“I couldn’t bring myself to tell my doctors or nurses, or the doctors and nurses in the NICU about the way I was feeling. I was already that “bipolar patient.” I had used opiates for a few years to cope with the pain that depression brought with the disease. I could feel myself becoming more and more depressed and desperate for help, but thought that if I asked for help, my baby would be taken away from me. My bipolar disorder had haunted me for most of my adult life, had labeled me, and now with a new baby, had no one to reach out to. Each time I left the NICU, I thought it would be the last time I would see my baby. That feeling was so traumatic, and even though my baby is now 1 year old, I still relive that fear every day.” – F.R., during a postpartum interview

In 2019, researchers in California reviewed 300 records of women who died within one year after giving birth. The second leading cause of death was substance use-related, and the seventh was by suicide. Two-thirds of the women who died had at least 1 visit to an Emergency Room or hospital before they died. In other words, these women had entered the healthcare system, and there may have been real opportunities to meet their mental health needs prior to their deaths. Screening for depression may have provided insight into their despair.

Compound this maternal mental health need with the public health crisis of racism and a stark picture emerges of women and birthing people in need of tremendous support. There are many facets that must be addressed within maternal mental health—access to care, transportation, stigma, insurance coverage, stable housing, to name a few. A greater prevalence of comorbid psychiatric disorders, physical and sexual abuse, intimate partner violence, and chronic pain disorders likely contribute to disproportionate rates of opioid use and misuse in women and particularly women during pregnancy. Combining mental health assessment and unmet social needs can be a powerful assessment tool. Do you think that a young mother worried about paying for food and rent may suffer from anxiety? Depression? Unmet social needs can create tremendous stress for mothers and their families.

Perinatal Quality Collaboratives (PQCs) and Maternal Mortality Review Committees (MMRCs) across the United States continue to focus on maternal mental health and strategies to address diagnosis, treatment, and referral. Rural and low-resource communities continue to struggle with resource availability. For example, healthcare systems that screen patients for postpartum depression, yet have no resource availability for referral or treatment, place patients at greater risk than not screening at all. Strategies to support maternal mental health are imperative. Some of these strategies include:

1. Destigmatize mental illness: Supporting women and birthing people experiencing maternal mental health illness, and reducing shame and self-blame, is critical in achievement of treatment regimens and continued engagement with healthcare providers.


2. Screening women for mental health during the postpartum period: NICU’s across the United States have begun to engage in various forms of screening and intervention to assist in reducing stress and depressive symptoms in mothers during admission. In many cases, maternal mental health concerns remain under identified and undertreated during a NICU stay, which can have deleterious effects on the baby.


3. Disparities in maternal mental health treatment: Overall, Black women are 3-4 times more likely to die during childbirth or within the first year after delivery. Increasingly, studies describe inequity in mental health screening, identification, and treatment for women of color and other vulnerable populations. Studies have shown that African American, Asian, and non-white women were less likely to be screened for postpartum depression than their white counterparts. In addition, this study also revealed that women insured by Medicaid and other state programs were less likely to be screened than those women with private insurance.


4. Use of Postpartum Doulas: A growing body of research continues to generate additional support for the use of doulas in the hospital and in the community. Providing personalized and trained support that can identify potential postpartum symptoms, including postpartum depression and other maternal mental health warning signs can be critical to both the health of the mother and the newborn.


5. Intentional postpartum screening of fathers/birth partners: In 2019, the American Academy of Pediatrics published a Call to Action to screen fathers for postpartum depression. Recognition of the importance of the father or birth partner as a critical support of the new mother. Ensuring the mental health of the entire family after the birth of a baby must be a priority for communities as they rally to promote maternal health.

Implicit bias and stigma remain against pregnant women with mental health needs. Providing judgment-free and respectful, compassionate care will support the open dialogue of mental health and illness. Imagine for one moment the experience of the mother described earlier. Could this experience had been different? How can we make discussing mental health as natural as discussing other health histories? What can we all do to support and normalize maternal mental health?

What difference are you making for mothers in your community? How will you help #EndTheStigma?