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Beyond Birth: Improving the Maternal Mental Health Crisis

In response to the urgent need for support, the federally funded National Maternal Mental Health Hotline was launched in 2022. In its first year, the hotline for new and expectant parents received more than 12,000 calls and texts, underlining the depth of the crisis affecting millions of Americans. For decades, the emotional highs and lows […]

In response to the urgent need for support, the federally funded National Maternal Mental Health Hotline was launched in 2022. In its first year, the hotline for new and expectant parents received more than 12,000 calls and texts, underlining the depth of the crisis affecting millions of Americans.

For decades, the emotional highs and lows after giving birth were dismissed as simply “the baby blues.” However, though we’ve made strides in understanding the severity of postpartum depression, the medical community (both from the physical and mental side) is still struggling to support perinatal mental health.

In light of this, we are weaving together our collective decades of experience treating individuals on their paths to parenthood to explore why the maternal mental health crisis persists; the current policies in place that overlook new and expecting parents; and the steps that healthcare professionals, employers, and the federal government can make to improve mental health outcomes.

What’s driving the maternal mental health crisis

CDC research shows that about 1 in 8 women experience postpartum depression symptoms and the rate of depression diagnosis at delivery is continuously increasing – with mental health related issues factoring into some of the leading causes of maternal mortality. Postpartum issues can have long term impacts on women’s mental health and potentially lead to spikes in depression and anxiety during the perimenopausal and menopausal years, especially if the person has previously suffered from mood disorders.

While there are many compounding factors that contribute to the high rates of postpartum physical and mental health issues, there are two pieces to the puzzle that are certainly exacerbating the issue: a fragmented healthcare system that separates physical health from mental health, and a lack of employer support for perinatal healthcare.

The majority of states are failing to provide key measures to support maternal mental health, including access to therapists, psychiatrists, or behavioral health treatment programs. Neglecting maternal mental health has a profound negative impact on not only the individual, but their personal and professional relationships. In many instances, obstetricians, who are frequently the initial points of contact for new parents, may lack the specialized training to address complex mental health issues. This highlights the need for a more integrated and multidisciplinary approach to maternal healthcare that seamlessly incorporates mental health considerations.

In the U.S., employers are gateways to healthcare and therefore play an integral role in ensuring that their employees who are of childbearing-age, pregnant, in the postpartum period, or going through menopause can access value-based care that supports every facet of maternal health. There have been more employers offering some sort of mental health insurance coverage, but it is rare to offer specific mental health programs that cater to individuals who are building their families and new parents. What’s needed is a team of dedicated and uniquely trained patient care advocates, who support patients through all aspects of their fertility journey and any mental health challenges they may experience. Unfortunately, this is not the situation for those employee patients who lack access to a fully comprehensive family building benefit.

Beyond birth: Providing full cycle support 

Fostering collaboration between obstetricians and mental health professionals can enhance the overall quality of care throughout the fertility journey – from preconception to menopause. We must equip OB-GYNs and other women’s healthcare professionals with the knowledge and support to address perinatal mental health conditions. We are seeing this begin to happen because of The American College of Obstetrics and Gynecologists’ recommendations to screen individuals for perinatal depression and anxiety at the initial prenatal visit, later in pregnancy, and at postpartum visits. It’s imperative, that we go beyond these mental health screenings to ensure individuals have timely access to assessment/diagnosis, effective treatment, and appropriate monitoring and follow-ups.

We continue to see women shy away from getting help because of persisting stigma. They are self-shaming, concerned about being judged as less than “the perfect mother,” and lack the information and financial support they need to get access to proper mental health support. Because physicians are frequently the first point of contact for new mothers, they need to receive sufficient, culturally sensitive, interdisciplinary training with perinatal mental health specialists. The deficiencies in maternal mental health support across the U.S. paint a concerning picture of unmet needs for new and expectant parents. We cannot stress enough the importance of collaboration among employers, policymakers, providers, and communities to work toward comprehensively addressing this issue. We encourage leaders at all levels to start looking at the benefits your company provides, start allocating funding and resources to this cause, and destigmatize mental health discussions. We can all do more to prioritize the holistic well-being of those on their family building journeys.

Photo: Arsenii Palivoda, Getty Images

Georgia Witkin, Ph.D., is Head of Patient Services Development for Progyny, an Assistant Professor of Psychiatry and Ob/Gyn and Reproductive Sciences at Mt. Sinai School of Medicine, and Director of Psychological Services for RMA of NY. Georgia is the author of 12 acclaimed books, including The Female Stress Survival Guide, The Male Stress Survival Guide, and Stress Relief for Disasters Great and Small, and is a prolific writer with 22 research works with 87 citations and a column in Psychology Today. She’s a thought leader and expert on women, stress, and reproductive medicine. She has also served as a health reporter/host for CNBC, WNBC, and other news networks, and has been featured as a guest expert on 20/20, The Today Show, Good Morning America, CBS Evening News, The Oprah Winfrey Show, and CNN. She has been honored by the American Infertility Association, American Fertility Association, RESOLVE, and City of Hope.

Dr. Janet M. Choi is a board-certified reproductive endocrinologist and serves as the Chief Medical Officer for Progyny where she brings her expertise to ensure Progyny provides the highest quality fertility and family building services to our members and continues to raise the bar as the industry leader. Dr. Choi has written, published, and lectured extensively on infertility, onco-fertility, and fertility preservation. She is an active member of the American Society for Reproductive Medicine, the American College of Obstetricians and Gynecologists, as well as the New York Obstetrical Society. Prior to Progyny, Dr. Choi was the medical director of CCRM New York for the last 7 years. Before CCRM, she was an assistant clinical professor in Obstetrics and Gynecology at Columbia University Medical Center and served as the Director of Onco-fertility and Co-Director of the Fertility Preservation Program. Dr. Choi graduated Magna Cum Laude from Harvard University with an A.B. in English literature and earned her medical degree and completed her residency in Obstetrics and Gynecology at Columbia University. She completed her sub-specialty fellowship in Reproductive Endocrinology and Infertility at Weill Cornell Medical College in New York.

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