Suicide, substance use disorder (SUD), overdose and other mental health conditions have broadly become the leading causes of pregnancy-related death for most women, and the second-leading cause of death for black women after cardiovascular conditions. This concerning data underscores mental health's crucial role within maternal healthcare and why the dialogue on equitable maternal health must inevitably include mental health.
The swift rise in anxiety and depression rates among young people also poses significant implications, considering this group constitutes a large proportion of the maternal population. Depression or anxiety often results in negative maternal outcomes, not only for expectant mothers but for their babies' health. Evidence further suggests that behavioral health issues can cause severe complications, such as preterm births, and increased C-section rates.
To substantially enhance results, we must adopt a whole-health approach, providing supportive social and emotional care throughout the maternity journey and incorporating medical and behavioral therapies where appropriate.
Open line of communication
Postpartum depression often ties back to a history of depression and anxiety. Routine screening for mothers is a critical first step to initiating a dialogue on mental health early in pregnancy. Patients often hesitate to have difficult conversations, yet by creating an environment of open communication we can encourage them to share information that could be significant to their care. Moreover, it’s important to emphasize to mothers the overall vulnerability of mental health during the postpartum period.
Healthcare providers play an essential role in this communication process. We must ensure patients are aware of their treatment options and understand that untreated depression and anxiety can be more harmful to the baby than potential risks from medications. It's important to discuss safer, less risky medication options, and stress the importance of treatment adherence.
As healthcare professionals, we must ensure patients are aware of the available treatment options, both medicinal and non-medicinal, and provide support throughout the process, assuring them that they are not alone in this journey.
Addressing substance use and mental health disorders
Another key aspect involves addressing substance use both during and outside of pregnancy. Substance use is strongly associated with depression and anxiety. With the ongoing opioid and SUD epidemics, discussing this association is vital to the health of the mother and child. SUD among women who may become pregnant contributes to increasing rates of neonatal abstinence syndrome (NAS) and neonatal opioid withdrawal syndrome (NOWS), two conditions that occur when newborns experience withdrawal from exposure to substances in the womb.
It’s imperative to provide comprehensive support for mothers with SUDs, extending beyond their substance use to also managing their mental health conditions. Programs like a women’s wellness and recovery initiative aim to decrease the prevalence of NAS and NOWS. Programs like this help to support women of reproductive age who are experiencing substance use disorder (SUD) or have been identified as medium or high risk for SUD. Support can be provided using non-clinical and digital methods.
In addition to member engagement from a program peer specialist, a digital app can give patients access to peer recovery support, available 24/7.
Wellness and recovery programs offer peer connection through various methods to reduce potential communication gaps with mothers. Strengthened connections support mothers to express their feelings effectively and ensure prompt responses to issues.
Healthier families and future generations
Supporting maternal mental health leads to healthier mothers, babies, and families. An untreated mental health disorder can lead to various adverse outcomes, like substance use, reduced attachment to children, and negative impacts on a child's long-term health and mental well-being. If one does not receive appropriate treatment and support, these issues can intensify or recur.
Supporting mothers isn't only beneficial for their health but for the health of their families, too. When mental health issues are left untreated, the risk of physical health problems, emotional attachment issues, and other conditions increase, not only for the mother but for the child as well.
Prioritizing maternal mental health by engaging mothers early in their care journey is critical. Equipping them with the necessary resources to manage mental health and substance use conditions aids in safeguarding the well-being of families and future generations.
Tiffany Inglis, M.D., is an obstetrician and serves as national medical director at Carelon Medical Benefits Management, part of Elevance Health.