If you need help, call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) or dial or text 988. Please contact the 988 Suicide & Crisis Lifeline. Spanish language services are also available.
BRIDGEPORT, Conn. — After moving to Bridgeport from Peru with her husband and young son in 2023, Milagros Aquino was trying to find a new home and had trouble adjusting to new food.
When Aquino, now 31, became pregnant in May 2023, “instantly everything became much worse than before,” she said. “I lay in bed all day feeling so sad. I was really lost and just surviving.”
Aquino has many friends.
Research shows that as many as 20% of women in the United States suffer from perinatal depression during pregnancy, postpartum, or both. In some states, nearly a quarter of new mothers or pregnant women suffer from anxiety or depression.
In the United States, there is no widespread system to screen mothers for mental illness, despite widespread recommendations, and many women go untreated. Experts say the lack of testing has led to rising rates of mental illness, suicide and drug overdoses, which are now the leading cause of death in women's first year after giving birth.
“This is a systemic issue, a medical issue, and a human rights issue,” says Lindsey, a perinatal psychiatrist and clinical and educational director at the Johns Hopkins Center for Reproductive Mental Health.・R. Standeven says:
Milagros Aquino (seated), community health worker Massiel Olivo (left), and her doula, Jacqueline Cariso, assigned by Emme Union. Aquino began experiencing symptoms of depression around the 11th week of her pregnancy. She said Cariso played an important role in her recovery. (Masiel Olivo)
Standeven said the root causes of the problem include racial and socio-economic disparities in maternal care and a lack of support systems for new mothers. She also pointed to a shortage of mental health professionals, a lack of maternal mental health training for health care workers, and a lack of reimbursement for mental health services. Finally, Standeven said the country's lack of maternity leave policy and access to weapons exacerbated the problem, she said.
These factors led to a 105% increase in postpartum depression from 2010 to 2021, according to the Journal of the American College of Obstetricians and Gynecologists.
For Aquino, it wasn't until the final weeks of her pregnancy that she enrolled in acupuncture to reduce stress. Social workers helped care for her through Emme Union, which connects girls and women with financial support and mental health. Counseling services and other resources.
Recent U.S. and international studies published in JAMA Network Open and The BMJ show that mothers diagnosed with perinatal depression or anxiety during or after pregnancy are less likely to engage in suicidal behavior than mothers without mood disorders. The risk of suicide is approximately three times greater, and the risk of suicide is six times greater. .
The ravages of the maternal mental health crisis are particularly acute in rural areas, which have become obstetric health care deserts, as smaller hospitals close their labor and delivery rooms due to plummeting birth rates and financial and staffing issues. It is.
This week, the Maternal Mental Health Task Force, jointly led by Women's Health and the Substance Abuse and Mental Health Services Administration and established in September to address this issue, announced that the Maternal Mental Health Task Force, which is jointly led by Women's Health and the Substance Abuse and Mental Health Services Administration, will open a new Maternity Care Center to serve as a hub for integrative care. recommended the establishment of a Build care and birth facilities by building on the services and human resources that already exist in the community.
Joy Burkhard, a member of the task force and executive director of the Center for Nonprofit Policy, said the task force will soon determine which parts of the plan will require Congressional action and funding to implement, and which parts will be “easy to implement.” It will be determined whether the results will be achievable in the future. Maternal mental health.
Burkhardt said equitable access to care is essential. The task force recommended that federal authorities identify areas for birth centers based on data that identify underserved populations. “Rural America is more important than anything else,” she said.
Burkhard said there is a lack of care in “low-probability areas,” including Los Angeles County, where some maternity units have recently closed. Underserved urban areas would also be eligible for new centers.
“All mothers want is sensible maternity care. Nothing like that exists at this point,” she said.
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Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas to provide guidance and support to mothers of newborns.
Rates of maternal depression before, during, and after pregnancy are higher in Montana than the national average. According to the Montana Pregnancy Risk Assessment Monitoring System, from 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression. The state received a federal grant to begin training doulas in 2019 and had the sixth-highest maternal mortality rate in the country.
To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana's population. Studies in obstetrics and gynecology show that Indigenous people, especially those in rural areas, have double the rate of severe maternal morbidity and mortality compared to white women.
Doula training has the potential to “counter systemic barriers that disproportionately impact tribal communities and improve overall community health,” said Stephanie Fitch, grant manager for Montana Obstetric and Maternal Support at the Billings Clinic. There is a gender,” he said.
Doula care is covered by Medicaid in 12 states and Washington, D.C., according to the National Health Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. According to the Centers for Disease Control and Prevention, about 41% of births in the United States are paid for by Medicaid.
Jacqueline Cariso, a doula assigned to Aquino through the Eme Coalition, played a key role in his recovery. Aquino said she could never have imagined going through such a “dark time alone.” With Carriso's support, she said, “she was able to pull through.”
Genetic and environmental factors or past mental health disorders can increase your risk of depression and anxiety during pregnancy. But mood disorders can happen to anyone.
Teresa Martinez, 30, of Price, Utah, struggled with anxiety and infertility for years before conceiving her first child. Her joy and her relief did not last long when she gave birth to her son in 2012.
Without warning, “dark clouds began to gather,” she said.
Martinez was afraid to tell her husband. “As a woman, she feels so much pressure and she doesn't want to have the stigma of not being a good mother,” she says.
In recent years, programs have been launched across the country to help doctors recognize mood disorders in mothers and learn how to help mothers before harm occurs.
One of the most successful is the Massachusetts Child Psychiatry Access Program for Mothers, which began 10 years ago and has since spread to 29 states. The program is supported by federal and state funding and provides tools and training for physicians and other health care professionals to screen for and identify disease, triage patients, and offer treatment options. .
However, the expansion of maternal mental health programs is occurring at a time when resources are scarce in much of rural America. Many programs across the country are underfunded.
Burkhard said the federal task force proposed funding Congress to create a consultation program similar to Massachusetts', but not to replace the consultation program already in place.
In April, Missouri became the latest state to adopt the Massachusetts model. Women receiving Medicaid in Missouri are 10 times more likely to die within the first year of pregnancy than women with private insurance. From 2018 to 2020, an average of 70 Missouri women died each year during pregnancy or within a year after giving birth, according to state statistics.
Wendy Ell, executive director of the Missouri Maternal and Child Health Access Project, calls her service a “lifesaving resource” that is free and easily accessible to health care providers in the state who see perinatal patients. said.
Approximately 50 healthcare providers have enrolled in Ell's program since its inception. Within her 30 minutes of request, her health care provider can consult with her by phone with one of her three perinatal psychiatrists. But while doctors can get help from psychiatrists, mental health resources for patients are not as readily available.
The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce in areas of greatest need, such as community mental health workers, patient navigators, doulas, and peer support specialists.
A new independent curriculum in reproductive psychiatry is designed to support psychiatry residents, fellows, and mental health practitioners who have little or no training or education in the management of perinatal mental illness. In a small study, the curriculum significantly improved psychiatrists' ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and was one of the study authors. It turned out that this was the case.
Nancy Byatt, a perinatal psychiatrist at the University of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Mothers in 2014, said there is still much work to be done.
“I think the most important thing is that we've made a lot of progress. In that sense, I'm kind of hopeful,” Byatt said.
Cheryl Platzman Weinstock's report was supported by a grant from the National Healthcare Management Foundation.
Cheryl Platzman Weinstock:
@CherylWeinstock
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