How Can Maternal Mental Health Be Improved During and After Pregnancy?

Posted July 12, 2016 by Josh Grant

Improving Maternal Mental Health
The Moms’ Mental Health Matters initiative offers free health education materials, in English and Spanish, to share with moms and their families. 

Maternal mental health is a key part of moms’ and children’s health outcomes. According to the World Health Organization, 10 percent of pregnant women and 13 percent of postpartum women have mental health concerns, such as depression. Fortunately, these cases are largely treatable, especially if doctors are able to intervene early on. 

To increase care and support for moms’ mental health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health (NIH), has launched Moms’ Mental Health Matters: a new initiative aimed at raising awareness for maternal mental health among families and healthcare providers. 

Triesta Fowler, MD, the coordinator of the NICHD National Child and Maternal Health Education Program which leads the initiative, recently spoke with us about the gaps in care that currently exist, what women should know about maternal mental health, and how health care providers can support pregnant and postpartum women with anxiety and depression. 

1. What gaps in care does the NICHD want to address with this new initiative?
We’re aiming to expand the understanding and awareness of postpartum depression. Research, such as this study in the Journal of Affective Disorders, shows that women can experience depression and anxiety, as well as other mental health conditions, after birth and during pregnancy. We’ve created materials to educate women and their families about the symptoms of perinatal depression and anxiety, and how to get help. We’ve also created a continuing education activity to teach health care providers about recognizing symptoms screening, and communicating effectively with patients and their families.

2. Why is it important to address this issue?
Research suggests that depression is one of the most common problems women experience during and after pregnancy. It is also the least discussed. Knowing what signs and symptoms to watch for can help women get help quickly. In most cases, depression and anxiety will not subside on their own and will require treatment. But the treatment makes the difference.

3. When untreated, how can these conditions affect moms and their children?

Depression during pregnancy can compromise the health of both the mother and her baby. In studies, it is linked to poor nutrition, poor prenatal medical care, risk of suicide and harmful health behaviors, such as smoking and substance misuse. Women with depression during pregnancy are also at a greater risk for preterm birth and low birth weight babies. (A topic NICHQ is addressing in the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN)).

In addition, women who have depression may respond less quickly or less effectively to infant cues, which disrupts early maternal-infant bonding. These disruptions can have adverse effects on the infant, including cognitive and language development delays.

4. Does the stigma surrounding mental health and motherhood prevent some women from seeking care and support?
It is a common misconception that pregnancy and new motherhood is “the happiest time of your life.” We see images of ecstatic pregnant women and new moms on social media, on TV, and in pregnancy magazines. But many women can also feel overwhelmed, sad, or anxious at different times during their pregnancy and after the baby is born.

They may then feel ashamed for feeling depressed or guilty for not sensing a strong bond right away with their baby. Moms can feel alone, and they may believe they are the only ones experiencing these emotions. Health care providers have an opportunity to reduce this stigma by reassuring pregnant women and new mothers that they are not alone and that perinatal depression and anxiety are common and treatable. Also, educating families gives women a close support system that will help encourage early detection and treatment.

5. What are the most common signs and symptoms of perinatal depression and anxiety?

Signs and symptoms of perinatal depression and anxiety include:
  • Persistent sadness
  • Impaired concentration or indecisiveness
  • Disconnection from emotions
  • Anxiety around the newborn
  • Feelings of inadequacy or guilt
  • Irritability or mood changes
  • Lack of interest in the newborn, family, or activities
  • Racing thoughts
Providers should be ready to assess these signs and determine whether they are symptoms of larger concerns to better tailor care and support to their patients.

6. What’s the most important thing for health care providers to know about perinatal depression and anxiety?

Many cases of perinatal depression and anxiety go undetected because women are reluctant to mention mood changes to their health care providers or loved ones. Also, many healthcare providers may not believe they have the tools or resources to deal with this issue. 

