Antenatal models of care for pregnant women deemed 'high risk'

The perinatal period can be a stressful and challenging time, and the exacerbation of pre-existing mental health challenges, as well as new episodes of mental health disorders, are common in this period. The World Health Organisation (2025) estimates that around 10% of pregnant women and 13% of postpartum women worldwide experience mental illness, with depression being the most common condition. Mental health challenges during the perinatal period are known to be associated with poor maternal and neonatal outcomes, including higher rates of pregnancy complications (e.g. pre-eclampsia, gestational diabetes, etc.), preterm birth, foetal growth restriction, and neonatal morbidity. Mental health challenges often intersect with other social, economic and health factors such as culture, Indigeneity, disability, childhood adversity, family violence and trauma (Hine et al., 2023). The care of pregnant women with mental illness poses unique challenges and requires careful consideration of the model of care that will best serve the woman and infant’s interests. In Australia, traditional prenatal care may involve any combination of midwives, obstetricians, and GP obstetricians. The Centre of Perinatal Excellence (2023) recommends that in during pregnancy, women with a mental illness should, where possible be cared for by a multidisciplinary team and continuity of care has been endorsed as effective practice for all women and particularly for Indigenous families (McLachlan et al., 2022). Antenatal care can act as a unique protective and preventative opportunity to identify women with mental health challenges and link them into specialised early parenting or mental health services to improve their outcomes over this demanding period of time. The literature on this topic highlights the diverse range of approaches to prenatal care for women with mental illness. Although different models of care represent differing acuities of care and severities of illness, in general, positive outcomes are seen when a multidisciplinary team is involved in the mother’s care. Antenatal care can act as a unique protective and preventative opportunity to identify women with mental health challenges and link them into specialised early parenting or mental health services to improve their outcomes over this demanding period of time. In this project, we are interested in examining how women’s self-determination, agency, voice and choice can be harnessed and enhanced through supportive, person centred and family focussed care, during the antenatal period and birthing process, to establish robust supports for navigating the postnatal period. We are particularly interested in the experiences of women who are flagged as ‘high risk’ and referred to specialised birthing hospitals outside of their local area, due to an identified need for higher capability levels of care (e.g. neonatal ICU, special care nurseries). This population of interest may include women who have experienced trauma (with or without a formal mental health diagnosis, women who have experienced sexual assault or family violence, women who have experienced grief/loss or previous birthing trauma), disabled women, and/or Aboriginal women, and we are particularly interested in women who reside in rural settings. This project may entail quantitative and/or qualitative data collection with multiple stakeholders to gain the perspectives of (for example) mothers, partners and families, maternity unit midwives, maternal and child health nurses, staff who work within specialist inpatient settings (i.e. Agnes Unit at Latrobe Regional Hospital, Regional Maternity Units in rural and urban sites) and perinatal practitioners from multidisciplinary backgrounds (GPs, social workers, nurses, midwives, occupational therapists, psychologists etc.). Questions this project may address include: How is holistic antenatal healthcare delivered for and with women deemed to be ‘high risk’? Is continuity of care a priority when women birth out of their local region? And if so, how is it facilitated? What are the gaps in antenatal care? What could be improved? Are birth plans routinely completed or referred to in order to provide individualised, person-centred care? Could healthcare providers use them to enhance self-determination and agency? Or to generate discussions about needs and expectations? This project could be undertaken via a range of methodological approaches and could be conducted in partnership with an Aboriginal organisation, if it was a priority need and met the four principles described in the AITSIS code: 1. Indigenous self-determination 2. Indigenous leadership 3. Impact and value 4. Sustainability and accountability *In selection of a PhD candidate, consideration will be given to the creation of safe and trauma-informed environments for participants and gender is a key part of this.