According to latest CDC datathe maternal mortality rate in the United States, already significantly higher than in comparable countries, continues to rise, especially for women of color.
One year postpartum, suicide and substance abuse are the leading causes of maternal death, with suicide accounting for 9% of the maternal mortality rate. Maternal mental health issues, such as anxiety, perinatal and postpartum depression, birth-related PTSD, are the most common complications of pregnancy and childbirth, affecting 1 in 5 women. of those affected, 75% are not treated. Although women of color are more likely to experience these conditions, they are also less likely to seek help.
What remains surprising is that 100% of these conditions respond to early intervention and/or treatment.
The AHA has partnered with 2020 Mom, a national nonprofit organization dedicated to closing gaps in maternal mental health care, to produce tools and resources specifically for hospitals and health systems to help improve maternal mental health.
As part of this partnership, we had the privilege of participating in two round tables at 2020 Annual Maternal Mental Health Forum, Building the Constellation of Maternal Mental Health. The first session focused on understanding the stressors of pregnancy, especially for women of color, and the other session explored best practices for improving maternal mental health outcomes.
The first session highlighted the need to start a dialogue about the real experiences of women of color and use the data to inform solutions to improve their maternal mental health. In partnership with First Year Cleveland, we watched the 20 minute film, Toxic: A Black Woman’s Storywhich took viewers through a day in the life of Nina, a pregnant black woman, and sheds light on the forms of racism she faces in her personal, professional and medical encounters.
After the film, Catherine Monk, MD, professor of medical psychology and director of women’s mental health at Columbia University Medical Center, backed up Nina’s experiences in the film with real-life data about the various causes of distress during pregnancies. She addressed its intergenerational impact and highlighted the racial disparities that plague the lives of black mothers and other women of color. For example, preterm mothers are more likely to give birth before term, especially among black women. Women of color were also shamed and blamed for loss. In addition, 10 to 20% of women suffer from perinatal depression; rates double for people of low socioeconomic status and for people of color. This continuous stress creates an allostatic load or “wear and tear” on the body.
Key points to remember
We then led a discussion with First Year Cleveland Acting Executive Director Katrice Cain and Dr. Monk to discuss how we can use both real-life experiences and data to improve outcomes by maternal mental health all women. They offered these tips:
- Recognize that racism exists in our communities, and has for over 400 years, no matter where you live and no matter how educated you are. “Nina being a pregnant black woman who seems to have all the protective factors such as education, job, safe environment, supportive and loving husband; she still cannot be protected from the individual, institutional and systemic racism that permeates every aspect of a black woman’s life, resulting in toxic stress and poor health outcomes,Cain explained.
- Create healthy and safe spaces for patients and colleagues to share their experiences and listen. Dr Monk shared: “We need to listen better to patients and individuals and reflect on our own feelings to better understand someone else’s experiences.. This builds confidence and courage to speak out and allows health care providers to offer social support and bring a certain community to the experience of prenatal care..”
- Inform the care you provide about real-life experiences, because “it’s a community issue,” Cain said.
- Encourage diversity among your organization’s decision makers, leaders, and boards.
- Be intentional and make it a key strategic priority supported by appropriate funds and resources.
Since hospitals are the hub for 98% of births in the country, they are key to improving maternal mental health outcomes. For our second roundtable, we joined leaders from Zoma Foundation, Premier Inc., CommonSpirit Health, SCL Health, and University of North Carolina Health to share how hospitals are using best practices to improve the quality of maternal health care.
Deb Kilday, Director of Women and Infant Services at Premier Inc., shared emerging trends in maternal mental health, noting that maternal patients with documented mental health issues vary widely by race and age group. age, are more likely to undergo cesarean section and are 1.5 times more likely to experience severe maternal morbidity. Premier uses data from its Human and Health Services Maternal Infant Collaborative to scientifically identify drivers of maternal and infant mortality and morbidity and implement solutions. The AHA collaborates with Premier and sits on the advisory committee of this collaboration.
Each hospital described its maternal mental health efforts, which varied by patient and community served.
- CommonSpirit Health has engaged obstetrics providers, perinatal nurses, social workers, and more. in a screening program to capture the mental health conditions of pregnant and postpartum women. For the past five years, this program has provided mental health training to providers and connected patients with identified risk for depression and anxiety with a social worker to assess their condition.
For its next deployment by June 2022, “a total of 68 CommonSpirit Health hospitals in 13 states with more than 85,000 births per year will screen postpartum patients, and we will review our data through a health equity lens,shared Jennie Torti, director of the Perinatal Behavioral Health System.
- SCL Health’s Integrated Maternal Mental Health Initiative administers universal mental health screening during and after pregnancy – inpatient and outpatient settings, and offers treatment and referral interventions through its Bloom Perinatal Behavioral Program Health. Patients are connected with community behavioral health providers to ensure that their assessment meets their needs. In 2021, SCL Health screened 11,000 women.
To gain buy-in and create culture change, “We individualize and personalize our program within different units so as not to disrupt the current workflow and create more load. We regularly shared outcome data and anecdotal patient stories to show we were getting things done,shared Heather Hagenson, Director of Operations and Business Development.
- UNC Health has established its own inpatient perinatal psychiatry unit, a model that is one of only three in the country. In this five-bed unit, women undergoing treatment for their mental illness have time to bond with their babies during their stay. However, this model presents liability and coverage challenges, noted Riah Patterson, MD, unit medical director, which makes it more difficult for many hospitals to adopt.
Throughout our experience at the forum, it became clear that certain key elements are needed to make lasting changes to maternal mental health outcomes.
First, it is impossible to holistically improve maternal mental health without digging deep into the disparities that exist within our society. These disparities, when collected and identified, can lead to substantial changes in improving access to care, improving policies and procedures, and even creating a culture shift within the organization. workforce and ourselves.
Second, timely screening and assessment of mental health issues, seamless integration of mental health care across the continuum of care, sharing of findings to gain leadership buy-in, are all necessary elements. to address maternal mental health, but we also need standardized processes for referrals and follow-ups, diverse and trained staff, and partnerships with community resources to meet the needs of those affected by mental health. View AHAs infographics on the key elements of a successful maternal mental health program.
Finally, when we work to improve maternal health outcomes for Black mothers, we naturally improve outcomes for all women.
However, like everything else in the healthcare system, we need to collaborate inside and outside of clinical walls to build this constellation of awareness and support for the mental well-being of mothers and their families.
Priya Bathija, JD, MHSA, is AHA’s Vice President of Strategic Initiatives. Aisha Syeda, MPH, is the Program Manager of Strategic Initiatives at AHA.