Integrating Women's Health Care for Maternal Mental Health

Co-Authored with Dr. Meg Earls

Maternal mental health concerns remain the no. 1 medical complication of pregnancy affecting between 15-20% of women. A recent research study indicates that for women with the most severe symptoms, maternal depression and anxiety often begin during pregnancy not just after giving birth. Yet despite this staggering statistic, 70 to 80 percent of these women never receive treatment, because they are never properly identified and diagnosed. Perinatal women across all demographics are vastly underserved with mental health needs and 50 percent of the women suffering from them aren't recognized, even when interacting with healthcare services.

Shelly knew something was wrong after the birth of her first child. Weeks after her baby's arrival, she felt detached from herself and from her baby. She cried frequently and had difficulty falling asleep at night. Her husband and close family members chalked Shelly's emotional difficulties up to the demands of new motherhood. They hired a mother's helper and encouraged her to rest. While this support was helpful, it didn't feel adequate. "I would have a few good days, but then I would feel badly again" says Shelly.

It wasn't until her second pregnancy that Shelly received the help she needed. At her OB appointment, her doctor gave her a questionnaire, with questions, such as "I have been so unhappy that I have been crying," and "I have been anxious or scared for no good reason." Her OB was concerned- and acted- when Shelly's answers indicated she was experiencing symptoms of maternal depression. Finally, Shelly was referred for psychotherapy. Shelly says she "felt relieved" when her OB mentioned that she might have maternal depression. Shelly felt something was "off" since the birth of her first child just fifteen months prior to her second pregnancy. Finally connecting with the emotional support she needed felt like a huge relief, and she began weekly psychotherapy and also met with a perinatal psychiatrist.

Sadly, there are too many women like Shelly who fall through the cracks of the healthcare system and do not receive the psychotherapeutic and psychiatric care they need during pregnancy and the postpartum period. Yet, some innovative healthcare strategies are on the horizon and the tides surrounding maternal mental health are evolving.

In San Francisco, California at Pacific Gynecology & Obstetrics Medical group, obstetricians have brought perinatal psychotherapists into the setting where pregnant and postpartum women receive healthcare: their doctor's office. By integrating these mental health services under the umbrella of their medical practices, physicians facilitate timely access to care, as well as help break the stigma associated with pre- and postpartum mood concerns. Many women feel embarrassed and ashamed when they do not feel "joyful" during their journey to motherhood. They may also feel reluctant to acknowledge mental health needs that might develop or become exacerbated during this vulnerable time. Their OBs' involvement with pro-active inquiry and identification is crucial to link them to the psychological care they need.

At PCOMG, patients can receive mental health care from two perinatal psychologists who are housed within the practice. During routine OB and postpartum appointments if concern arises, patients are referred for in-office psychotherapy consultations. By providing integrated behavioral health services, OBs are reassured that their patients' psychological and emotional needs are being met.

There are very real consequences of untreated prenatal depression and anxiety. These range from short-term risks, such as preterm delivery, to more long-term risks. Infants born to mothers with depression during pregnancy have been found to have lower motor scores, more frequent bouts of crying and irritability, disrupted mother-child attachment, and higher rates of behavioral disorders later in life. Getting treated is truly the best of preventative care for the next generation. This integrated practice model brings maternal mental health care to the forefront of primary care, combining behavioral health in a way that's accessible for mothers, and 'catching' them in a safety net when they might otherwise fall into the shadows.

A directory of postpartum depression resources can be found at Postpartum Support International and Postpartum Progress. Both of these non-profit organizations advocates for women and families struggling with perinatal mood concerns.