The Importance of Integrating Maternal Mental Health with Pregnancy Care
There is a popular perception that pregnancy is a time solely of joy, excitement, and emotional well-being. It is a myth that mental health is protected in pregnancy. Because of this, many people who struggle with mental illness in the perinatal period are reluctant to discuss their mental health with their providers. Over 80% of mental health problems in pregnancy go unreported. For this reason, the American College of Obstetricians and Gynecologists (ACOG) recommends screening for anxiety and depression in a systematic way using validated tools during pregnancy and the postpartum period.
The Women’s Integrated Behavioral Health Service, part of the Women’s Medicine Collaborative, is one of only a few in the country that provides specialty mental health care right in your OBGYN’s office. This integration makes it easy to access mental health care and allows your OBGYN and mental health professional to communicate quickly and efficiently to provide the best care.
What is maternal mental health?
The World Health Organization defines maternal mental health as “a state of well-being in which a mother realizes her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her community.” Perinatal mental health disorders can begin before, during, or soon after pregnancy.
How does pregnancy affect your mental health?
Changes that are inherent during pregnancy, including physical and social changes, can increase the risk of mental illness. For example, changes in reproductive hormones (estrogen and progesterone) that are a normal part of pregnancy can increase risk for depression and anxiety. Additionally, the transition to parenthood and changes in other social roles can increase risk.
Baby blues vs postpartum depression
- Up to 20% of pregnant people experience depression during pregnancy.
- It is common for people to experience baby blues, which is mild symptoms of dysphoria occurring in the first 10 days after giving birth. This is related to hormonal fluctuations following delivery.
- Post-partum depression continues past 2 weeks postpartum and consists of at least moderate symptoms.
Anxiety and pregnancy
Anxiety can start during pregnancy or after delivery. Symptoms include uncontrollable worry about the baby’s health and safety, restlessness and an inability to relax, difficulty sleeping due to physical unrest and/or worry.
- Between 13-20% of pregnant people experience anxiety while pregnant.
- More than 20% of people experience anxiety during the postpartum period.
How can an integrated approach to maternal mental health help?
Even when mental health problems are identified, many patients have difficulty finding specialty mental health care. Only 15% of pregnant people with depression and anxiety actually get connected to care. Barriers to seeking care include stigma, lack of time, insurance and conflicting medical appointments. Systemic barriers also exist. In traditional care models, specialty mental health care is separate from obstetric care (i.e, different offices, different medical records, different hospital systems, etc.) making it harder to know where to seek care and making it harder for prenatal care providers to coordinate treatment plans with mental health providers.
With our Integrated Behavioral Health service, we strive to make it as easy as possible—so there’s no concern about conflicting appointments or if multiple offices will take your insurance. And your OBGYN and mental health providers are all in one building, sharing one electronic medical records system, so they can easily communicate to coordinate your care.
When should I talk with my OBGYN about mental health concerns?
- You find it difficult to take care of self – such as having little interest in eating, showering, and other basic self-care tasks.
- You are having difficulty bonding with pregnancy.
- You find your sleep is greatly disturbed.
How can I keep my mental health while pregnant?
Talk openly with your prenatal care team about mental health and well-being, asking questions if you have a concern. At the Women’s Medicine Collaborative, our goal is to provide one center for comprehensive care that a woman could ever need at any stage of life. Our Integrated Behavioral Health service, one of only a few in the country, is just one example of how we’re providing comprehensive, patient-centered care.
About the Author:
Margaret H. Bublitz, PhD, and Meghan C. Sharp, PhD
Margaret H. Bublitz, PhD, a psychologist at Women’s Behavioral Medicine at the Women’s Medicine Collaborative, directs the integrated behavioral health service at Women's Primary Care, and is a senior research scientist in its research department.
Meghan C. Sharp, PhD, is a psychologist at Lifespan Physician Group, Obstetrics and Gynecology and a research scientist in the Women’s Medicine Collaborative research department. Dr. Sharp specializes in perinatal psychology and provides individual treatment with integrated behavioral health.
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