Table 4 Contextual factors influencing the translation of the learned skills into clinical practice / the implementation of a training program.

Society level factors

Switching from infant-centred care to family centred care in the peripartum and providing non stigmatizing information about PMH to all parents/

Mother 3: “I was the focus of the consultation and because before ultrasounds, they asked me, “how are you feeling? Are you eating well? Are you sleeping well?” And I told myself, “I’m not only the person who bears”.”; Psychiatrist 3 [female, 32 years old]: “that’s very much a story of awareness of the general population”; Midwife 14: “that it would be part of the landscape […] Known and recognized”; Psychiatrist 2: “that it would be part of the information, just like we will inform women on Guthrie or breastfeeding”; Mother 3: “on my sickness leave, it was written […], “psycho-depressive disorder” […]. I told myself, “ok, you’re part of that group”, […] “that’s it, all you didn’t want to, well, you’re inside”; Mother 1: “My husband […]. For him, depressed are people letting themselves go, you know? […] My major fear was he that he would leave me”; Paediatrician 1: “there is a great worry, I think, from families, if they’re not “well-behaved”, (…) because it could lead to a report of the child.”; Mother 1: “being perfect, to take perfect care of her house, to succeed at breastfeeding, to have quiet children”; Obstetrician 1: “I wish it could last longer in postpartum, that the peripartum network could continue in postpartum”; Mother SMI 8 [40 years old]: “the lack of care. I found it hard to be abandoned […] after childbirth, that I didn’t have a doctor anymore and all that. […]. I would not like to be abandoned. the part on maternal healthcare is important.”

Organizational level factors

Continuity of care between pregnancy and postpartum and stakeholders involved in perinatal mental health; needs extra-time to address PMH issues; coordinated care by specialist midwives; Multidisciplinary work; knowing each other role; joint psychiatric and obstetric services; need for feedback from MHPs

Midwife 27 [female, 34 years old]: "I receive letters for patients that I never saw and they explain to me that I was supposed to take over. […] No appointment was made, and they did not contact us.”; Midwife 1: “we often ask ourselves about postpartum depression during the next pregnancy. […] There is a period of emptiness for women in postpartum between the end of the private practice midwife’s care and the 1^st appointment with the GP.”; Midwife 12 [female, 54 years old]: "we try to do this prevention in any case, but it’s not always easy because we sometimes don’t have the time to see everyone"; Midwife 18 [female, 64 years old]: “what’s essential is that there is that someone continues intervening”; Paediatrician 3: “We don’t always have access to that, maybe also because we don’t have much time to ask people […] we still have to do a certain number of things and maybe we don’t always have the space to go further.”; Midwife 17 [female, 36 years old]: “Well, in my small town, there is no psychiatrist. So that, that’s already complicated.”; Midwife 3: "we are lucky to have that position of midwife case manager, which allows […] to detect vulnerabilities, precariousness, psychological distress, patients using drugs, and then in a second step we can call them, orient them and that creates trust."; C&A psychiatrist 1 [female, 52 years old]: “the connections between health providers and so later the trust between the patient who will refer herself to a midwife and then will have to refer herself to a psychiatrist or a psychologist. […] offering joint consultations”; Midwife 21 [female, 38 years old]: "that there be a sort of multidisciplinary follow-up. And in multidisciplinary that’s not just gynaecologist, paediatrician, midwife that’s the psychiatric side too."; Midwife 19: "the fact that we communicate with each other, I have the feeling that it reassures them. […] Each one in our place but working in the same direction. Each one with our own skills and specificities"; Midwife 18: “When they’re followed by psychiatrists, that’s very complicated to have feedback.”

How education programs should be delivered—Common training & role plays

GP1: "Learning how to know each other better, could it go through common trainings so that we could know each other better?"