Mothers are dying across the US at unprecedented rates. Mood and anxiety disorders are the most common complication of pregnancy. Maternal suicide is a leading cause of pregnancy-related deaths. More postpartum women die from suicide than from medical causes. This is why maternal mental health is everybody’s business. Anyone with a mother has a stake in this. And that is all of us.
If this is everybody’s business, what can we do about it? First, we can value mothers’ mental health as much as physical health. We know that a mother’s mental health impacts her baby and later her child’s health. We need to recognize that we cannot raise healthy children and have healthy families without addressing maternal mental health.
Second, we can recognize that getting mental health support and treatment is valuable and often the best thing a mother can do for her and her family. It takes courage and strength to get mental health support and treatment. We need to value taking care of our mental health just as much as we value, and often don’t think twice about, getting what we need for our physical health (e.g., going to our primary care physician).
Third, we need to redefine women’s health to include emotional health. As front-line providers for pregnant and postpartum women, obstetric providers are in an ideal position to support maternal mental health. Even women with low risk pregnancies, will have 12-15 visits in under a year, providing repeated opportunities to detect and address mood and anxiety disorders in the context of obstetric care.
So, how do we do this? We can start by making the detection, assessment and treatment of mood and anxiety disorder a routine part of obstetric care, just like any other medical illness. Let’s use diabetes as an example. All women are screened for diabetes. If they screen positive, women are started on treatment and then there is close follow-up to make sure the blood sugar is under control and mom and baby are healthy. Depression is twice a common as diabetes in pregnancy. Just like diabetes, depression affects mom and baby’s health. Despite this, depression often goes unaddressed and untreated. Mood and anxiety disorders need to be addressed just as proactively as diabetes. This can be done by: 1) educating women and their family about it, 2) detecting illness through screening, 3) assessing for what treatment may be best, 4) starting treatment when it is needed, and 5) proactively following up to make sure women not only get started on treatment, but also stay in treatment so they get well and stay well.
Despite numerous recommendations to screen for depression and anxiety in obstetric care settings, the care of women is lagging behind these changing standards of care. Maternal mental health is everybody’s business and must be part of women’s health care. Integrating care for mood and anxiety disorders into obstetric care carries the potential to reduce maternal deaths and improve the overall health of mother and families. As our nation gears up to address its maternal mortality crisis, efforts will fail if we do not take this opportunity to address the mental health of mothers across our nation.
