Wrap-Around Mental Health Services Needed for Mothers, Birthing People, and Families

Perinatal mental illness is a significant complication of pregnancy and the postpartum period that includes a variety of disorders such as depression, anxiety disorders, and postpartum psychosis, which usually manifests as bipolar disorder. Perinatal depression is the most common and underdiagnosed obstetric complication in the U.S.

According to the American Academy of Pediatrics, perinatal depression affects 15 to 20 percent of new mothers – almost double that number for mothers living at low income, and triple that for low-income adolescent mothers.

A 2021 study examining challenges and opportunities to combat perinatal depression, identified several risk factors for perinatal depression, including stressful life events, history of depression, poor social support, unplanned and unwanted pregnancies, poor relationship quality, current or previous abuse, and low socioeconomic status.

The U.S. Preventive Services Task Force recommends that doctors look for and ask about symptoms of depression during and after pregnancy, regardless of a woman’s risk of depression.

Meera Menon, Ph.D., Associate Director of Applied Research and Evaluation at NICHQ, reflected on her pregnancy and postpartum experience, navigating the health system as a maternal and child health researcher.

“There’s so much care for a pregnant person and then once the pregnancy is over, it’s kind of like, here’s your six-week checkup, and hope you’re great,” Menon explained.

Although she was engaged with a form in each visit asking about depressive symptomatology, Menon said during follow-up appointments, she was often preoccupied with questions for doctors about her child’s growth and development.

“That’s just putting a lot on a single provider to assuage a parent’s worries about their child, to check in on their mental health, to connect them to resources, to make sure they’ve been connected, to make sure they’ve taken up on those resources,” Menon said.

To combat perinatal mental health disorders and improve the experiences of mothers, birthing people, and families before birth and beyond, additional mental health support during and after pregnancy is needed.

Though she experienced some of the common challenges new parents face, Menon shared that she was equipped with the education to help identify signs of depression and a strong financial and familial support system, which many new parents may not have access to.  

“Something that I reflected a lot on during my postpartum time was being hyper-aware of… is this normal or is this depression? And I can’t help but think that because of my circumstances, I never dipped into depression because I had a lot of social support,” Menon said. “My mom stayed with me for the first three months postpartum. I knew who to access. I had the financial resources to access support. I had support so I could take a nap if I needed to.”

There are various ways healthcare providers, families, and policymakers can come together to reduce stigma and improve systems of care to ensure better outcomes for all people.

• Advocate for more expansive paid parental leave policies. Research in the United States and other high-income countries (HICs) suggests that access to longer paid leave after childbirth is associated with better perinatal mental health.
• Implement healthcare system-level intervention that utilizes case managers. Having adequate systems and clinical staff in place helps ensure patients are screened for depression, and, if they screen positive, are appropriately diagnosed and treated with evidence-based care. Case managers can effectively link primary care providers, patients, and mental health specialists.
• Consider social determinants of health and the impacts of disparities related to racism and other forms of oppression. Caregivers who experience poverty are more than three times as likely to have depression as caregivers who don’t. Providing economic support to families and caregivers can help reduce the risk of depression and other mental health disorders. Medicaid plays a central role in improving children’s health and mandates coverage of services recommended by the U.S. Preventative Services Task Force, such as screening for depression.
• Increase and improve partnerships with doulas, midwives, and other trained birth workers. As advocates and intermediaries between physician and patient, doulas educate women and birthing people, fathers, and other caregivers on what to expect during labor, allow for improved communication for the patient, and establish birthing plans. With the primary role of supporting the patient’s physical, emotional, and social needs, doulas may help reduce peripartum anxiety by reassuring and empowering laboring mothers.
•  Normalize talking about mental health for all new parents. The changes that come with pregnancy, childbirth, and caring for a newborn can take a toll on anyone’s mental health. Maternal mental health concerns can affect all parents, regardless of gender identity, sexual orientation, or socioeconomic status. However, nonbinary and transgender people report higher rates of perinatal mood issues when denied proper help. They also encounter more breast/chestfeeding challenges.
• Know the signs. Postpartum Support International offers helpful educational materials for parents and caregivers as well as providers and health professionals seeking resources and training to better prevent, identify, and treat perinatal mental health disorders.  

Listen to our conversation with Dr. Meera Menon on Before Birth & Beyond, to learn more about her experiences navigating her roles as a mother and MCH researcher and thoughts about how public health practitioners can hold maternal mental health more compassionately for all new parents –especially those negatively impacted by social determinants of health.