Helping Mothers Navigate Postpartum Depression: Interventions for Healthcare Organizations

By Christina Driskill, MPH, RN, CPHQ

Vizient Performance Improvement Program Director

New moms often find it hard to speak up and ask for help when they need it. They are stretched thin, still learning how to care for a baby and often sleep deprived and undernourished. Societal pressures make them feel like they should be able to do it all, further complicating an already demanding situation. Considering the challenges that can occur in early motherhood and the physical and psychosocial changes that women go through during this time, it is not surprising that postpartum depression impacts one out of every seven women. Suicide, overdose or poisoning are now the leading causes of pregnancy-associated mortality, accounting for more than 23% of pregnancy-related deaths. Even more alarming is the fact that 100% of pregnancy-related deaths by suicide are considered preventable, according to the Centers for Disease Control and Prevention (CDC).

This distressing data paired with the societal impact of maternal mortality and the critical role that mothers play in their baby's ability to thrive highlight how important it is that we, as healthcare providers, and as a society normalize conversations about mental health. We also must not ignore the racial disparities in maternal mental health disorders. While white women are more likely to be diagnosed with postpartum depression, women of color are less likely to be screened for postpartum depression. Offering equitable care where all mothers, regardless of their race or ethnicity, are encouraged to share their struggles will increase the opportunities we have to prioritize care for their mental health needs. In support of the health and wellbeing of mothers, Vizient's Patient Safety Organization has compiled a list of low-cost, high-impact interventions that organizations can implement to create a safe environment where postpartum moms feel supported.

• Initiate frequent and early screening for postpartum depression using a validated screening tool and allowing space and time to complete the screening independently from staff and other members of the family. Consider screening moms at their 36-week visit and immediately after delivery while she is still in the hospital. The American Academy of Pediatrics recommends Pediatricians screen new moms during the newborn and well-infant visits during the first six months post-delivery. If she has an increased risk for postpartum depression, strategize with the mom to identify her support system, refer her to a mental health provider and schedule an earlier postpartum visit with her obstetric provider.
• Incorporate high-touch postpartum care to include more frequent visits and virtual check-ins with new moms. Schedule expanded visits in the postpartum period to allow providers ample time to assess the new mother's mental and physical health and to perform the necessary screening assessments to evaluate the mother's mental health. Take time during the visit to tell the new mom that postpartum depression is treatable and diagnosing and addressing the concern does not mean that her baby will be taken away from her. Consider offering group pregnancy care visits to support maternal mental health and lead to improved postpartum depression outcomes. Partner with local doulas within your organization or through your community networks and offer postpartum home visits during the first week after delivery.
• Develop postpartum safety plans for mothers that screen positive for postpartum depression and include components on establishing a support network, monitoring mental health, self-care strategies, educating loved ones and identifying emergency contacts. Encourage her to reach out immediately if she needs support.
• Conduct caring call backs within seven days of discharge to check on the postpartum mom's mental and physical wellbeing following delivery. Share resources during these calls to facilitate a smooth transition to home and to encourage a supportive and caring relationship between the mom and clinical support staff.
• Offer support groups for postpartum moms to help them build a support network and peer group while creating a safe place for them to share their feelings and experiences on specific topics.
• Utilize technology resources, such as telehealth visits for moms who screen positive for postpartum depression, or mobile phone applications that screen patients and provide guided prevention and early intervention strategies to reduce the risk of escalating mental health instability.
• Share information about the 988 suicide hotline, which is a federal resource offering confidential and free support that is available 24/7/365 to connect those experiencing a mental health, substance use or suicidal crisis with a trained crisis counselor. Utilize resources in the 988 partner toolkit to increase visibility of this hotline.
• Refer to counseling services to provide a safe place for postpartum moms to express their feelings and identify the best way to manage symptoms or prescribe medications to treat postpartum depression.

Engaging in the maternal mental health and postpartum depression conversation is critical to letting postpartum moms know that they are not alone. Providers can seek opportunities to remind the new mom that she is doing a great job, that she has a support network and that there are resources and safe places for her to communicate her struggles. Supporting postpartum moms is critical to helping both moms and babies thrive.