Supporting Mothers Means Supporting Mental Health

Pregnancy, childbirth, and parenthood come with ups and downs. They can also cause significant physical and emotional challenges. 

Mental health conditions remain the leading cause of death for pregnant people during and after the birth of their children. Suicide and substance-use-related deaths make up the greatest proportion of these deaths.

Often, these mental health conditions are chronic conditions that are misdiagnosed and untreated. 

Pregnancy and  Postpartum Info Can Be Hard to Navigate

This may be news to some, but there is not a clear-cut path for what pregnancy looks like. The feelings, weight gain, energy level, resources, access, and overall experience of pregnancy are varied. This also means that the way pregnant people look on TV and on social media can feel distant from reality. 

“There is also a distinct lack of social support for mothers, particularly in the postpartum period,” says Sarah Blake, PhD, director of the Emory University Maternal and Child Health Center of Excellence. “The lack of postpartum care is a contributing factor and a reason that most preventable maternal deaths occur in the postpartum period. Doula support is an essential option for women during and after pregnancy. The lack of Medicaid reimbursement for doulas in Georgia and in most states, is a travesty and policy failure.”

Whether the pregnancy has been planned or not, the amount of information, appointment logistics, and costs can feel tricky to navigate. Part of the challenge is the amount of information available and confusion in knowing where to look for accurate guidance. 

The best sources for legitimate pregnancy information are:

• Doctors’ offices
• American College of Obstetricians and Gynecologists
• American Pregnancy Association
• Other mothers—or people who have been pregnant—that you know or trust

While there are some merits to social media content, there have also been documented harms, including spreading misinformation and influencing anxiety and depression. 

Not all websites are created equal. Despite the name, crisis pregnancy centers are unregulated, urge against abortion, are not bound by HIPAA, and often are not staffed by licensed medical professionals. 

Preventing Maternal Deaths Means Supporting Women’s Mental and Reproductive Health

The first step to preventing maternal deaths is making sure women are screened accurately and consistently before pregnancy, but also during prenatal visits and are navigated to mental health care treatment. “Many mental health care practitioners are afraid to treat pregnant patients and refuse these referrals,” says Blake.  

Another key step to improving women’s health is expanding women’s access to reproductive health care. The recent back-and-forth court discussions over telehealth mifepristone prescriptions is a strong example. This FDA-approved drug is used for medication abortions as well as to treat miscarriages, uterine fibroids, and endometriosis.  

According to researchers with the Center for Reproductive Health in the Southeast (RISE), limiting access to mifepristone via telehealth, by mail, and pharmacy could impact certain groups more than others. This is especially true among people of color, immigrants, people living in poverty or rural communities, and LGBTQ+ communities.

Restricting access, “if enforced, may also mimic the harms that abortion restrictions create overall, including straining the health care service delivery system, worsening inequalities in access to care, and increasing pregnancy-related health risk,” according to RISE. 

“We know that telehealth medication is extremely safe and effective, has satisfaction rates comparable to or higher than in-person medication abortion care, and has rapidly expanded access to care,” says Sara Redd, PhD, director of research translation with RISE. “Consideration of potential restrictions on access by eliminating telehealth access options is not based in the scientific evidence base and in fact contradicts it. It is true that these restrictions will most likely be felt inequitably by people with different social positions.”

Policy Changes Can Save Women’s Lives and Improve Families’ Health

Maternal deaths remain high in the United States. This is especially true for women of color. Recently released CDC data reveal that non-Hispanic Native American and Black women experience the highest rates of pregnancy-related deaths (54.6 and 45% per 100,000 live births). More than 80% of all maternal deaths have been deemed preventable by states’ maternal mortality review committees, who identify multiple contributing factors to these deaths. These include a lack of structural and financial access to prenatal and postpartum care. Much of America resides in a maternal health desert, or places where there are no maternal health care providers.

This makes it difficult to keep OB and postpartum appointments, which are critical for a mother’s health. Sick or medical leave policies and stronger workplace flexibility are also essential for pregnant people during and after pregnancy. Yet, just 14 U.S. states have paid family leave policies, 12 of which are currently in place. This is a start toward promoting resilience in mothers, babies, and families, but is still a small fraction of the total nation’s needs.

When mothers do not have paid leave or workplace support, breastfeeding can be tremendously difficult—if not impossible—and warning signs for deadly health conditions, including postpartum preeclampsia, heart disease, diabetes, and depression can be worsened or overlooked.

Mental Health Care is Maternal Health Care 

Selective Serotonin Reuptake Inhibitors have repeatedly been shown to be safe for pregnant people and their babies during pregnancy and while breastfeeding (as is Tylenol). These drugs, used to combat depression and anxiety, are safe for pregnant people to use and can be lifesaving for mothers. 

Communication efforts to better promote warning signs for postpartum anxiety, depression, and mania—all of which extend far beyond the “baby blues”—have made progress toward normalizing mental health conditions during and following pregnancy. 

The American Rescue Plan Act of 2021 allowed states to extend Medicaid for qualifying mothers from 60 days to 12 months postpartum, which is a change 49 states, including Georgia, have implemented. This type of change demonstrates ways that policy changes can impact maternal health, especially as it relates to mental health. 

Expanding mental health care availability and access to include telehealth—particularly for those residing in maternal health deserts—could make a difference in health outcomes for mothers and the support they feel during and after pregnancy. 

“We still face the problem of having an insufficient mental health care provider network, especially for pregnant and postpartum women,” says Blake. “We need more investment in telehealth, psychiatry, and mental health support because it is important for access and needed support for mothers.” 

When women are healthy and supported, it doesn't just benefit individual women. It helps family health, community health, and by extension, the health of all Americans.