On January 23, we recognize Maternal Health Awareness Day, an initiative by the American College of Obstetricians and Gynecologists (ACOG) to increase awareness and action related to maternal mortality and morbidity in the U.S. As we work to improve all aspects of maternal health, we must bring more focus to an area of critical concern — supporting maternal mental health.
Maternal mental health is the emotional, psychological, and social well-being of women during pregnancy, birth, and the postpartum period. It affects not only the mother, but also their children, their families, and their communities.
According to the World Health Organization, about 10% of pregnant women and 13% of women who have given birth experience a mental health condition such as depression. In developing countries, this percentage can be even higher, ranging from 15.6% to 19.8%. Maternal mental health disorders can have serious consequences, such as impaired mother-infant bonding, poor child development, and increased risk of death from suicide or other causes.
Despite the prevalence and impact of maternal mental health issues, they are often overlooked, underdiagnosed, and undertreated. Many factors contribute to this neglect, such as stigma, lack of awareness, lack of resources, lack of training, and lack of coordination among healthcare providers. The effects of social determinants of health, racism, and bias compound the problem by making needed care harder to get for specific populations.
In this article, we will discuss why maternal mental health is a critical issue that needs more attention along with strategies and tactics for improving it. Healthcare professionals play a key role in screening, referring, treating, and following up with mothers who are struggling with their mental health.
A new mom attends a postpartum appointment with her healthcare provider.
Why maternal mental health matters
As I’ve previously discussed, maternal mental health has affected my family in several ways. As a nurse for over 35 years, a healthcare executive, and the family member of a new mom who tragically lost her life, I will always continue to advocate for better screening, treatment, and follow-up — until no one suffers from untreated perinatal mood disorders.
Maternal mental health is not only a matter of personal well-being but also a public health concern that can have significant and long-lasting health effects. Some of the negative outcomes associated with maternal mental health disorders are:
- Reduced quality of life and functioning for the mother
- Increased risk of complications during pregnancy and childbirth, such as preterm delivery, low birth weight, and preeclampsia
- Increased risk of postpartum hemorrhage, infection, and anemia
- Increased risk of chronic diseases, such as diabetes, cardiovascular disease, and obesity
- Increased risk of substance use, domestic violence, and child abuse
- Impaired mother-infant attachment or breastfeeding
- Poor cognitive, emotional, and behavioral development for the child
- Increased risk of mental disorders for the child, such as anxiety, depression, or autism
These outcomes can have a ripple effect, resulting in increased healthcare costs, social welfare needs, and productivity losses for all involved. Moreover, maternal mental health disorders can affect the intergenerational transmission of mental health, creating a future cycle of vulnerability and suffering.
Where a mom goes, a family goes. If a mom isn’t doing well, her kids will fail to thrive — they may do poorly in school and in life. Addressing maternal mental health through screening and treatment not only helps the patient but avoids perpetuating a downward spiral for the family and community.
How to improve maternal mental health
In the U.S., the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) have done a great deal of work to build on the momentum of national recognition that we have neglected maternal health and the role that social determinants play in the outcomes of women and children. Millions of federal dollars are now also going to the states for this purpose.
However, improving maternal mental health requires a comprehensive and coordinated approach that involves multiple stakeholders, including policymakers, healthcare providers, community workers, and families. Healthcare professionals, who are often the first point of contact for pregnant and postpartum women, can make a difference by implementing the following strategies and tactics.
Screening
Most importantly, healthcare professionals should always screen pregnant and postpartum women for mental health disorders using validated tools such as the Edinburgh Postnatal Depression Scale (EPDS). This assessment can be taken either in person or online and takes less than five minutes. It is recommended that the questions be completed with a healthcare professional. A score of 10 or higher indicates possible depression, and a score of 13 or higher indicates probable depression. The EPDS can also detect other mental disorders, such as anxiety, bipolar disorder, and post-traumatic stress disorder. Screening should be done at least once during pregnancy and once after delivery, preferably at six to eight weeks postpartum.
Referral
Healthcare professionals should refer women with a positive screening for a mental health disorder to appropriate services, such as a psychiatrist, psychologist, counselor, social worker, or support group. Referrals should be made as soon as possible, and the healthcare provider should follow up to ensure that the patient receives the care she needs. Referrals should be based on the severity of the disorder, the availability of the service, the preference of the patient, and the cultural context. For example, some women may prefer to receive counseling from a female provider, from someone who speaks their language, or from someone who shares their religious beliefs.
Treatment
Healthcare professionals should provide or facilitate the treatment of patients who have mental health disorders using evidence-based interventions such as psychotherapy, which could involve medication. Treatment should be tailored to the individual and consider symptoms, medical history, comorbidities, pregnancy status, breastfeeding status, and potential side effects. Treatment should be monitored and adjusted as needed, and the healthcare provider should communicate with the patient and family about the benefits and risks of the treatment. In locations where resources are not available, we have a bigger problem to solve. Providers and communities may need to investigate or create new ways to treat patients, such as through telehealth options.
Follow-up
Healthcare professionals should follow up with patients who have mental health disorders to assess their progress, provide support, and address challenges or concerns. Follow-up should occur regularly — at least once a month or more frequently if needed — and include re-screening, reviewing the treatment plan, evaluating the response to the treatment, and identifying any barriers to treatment. If possible, involve the patient’s family to provide education, guidance, and encouragement. Continue with follow-up until the patient recovers or transitions to another level of care.
“All or None” Bundle
Encompassing all these steps, the Maternal Mental Health “All or None” Bundle is a set of evidence-based practices for healthcare providers to implement that can improve the quality and safety of care for mothers with mental health disorders. Developed by the California Maternal Quality Care Collaborative, the bundle consists of four components: universal screening, timely referral, access to treatment, and follow-up.
By following these steps, healthcare professionals can help mothers overcome mental health challenges. However, healthcare professionals cannot do it alone. They need the support and collaboration of all stakeholders. Together, we can create a culture of awareness, acceptance, and action for maternal mental health.
Resources and tools
If you are a healthcare professional who wants to learn more about maternal mental health, or if you are a mother who needs help, here are some resources and tools you can use:
- National Maternal Mental Health Hotline — This toll-free, confidential, and multilingual hotline from the Maternal and Child Health Bureau connects mothers and their families to trained counselors who can provide information, referrals, and support for maternal mental health issues. The hotline is available 24/7 at 1-800-944-4773 or by texting 503-894-9453.
- Maternal Mental Health Alliance — This coalition of national and international organizations works to improve the mental health and well-being of women and their families during and after pregnancy. The alliance provides advocacy, research, education, and resources for maternal mental health.
- Postpartum Support International — This non-profit organization provides education, support, and advocacy for women and families affected by perinatal mood and anxiety disorders. The organization offers online and in-person support groups, training, webinars, podcasts, and publications for maternal mental health.
Maternal mental health is a neglected but vital issue that affects millions of women and their families around the world. By raising awareness, reducing stigma, and providing care, we can make a difference in the lives of mothers, their children, and their families. Healthcare professionals have a unique opportunity and responsibility to support maternal mental health. Let’s make it a priority and a reality.
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Almost one in nine pregnancy-related deaths in the United States had mental health conditions as the underlying cause. Understand and address the complex interplay of clinical and nonclinical factors that contribute to the health of mothers and babies, including how social determinants can affect maternal health outcomes.
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