therapy and for visits from friends and family.

You will have regular meetings with the staff team. This will ensure they understand why you became unwell, agree a plan for your care and review your treatment and progress.

Your partner, or other family members, will be invited to join these meetings if you want them to. Other professionals involved in your care will also sometimes attend. This may include your midwife, health visitor, care co-ordinator or social worker.

You will have a care plan which will outline your treatment. It will also include support to help you recover and to help keep you well when you go back home. 

On average, people stay for 8 weeks - but some will stay for a couple of weeks, some for a few months. Leaving the ward happens gradually, with increased periods of leave so you can get used to be being at home.

This helps to maintain the recovery that you have made on the ward. It also means there is time to make sure you have the right support for your mental health and to increase your confidence as a mum. 

 “Ask for as much help as you need – don’t be afraid to ask for help when you need it. You WILL get better and to a point when you are ready to go home”

“Talk to the staff about your thoughts and feelings, do not bottle them up”

“Even on your darkest days have faith in yourself keep going. I will be forever grateful to all the staff and doctors for making me well again! You WILL GET BETTER!”

“Take it hour by hour, day by day try and find one thing positive each day, even on your worst days”

“Remember there is light at the end of the tunnel and things will get better”

 “I can pinpoint the turning point in my recovery.  It was in the middle of a session with the unit’s child psychologist (who helped mums and babies bond together and kept an eye on the babies’ development).  She had a gentle, calming air and she encouraged me to actually look into my son’s eyes and smile and laugh with him.  Before that point I had never even seen him as a little person.  I had struggled anxiously with every nappy change, every bottle feed, every bath time.  But here we were, smiling at each other.  I cried some happy tears then – my baby was going to be ok! My family was going to be ok! I was going to be ok!”

“I came to see the MBU as a place of safety. It offered baby massage sessions, weaning classes and splash play activities, all of which enabled me to be the mother I wanted to be. There was also the opportunity to meet other mothers who were going through the same thing and discuss the impacts of our various treatments as well as the trials and tribulations of motherhood. In short, it was a place that helped me to re-grow the confidence that my disease had decimated, making me feel positive about our ability to thrive together at home.”

Tommy’s - www.tommys.org/pregnancy-information/im-pregnant/mental-wellbeing  

Mental wellbeing in pregnancy – patient information written by midwives

Action on Postpartum Psychosis - www.app-network.org/ 

A national charity for women and families affected by postpartum psychosis.  Provides information and peer support, including online forums and workshops

Maternal OCD - www.maternalocd.org/ 

Support and Information for women with Perinatal Obsessive Compulsive Disorder

Twitter support group: #Bumpsandmumsocdhr 

PANDAS - www.pandasfoundation.org.uk 

Antenatal and postnatal depression information and support for women and families. Support groups and helpline

Best Beginnings - www.bestbeginnings.org.uk/ 

Baby Buddy App – allows you to create a Bump Buddy avatar to guide you through your pregnancy.   Provides information about many aspects of pregnancy and parenting, including mental wellbeing, in the form of short video clips

Best Use of Medicines in Pregnancy (BUMPS) - www.medicinesinpregnancy.org/ 

Information leaflets for women and their partners about use of a medication in pregnancy

1. Howard LM, Molyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J.  Non-psychotic mental disorders in the perinatal period. The Lancet 2014; 384: 1775-88.

2. Howard LM, Ryan EG, Trevillion K, Anderson F, Bick D, Bye A et al. Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy. Br J Psychiatry. 2018; 212: 50-56.

3. Jones I, Chandra PS, Dazzan P, Howard LM. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet. 2014; 384: 1789-99. 

4. Royal College of Psychiatrists (2015). Perinatal mental health services: Recommendations for the provision of services for childbearing women. College Report CR197

5. NICE Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192] Published date: December 2014 Last updated: August 2017 https://www.nice.org.uk/guidance/cg192  

6. Royal College of Psychiatrist’s CCQI Perinatal Quality Network Service Standards for Mother and Baby Units: 5th Edition (2016). Eds: Peter Thompson and Harriet Clarke. 

This information was produced by the RCPsych Public Engagement Editorial Board.

The ‘Building Capacity, Psychiatry Leadership in Perinatal Mental Health Services’ project: commissioned by NHS England in partnership with Health Education England and delivered by the Royal College of Psychiatrists.

• Expert review:  Dr Laurie Windsor, Dr Gill Strachan and Dr Lucinda Green
• Service users and carers: Action on Postpartum Psychosis
• Series Editor: Dr Phil Timms 
• Series Manager: Thomas Kennedy