Giving birth and becoming a new mother is often viewed as one of the happiest moments in a woman's life.
However, this significant life change is often accompanied by changing mental and emotional needs. In fact, mental health conditions are the most common complications of pregnancy and childbirth, impacting at least one in five women during the perinatal period (the time while pregnant and the year following pregnancy), with individuals from historically marginalized communities at even higher risk. Untreated maternal mental health conditions can also lead to longterm negative health impacts on mothers, babies and families, which cost $14 billion each year to address.
Though these numbers convey the scope of the maternal mental health crisis, each number represents an intangible impact on individuals and families. In our work supporting women's holistic health and maternal mental health, we have heard from new mothers about the ways that disconnection, sleep deprivation, anxiety, and exhaustion, among other impacts, have affected their lives, their health and their families. Having gone through some of these experiences ourselves, we know just how much it can weigh on each person.
It has also become clear that this crisis is exacerbated by inadequate support from the place that has the potential to help new mothers the most: our healthcare system.
The state of maternal health today: Why the system fails new mothers
As is seen across the entire healthcare system, significant workforce shortages affect women's ability to get the prenatal and maternal care they need, when they need it: 36% of counties nationwide are "maternity care deserts," meaning they have no obstetric hospitals or birth centers and no obstetric providers, and 96% of birthing-age women in the U.S. live in locations with a maternal mental health professional shortage. Studies also suggest that there are low rates of preconception care, a time window that offers an opportunity to manage mental health conditions that might occur prior to pregnancy. Limitations on women's time, finances and flexibility mean some women may not go in to see their provider during the postpartum period, either.
Even when women do see a doctor, their mental well-being may not be discussed or explored. Though pregnant and postpartum people have an average of 25 interactions with healthcare providers during a routine, uncomplicated pregnancy and first year of baby's life, providers who care for pregnant and postpartum patients are not always trained in identifying, treating or referring for maternal mental health conditions. Hectic schedules and physician shortages make it difficult for providers to find time for patient education, screening and treatment for maternal mental health conditions.
As a result, fewer than 20% of women are screened for postpartum depression, and the vast majority of those impacted – up to 75% – never receive treatment.
Building a better world for our patients and all mothers
Addressing the maternal mental health crisis is simple in theory but challenging in practice, given the barriers noted above. To better support the mental health of new mothers and birthing people, we must emphasize holistic health across a woman's life, with special attention during the vulnerable childbearing years:
1. Prioritize prevention.
Several evidence-based programs have proven successful at preventing postpartum depression, and group models of prenatal care also provide protective benefits such as education and social support. Even encouraging patients to create a simple postpartum plan – which encourages expectant parents to think through daily logistics such as childcare, sleep, meals and visitors – can help alleviate some of the stress of having a new baby in the home.
2. Help educate and empower providers.
All providers who care for pregnant and postpartum patients – from OB/GYNs to mental health professionals to primary care providers – need to be supported to discuss and treat women's mental health needs throughout the perinatal period. Training in how to provide this care must start early – in medical and nursing schools, residency programs and other educational institutions – so that healthcare professionals across all specialties are properly trained to treat women's mental health throughout every life stage, including pregnancy. Hospitals, health systems and other health care organizations can also provide education and training for employees, with assistance from groups like Postpartum Support International (PSI) and Shades of Blue. CVS Health is working to support providers by investing in perinatal mental health training, educating our MinuteClinic mental health workforce through PSI, and helping navigate patients to the right providers across their care continuum.
3. Embrace integrated care teams and new models of care.
Healthcare organizations can emphasize the importance of integrated care teams, including working with social workers or other mental health professionals to give women extra support throughout the perinatal period. Integrating or embedding mental health providers within obstetric or primary care practices can also enable immediate connection to mental health services and increases the likelihood that individuals will actually get the care they need.
With patient data now more connected, providers can tap into their networks and help connect the dots between women's holistic health history and maternal health needs. This can include support from community-based resources such as doulas, lactation consultants, community health workers, as well as peer support groups – which can now increasingly be accessed online as well as in person.
4. Bolster intervention resources for providers.
Sharing just one link or one phone number can save a life. New mothers may not be able to recognize the signs and symptoms of postpartum depression or other maternal mental health conditions or know how to describe these experiences to providers. That is why it is so important for providers to be supported by resources like the National Maternal Mental Health Hotline (1-833-TLC-MAMA), established by the Maternal Mental Health Leadership Alliance (MMHLA), which provides free, confidential, 24/7 voice and text support in English and Spanish for mothers and others impacted by maternal mental health conditions. These resources can offer critical lifelines in a time of crisis.
The perinatal period offers a unique opportunity to change the life course for both the parent as well as the infant. We all have a mother or mother figure in our lives. Many of us are mothers ourselves. We all deserve better support as we navigate the joys and challenges of pregnancy and new motherhood.
Joanne Armstrong, MD, is Vice President and Chief Medical Officer of Women's Health and Genomics at CVS Health. Adrienne Griffen is Executive Director at Maternal Mental Health Leadership Alliance