Commentary: Prenatal care should also include mental health screening, treatment for moms

If we care about the future of Orange County families and the economic engine of our county, we need to start asking a tough question about the mental health of mothers.

Instead of wondering why a new mom is depressed or not feeling herself, we need to ask, “What’s keeping you from getting the treatment you need?”

The answer to this question has changed over the past 25 years, as has the prevalence of treatment options that affect Orange County public health.

According to the Centers for Disease Control, up to 20% of women who give birth each year experience maternal mental health (MMH) disorders, such as depression, anxiety and other mood disorders during pregnancy, as well as postpartum depression. In Orange County, this rate translates to close to 8,000 women, as well as their children, who are impacted each year.

Despite the prevalence, women battle not only the symptoms of MMH disorders, but also the stigma around this misunderstood issue that affects the health of both the woman and her child, even throughout adulthood, as new research suggests.

Maternal mental health goes far beyond the so-called “baby blues,” the typical stress, fatigue, worry and anxiety that almost every new mother feels. Instead, maternal mental health disorders begin to surface during pregnancy and can continue as postpartum depression if not treated.

The disorders associated with MMH cut a wide swath across all Orange County demographics. We see mental health disorders affecting women who had difficult pregnancies, as well as easy ones. Women with more than one child are just as likely to experience depression as first-time mothers, and MMH disorders surface among every income, age, race, ethnicity and educational bracket.

In the summer of 1989, the March of Dimes Birth Defects Foundation commissioned a perinatal needs assessment and program plan for its Orange County chapter. Many of the ideas and concepts developed to address some of the most compelling needs identified in 1989 created the seeds that became the Maternal Outreach Management System, which since 2008 has been known as MOMS Orange County.

As part of celebrating its 25 years of service, MOMS just commissioned a retrospective review of the environment out of which MOMS was born and the changes Orange County has experienced since then. The 1989 March of Dimes Perinatal Needs Assessment focused over three-quarters of its report on one crucial area: the availability and accessibility of perinatal health care services.

The MOMS-commissioned retrospective combined with outcomes of two focus groups comprised of local perinatal experts is providing a starting look at the current state of perinatal needs. As in 1989, early prenatal care and substance-exposed infants are critical areas of perinatal health requiring concentrated attention. However, three other areas surfaced this year — breastfeeding, maternal morbidity and maternal mental health — zooming ahead and requiring prioritization, according to the perinatal experts surveyed.

Why has maternal mental health become such a priority in 2017? The answer is a question of socio-economics and the result threatens public health. Although income doesn’t preclude a woman from developing maternal mental health disorders, her access to mental health care largely depends on her income, and this presents a growing gap in how Orange County approaches maternal mental health.

Untreated MMH disorders significantly and negatively impact the short-and long-term health and well-being of affected women and their children. Symptoms lead to adverse birth outcomes, impaired maternal-infant bonding, poor infant growth, childhood emotional and behavioral problems and significant medical and economic costs. Despite these consequences, screening for MMH disorders is not routine.

Some work has been done to increase the services and resources in Orange County. At Hoag, for example, a peripartum mental health program is being developed in recognition of the great need. The program includes screenings for all women who deliver at the hospital , as well as assessments, consultations and linkage to services for women who require them.

Currently, Hoag offers a maternal mental health support line to help connect both physicians and families with a mental health specialist. Additionally, a postpartum adjustment support group is offered weekly to new mothers experiencing the baby blues, or having difficulty adjusting to motherhood. Moms who gave birth at any hospital in Orange County are encouraged to attend.

Despite the abundance of wealth in Orange County, the lack of maternal mental health services disproportionally affects lower-income women – and this is creating a near public health crisis. Women in families whose income is below 100% percent of the federal poverty level (FPL) experience depression at over double the rate of women in families with income higher than 300% of FPL.

With advancements in science and a deepening understanding of the connection between perinatal mental health, we now understand that the offspring of mothers who experience postpartum depression and other mental health disorders suffer well past infancy. These children grow into adults who often exhibit increased impulsivity, maladaptive social interactions and depression.

Backed by this new investment in data, it’s time to act before another 25 years of inadequate perinatal health care services affects the next generation of families. MOMS is taking a stand by implementing strategies to improve maternal mental health in Orange County, and you, too, can contribute to the future of Orange County.

If you have the opportunity to influence pregnant women, encourage them to participate in maternal mental health screenings and seek treatment for disorders. If you are pregnant or are considering becoming pregnant, avail yourself of maternal mental health screenings and services offered through MOMS or other health care providers. We welcome your efforts to empower mothers and strong families throughout Orange County.

PAMELA PIMENTEL, a registered nurse, is CEO of MOMS Orange County. PATRICIA DE MARCO CENTENO, a physician, is director of consultation-liaison psychiatry and Women’s Mental Health at Hoag Hospital.