Disclaimer: Female pronouns and “mother” are used throughout while recognizing that not everyone who carries a child or parents identifies as such.
“If Mom’s not happy, nobody’s happy.”
Spoiler alert: Mom’s not doing well.
In September 2024, the US Surgeon General issued an advisory about a parental mental health crisis in our country. Parents are more involved in their children’s lives than ever, while at the same time, facing obstacles to their own mental health including the financial strain of annual childcare costs, rising grocery prices, cuts to Medicaid, and the increasing rates of gun violence in schools. While these are all worthy of their own systems change work, a foundational piece of a family’s well-being is often overlooked: the mother’s mental health in the perinatal period.
According to the CDC and NIH, at least 1 in 5 women will experience a mental health disorder in the perinatal period, defined as pregnancy through the first year or two postpartum. This is due to the incredible hormonal changes in the brain combined with a litany of other risk factors including lack of sleep, genetic predisposition and socioeconomic influences. Mental health conditions are the number one complication of pregnancy and childbirth, yet the perceived and real stigma of being a new mom who says, “I’m not ok!” keeps many suffering in silence.
Unfortunately, getting women the help they need isn’t as easy as urging them to ask for help for many reasons.
- New parents don’t know what “normal” is. Are a new mom’s tears because of the Baby Blues- the expected emotional roller coaster in the first two weeks postpartum due to plummeting hormone levels- or does she have postpartum depression, a clinical diagnosis with multiple treatment options? Maternal mental health advocates walk a fine line between sharing stories to reduce stigma and normalizing the hardships of having a baby so much that someone in crisis thinks they’re supposed to grin and bear it. I suffered from terrible insomnia after the birth of my son, but had been told by all seasoned parents that I’d never sleep again, so I had no idea it was a symptom of postpartum anxiety.
- Healthcare providers aren’t equipped. In a state with at least one-third of our counties classified as maternity deserts with more OB unit closures anticipated, it’s no wonder that 83% of Iowa OB/GYNs said in a University of Iowa survey that they “felt they had incomplete knowledge to treat perinatal mood and anxiety disorders” in their patients (Radke, IMQCC MOMMS Expert Meeting, 9/6/24). Today’s birthing population is waiting to have babies later, they’re presenting with more comorbidities than ever, and the US maternal morbidity and mortality rates continue to be by far the highest of any first world nation. OBs and midwives are working their hardest to get moms and babies home alive and well; they don’t also have the capacity to address mental health issues.
- Mental health is not a priority for new families. And who can blame them? 1 in 4 women returns to work within two weeks of having a baby, according to data analzyed by Abt Associates for In These Times. Setting aside what is still physically happening to a woman’s body two weeks postpartum, being separated from their newborn at two weeks does not support mental nor emotional wellness. A majority of patients don’t go to their six-week follow-up OB or midwife appointment because of lack of childcare, lack of insurance, and lack of paid time off work. Birth control, something often addressed during this visit, is then not reliably implemented and rates of closely spaced pregnancies rise– another risk factor for postpartum mental health disorders.This creates a cycle of unaddressed mental health issues that have devastating ripple effects for the family.
So, what can we do? A myriad of things, but to start:
- Increase mental health screenings, both during pregnancy and after hospital discharge. The current common screening tools aren’t perfect, but they’re better than burying our heads in the sand and assuming a mom will ask for help if she needs it. New parents need to know that postpartum mental health screenings aren’t tests to see if they’re equipped to parent their baby. Providers need to know that screening tools aren’t diagnostic, they’re a conversation starter. We’d do better by both moms and healthcare professionals if we increase the amount of screenings to not only catch possible mental health issues, but to normalize the conversation about mental health.
- Iowa can join over 30 states in creating a perinatal psychiatric access program. My fellowship project, Iowa Maternal Psychiatric Access and Consultation Team (IMPACT) would contract with the state’s existing handful of perinatal psychiatrists to be available in real-time to anyone providing care to a pregnant or postpartum patient. It also connects struggling patients to resources and referrals in their local region, and increases our current healthcare workforce’s confidence and capacity.
- Advocate for statewide paid leave for all parents, create in-person and virtual peer support groups for parents of children of all ages, implement flexible workplace policies that support families, and hold space for parents to safely share their stories without fear of judgment. There are many fronts we can move on together to make sure that if Mom’s not at least happy, she’s better educated, more supported, and actually treated.
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