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.

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