May 3rd, 2023

Creating a Safe Space For Addressing Maternal Mental Health

By Amber Johnson, DNP, CNM

As a Certified Nurse Midwife at Colorado’s primary safety net institution and quality improvement consultant for Colorado’s perinatal quality collaborative, I address the leading causes of maternal death statewide and work directly with pregnant and birthing people. My clinical role entails guiding individuals through pregnancy and birth, centering on the most vulnerable and sensitive aspects of the human experience.

Reproductive healthcare often focuses on physical interactions, such as conducting physical exams, offering contraception, performing procedures, prescribing medications, and delivering babies. However, this overlooks a critical component of quality care: mental health. Being a midwife involves cultivating relationships with patients as they navigate pregnancy, birth, and parenting, recognizing that the emotional and mental aspects are just as crucial as the physical ones. I chose the path of midwifery after a college professor profoundly stated, “The feelings experienced during one’s birth journey have a lasting impact on their life.” This powerful insight serves as a constant reminder that providing holistic support—encompassing physical, emotional, and mental aspects—during pregnancy and birth is essential for patients’ well-being, both in the present and the future.

Perinatal mood and anxiety disorders are the most common complications during pregnancy and postpartum, more prevalent than conditions like diabetes and high blood pressure, which are routinely screened and medically treated. Despite this, many maternal care providers are proficient in obstetrics but lack competence in addressing behavioral and mental health. Mental health conditions during pregnancy and postpartum, such as depression, anxiety, and psychosis, have far-reaching and lasting effects impacting pregnancy, birth outcomes, and parental bonding and care.

Maternal mental health in America is alarmingly subpar, with maternal suicide rates in Colorado highlighting the severity of the situation—it is a leading cause of maternal mortality. In addition to routine screening for depression and anxiety, my approach to addressing mental and emotional health with patients involves eight foundational words: “You can’t say anything that will scare me.” This message conveys to patients that I am a safe space, and they are not alone.

As a midwife, my greatest fear is a patient who feels unable or unwelcome to discuss their mental health concerns and consequently misses out on potentially life-saving care and treatment. It is the responsibility of healthcare providers to create a safe space and proactively address mental health for every pregnant and birthing person. Routinely screening for mental health conditions during and after pregnancy is well within our scope and responsibility. We must not assume that mental and behavioral health professionals are solely responsible for handling the emotional and mental needs of pregnant and birthing people. As a quality improvement consultant, I am working to make mental health screening in the obstetric setting standard of care for all birthing people in Colorado.

Your words to create a safe space for addressing maternal mental health may differ, but the message should remain consistent. For me, “You can’t say anything that will scare me” has opened doors for patients to share their concerns and allowed me to offer support, tools, and treatment to confront preventable maternal deaths due to suicide head-on.

Amber Johnson, DNP, CNM serves as a quality improvement coach at CPCQC. She supports activities related to evidence-based, data-driven, continuous quality improvement projects in maternal and infant health across the state.

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