As an RN in a busy Manhattan OB/GYN clinic serving high-risk populations, I rarely had time for conversation. One day, when I was rushing through my regular check-ins, I met with a prenatal patient I’ll never forget. As I asked her questions, she quickly answered them without affect or eye contact.
I paused and stopped everything I was doing to just ask her how she was feeling. She looked up at me, started crying, and told me how depressed she was and unsafe she felt at the local shelter. She admitted she was ready to take her life.
Her story is only one example of the host of mental health challenges that maternal patients can face at any stage during their care journeys. And these conditions require intentional and proactive interventions to ensure safe and positive experiences during and after pregnancy.
But the uncomfortable truth about maternal mental health is twofold. First, those confronting these mental health challenges are still shadowed by incredible societal stigma. Second, the current standard of care isn’t built to support patients with the compassionate, high-touch care they need.
With individuals often facing these conditions alone or with limited assistance, it’s important to understand updated recommendations from the American College of Obstetricians and Gynecologists (ACOG) for supporting maternal mental health, as well as how innovative technology can support patients and their providers to realize better outcomes.
The state of maternal mental health in the U.S.
The year 2021 ushered in record highs for maternal mortality in the U.S., with rates jumping 40% from 2020. But what’s buried in that number is another alarming statistic: Almost 23% of those deaths were related to mental health conditions.
That makes them the leading cause of death in maternal care. In worst cases, suicide and overdose or poisoning are the most frequent reasons for pregnancy-associated maternal mortality. Importantly, the CDC has determined all of these scenarios to be preventable.
But perinatal mental health issues shouldn’t have to result in death to be taken seriously. Postpartum depression affects one in eight moms throughout the U.S. — with data from our own care programs showing that number could be even higher — and perinatal mood and anxiety conditions are considered the largest contributors to complications during pregnancy and childbirth. Furthermore, maternal mental health challenges can even impact children’s cognitive, behavioral, and academic development.
Healthcare falls short of delivering equitable maternal mental healthcare
Although the urgency of treating perinatal mental health conditions is evident, healthcare by-and-large fails to do so.
According to a 2023 article in The New York Times, only 20% of prenatal patients are asked if they experience depression. Almost half of mothers with this condition are never diagnosed by a clinician. And of those affected with maternal mental health conditions, 75% go completely untreated.
Things get even more drastic when we account for disparities in receiving care. At-risk patients experiencing or marginalized by racism or socioeconomic inequities are much less likely to receive screenings or treatment for depression following childbirth.
This lack of support has very real, very dire consequences. Maternal death rates among Black women are twice that of their white counterparts. Tragically, this disparity has barely budged since the 1930s. Though several factors might contribute to this sobering fact, one thing is clear: Black mothers are twice as likely to encounter mental health conditions as white mothers, but half as likely to receive treatment.
In healthcare, we know that when communities are underserved, we all lose out on a healthier, happier world. And with inequities continuing to damage our health at individual and societal levels, bridging the gap to expand equitable care has never been more imperative.
Understanding updated guidance for treating perinatal mental health conditions
In response to growing concerns about mental health’s connection to maternal mortality, ACOG recently announced new mental health screening and diagnosis criteria. It now recommends screening for perinatal depression and anxiety in the prenatal period, during delivery, and after giving birth. This expands on prior recommendations of screening at least once during the perinatal care journey.
Another update to the guidelines is a recognition of the burden of bipolar conditions. Pre-existing bipolar disorders have been classically tied to higher instances of postpartum psychosis — a rare, but extreme, condition that manifests as severe episodes of mania and depression.
However, recent research suggests around 20% of patients with no known history of psychiatric illness express their first bipolar symptoms during the perinatal experience. As part of its new guidelines, ACOG recommends at least one bipolar screening before starting pharmacotherapy for anxiety or depression.
An additional notable change is ACOG’s revised advice to begin interventions early and continue them throughout care journeys.
Where intelligent care enablement can play a helping hand
Committing to renewed standards of mental healthcare for maternal patients is a positive first step for fostering more equitable, safer care experiences. But, in reality, implementing forward-thinking strategies to make this vision a reality requires investment in time, resources, and sweeping organizational changes.
That’s where intelligent care enablement — scalable technology that supports patients and providers through complex clinical episodes — can help simplify the process. Memora Health’s platform is particularly equipped to support maternal patients for the long term — proactively following up and screening them for mental health conditions, all while giving providers the insights they need to effectively intervene.
Some particular advantages of Memora’s technology include:
1. Optimizing mental health screenings cadence
Per ACOG’s updated recommendations, the minimum frequency with which providers should screen patients has tripled. However, to accomplish this with traditional infrastructure, care teams would need to put in extra hours and heap on tasks to their (already numerous) daily routines. For many health systems — some of which confront dwindling resources and record staff burnout — the idea of stretching their clinicians in this manner is unfeasible.
Screening patients three times during pregnancy and twice postpartum, Memora Health’s conversational AI makes this robust cadence possible and manageable. Maternal care units need an intelligent, proactive platform to extend their reach without overextending their bandwidth. With automated mental health screenings sent via text message, individuals receive mental health support tailored to their care journeys, right where they are and when it matters most.
2. Enhancing quality and access of perinatal care
Beyond the number of touchpoints care teams need to have with their patients, ensuring the quality of those touchpoints for all patients is increasingly important for delivering excellent care. And as leaders in maternal mental health continue to improve their guidelines, providers will need to be increasingly vigilant about their patients’ statuses to understand what they need — especially when they’re at home or away from the clinical setting.
Memora Health uses native text messaging to ensure any patient with a basic cellphone can opt in. But it also arms clinicians with remote patient monitoring data and accessible patient messaging histories. Doctors can tag specialists and other care team members within one dashboard to enable them to view these insights and coordinate appropriate interventions. Furthermore, Memora partners with providers to establish automated triaging of the most urgent care concerns — meaning maternal patients facing acute mental health conditions get the help they need as soon as possible.
Memora Health’s conversational AI accurately addressed over 70% of spontaneous postpartum patient messages at Penn Medicine. Read the full case study.
3. Helping forge trusting patient-provider relationships
Confronting mental health conditions is an isolating and uncomfortable experience for maternal patients. But even as providers put more strategies in place to support them, building trust is an essential ingredient for ensuring the effectiveness of these interventions.
Automation can sometimes feel sterile. But by using advanced natural language processing (NLP), Memora’s platform receives and responds to unprompted messages throughout the perinatal care journey, answering routine questions quickly and accurately — while escalating more complex care concerns to patients’ maternal care providers. Talking with individuals at a human level is critical for connecting with those in the throes of maternal mental health battles — especially when they feel most vulnerable. And our technology is designed to do so to foster more trust between patients and care teams.
Improving maternal mental health for all isn’t an easy goal — especially given where we are and how much progress needs to be made. But by understanding contemporary guidelines and putting them into practice with the help of efficient technologies, health systems can begin to change course.
Ready to see how Memora Health’s platform can help you support your maternal patients’ mental health? Speak with one of our experts today!