Written by Justine Sanders, LICSW
Starting a family is something that society associates with all things positive. However, few people know that over 15% of pregnancies are complicated by mental health issues. These challenges can continue into the postpartum period and beyond. In addition, these issues also come at a high personal cost. For mothers, untreated mental health challenges adversely impact parenting and can contribute to increased risk of unemployment, suicide and substance misuse. It also makes people more susceptible to chronic illness, decreased life expectancy, and social isolation. Consequently, their newborns are at increased risk for premature birth, low birth weight and developmental delays. The strain on the healthcare system and society posed by untreated mental health issues is significant.
To help identify maternal mental health issues, screening is an important part of obstetric and primary care. Identifying concerns early not only improves the pregnancy experience but improves outcomes. The screening process involves mothers being provided a questionnaire that asks about mood and behavior. Pregnancy can be an ideal time to address mental health issues as mothers are emotionally invested in their pregnancy and are engaged in at least ten successive visits with their obstetric provider. Standard treatment intervention for mental health treatment is counseling and/or medication which studies show is typically effective. With the shortage of psychiatric providers in the country, obstetric providers are often the primary treatment providers for women.
Social Determinants of Health (SDOH) can contribute to and exacerbate mental health issues. SDOH are the conditions that one is born into and/or is exposed to. There are five areas of social determinants:
1) healthcare which includes access to primary care and health insurance;
2) economic stability which includes employment, food and housing security;
3) education which includes childhood development and higher education;
4) community life which includes discrimination and workplace conditions; and
5) neighborhood which includes water quality and crime/violence.
Research has shown that mitigating these issues improves mental health outcomes and improves the overall stability of families. As society strives to achieve health equity, it is impossible to do so, without acknowledging and creating solutions around some of the inequities many mothers experience. It has been shown there is more inequality in rural areas where there are less public transportation options, fewer grocery stores, etc. Often there is less than optimal access in these communities to mental health care primarily due to the shortage of mental health providers and lack of public transportation. The availability of tele-health and tele-therapy has helped, but in communities where internet and cellular service is limited, gaps in care perpetuate.
Addressing the overall health equity gap in mental health care is important and there are opportunities to extend the work. An evidence-based health care model that is integrative and collaborative helps address and optimize mental health outcomes. The Vermont Blueprint Women’s Health Initiative incorporates this type of model which helps to ensure that women’s health care services have the provisions they need to help a woman’s well-being, including avoiding unintended pregnancies and building thriving families. As well as medical providers, the health team includes social workers and health coaches. This team can assist with mental health counseling, tobacco cessation, in addition to assisting women accessing available community resources. As we look toward improving health equity, we should consider the evidence of improved outcomes by using the existing services while considering additional supports such as birth doulas, lactation specialists, peer counselors and postpartum caregiving supports.
Since mental health issues may develop during or after childbirth, continuing to monitor and address them throughout various stages of parenting is important. Mothers can experience the baby blues, which is normal and self-limiting. However, some moms develop postpartum depression which is a more severe, long lasting form of depression that can last for several months.
Mothers with untreated mental health issues are at increased risk for co-occurring substance use disorders. Co-locating medication assisted treatment (MAT) into their obstetrical care is ideal. MAT programs utilize medication in combination with therapy to assist mothers with recovery of opioid use disorders. These programs are evidence based and as we move toward an obstetrics culture that is recovery friendly, an improved partnership with MAT programs is important.
And lastly, the ability of women to choose when they want to become pregnant has demonstrated to give the best outcomes. Contraception helps women to choose the optimal time to have a family. LARC (Long Acting Reversible Contraception) helps make contraception simple and effective. Common LARC methods include implants under the skin, intrauterine devices and injections. It lasts for years and can be stopped when the woman feels it is the best time to become pregnant.
Women’s Health month is an opportunity to recognize the progress that has been made and what we can accomplish together to improve maternal mental health outcomes. Motherhood is a time to be celebrated and communities can play a pivotal role but investment in maternal support is needed.
About the Author: Justine Sanders LICSW, is Gifford’s Ob, Gyn and Midwifery Social Worker and a member of the Community Health Team. She brings thirty years of social experience in healthcare with a focus on women’s health and mental health.