Healthcare providers should screen pregnant and postpartum patients for their risk of perinatal depression and anxiety based on guidelines from the American College of Obstetricians and Gynecologist, once during perinatal period, and the American Academy of Pediatrics, at the 1-, 2-, and 4-month well-child visits). Health care providers should be prepared to connect patients who screen positive to professional resources such as the Substance Abuse and Mental Health Services Administration’s National Helpline; (1-800-662-HELP), or peer support resources, such as Postpartum Support International or Postpartum Progress.


Add your comment





QI quality improvement sustainabilty im coiin nichq preterm birth Baby-Friendly breastfeeding Pediatric journal Best Fed Beginnings infant health safe sleep tips PDSA cycle baby box infant mortality family engagement eccs coiin immunizations health equity health disparities accreditation astho onboarding collaboration engagement partnerships larc nashp new york wic new york state hospitals mom mother partners epilepsy data AAP early childhood pdsas texas community support learning session children's health new technology engineering transgender collaborative learning planning PDSA planning paralysis underplanning analysis paralysis vision eye health smoking smoke-free housing second-hand smoke toolkit e-module dental care oral health underserved populations health inequity public health Maternal and Child Health Journal leadership engagement Sickle cell disease indiana SCD medicaid perinatal regionalization sudden infant death syndrome national birth defects prevention month birth defects pregnancy planning one key question prepregnancy health preconception health public breastfeeding support families patients experts insights CHOPT childhood obesity innovation food desert telemedicine TBLC breastfeeding supporting prematurity racial disparities audiology ehdi follow-up illinois talana hughes vulnerable populations sports asthma soccer basketball obesity football SIDS Pokemon Go gamification smartphones interconception care birth spacing issue brief contraceptive use postpartum care CoIN HRSA early childhood trauma NHSA community health consumer advocacy womens health interconception health teenage health PATCH wisconsin missouri risk appropriate care community health workers SCD< infographic infant mortality awareness month inspirations childrens health national breastfeeding month maternal health patient engagement hearing loss hearing treatment pediatric vision vision screening eyesight pre-term birth early-term birth SCD clinic los angeles LOCATe CDC levels of care neonatal care maternal care smoking cessation project safe sleep practices neonatal abstinence syndrome NAS opioids maternal and child health MCH Family voices quality care mental health hydroxyurea SCDTDP men dads testing change data sharing state government city government apps sleep AJPM preconception care senior leadership breastfeeding support video series access BQIH exclusive breastfeeding long-acting reversible contraception unplanned pregnancies social determinants of health health innovations Best Babies Zone CoIIN baby boxes Rhode Island progesterone rooming-in parent partner patient and family engagement healthy weight healthy lifestyles primary care telementoring ECHO video conferencing socioemotional health childhood development pediatric Tennessee interview National Coordinating and Evaluation Center medical-legal partnerships mobile app disparities perinatal care overweight obese healthy weight clinic wellness pilot sites data collection education resources paternal engagement risk-appropriate care preterm infants high-risk babies Ten Steps public relations social movement reversible contraceptives medical home pediatric medical home patient transformation facilitator PTF skin-to-skin rooming in prenatal smoking information visualization charts SUID postpartum new mother webinar AMCHP QI Tips ongoing improvement fourth trimester partnership quality and safety coaching leadership support year end holiday message reflections gratitute Medicaid data doctor relationship PQC perinatal quality collaboratives vision care vision health evidence-based guidelines ASH health and wellness healthy living healthy eating home visitors home visiting programs March of Dimes APHA results evaluation supplementation formula reduction video infant loss social media advocacy leadership Berns Ten Steps to Successful Breastfeeding sustainability stress prenatal care data capacity epidemiologists surveillance data PFAC community partners preconception and interconception care motivational interviewing Native Americans ADHD NICHQ Vanderbilt Assessment Scale ADHD Toolkit system design care coordination skin to skin newborn screening reduce smoking aim statement safe birth Texas Ten Step skin-to-skin contact 10 Steps staff training small tests acute care mother-baby couplet collective impact population health preconception Newborn Screening Program substance abuse breast milk formula milk bank crisis first responders NYC improvement healthcare health system sickle cell diease treatment protocol family health partner maternity care Collaborative Improvement and Innovation Network Health Outcomes Cross-Sector Collaboration Knowledge Sharing Child Health