"I ask them what autism means for them": a qualitative study of staff experiences of working with autistic women and birthing people in community perinatal mental health teams.

BACKGROUND: Autistic women and birthing people (AWBP) face an increased risk of perinatal mental health issues and may be referred to Community Perinatal Mental Health Teams (CPMHTs). However, staff members of CPMHTs often lack sufficient training and knowledge about autism, leading to barriers in providing appropriate care. To date, no studies have examined the experiences of staff supporting autistic women and birthing people within CPMHTs. METHODS: We carried out individual qualitative interviews with 20 staff members from different professional backgrounds across four CPMHTs in England to understand their experiences working with AWBP and to identify how CPMHTs could better meet their needs. Thematic analysis was used to synthesise findings. RESULTS: We identified four key themes: (1) recognizing the complexities of AWBP, (2) addressing the unique needs of AWBP (3) varying levels of knowledge and understanding across both the CPMHTs and individual clinicians, and (4) envisioning improvements for the future. Staff reported that working with AWBP was an unexpected aspect of their roles, further complicated by difficulties in accessing autism assessments for those who had not yet received a formal diagnosis. They highlighted both barriers to providing appropriate care and the adjustments they could make to improve their practice. Additionally, staff expressed a need for targeted training and suggested other areas for development, including appointing an autism champion, employing autistic peer support workers, and involving individuals with lived experience of autism and perinatal mental health challenges in co-producing service improvements. CONCLUSIONS: Working with AWBP is a current area of challenge for CPMHTs. Perinatal-focused autism training and expert supervision are important for staff to feel confident in making appropriate adaptions to care to provide the best possible support.