As a Certified Nurse Midwife, people often assume the most critical issues I deal with are physical complications, like hemorrhage, infection, or high blood pressure. They’re surprised, even shocked, when I tell them that the leading cause of maternal mortality in Colorado is suicide.

There’s a common perception that pregnancy is the happiest time in a person’s or family’s life. But for many, it’s also a time of mixed emotions, isolation, anxiety, and overwhelming change. The truth is, perinatal mental health conditions (PMHCs)—like depression, anxiety, and substance use disorders—are the most common complications of pregnancy and childbirth. And they’re far too often unrecognized and undertreated.

That’s why the Colorado Perinatal Care Quality Collaborative (CPCQC) has made maternal mental health a top priority across all of our quality improvement (QI) initiatives. Instead of treating perinatal mental health conditions (PMHCs) as a separate issue, CPCQC has chosen to integrate mental health into every aspect of our work, from labor and delivery to postpartum care and beyond.

Whether it’s promoting trauma-informed care during unplanned or emergency Cesarean births, enhancing care for families affected by perinatal substance use, strengthening postpartum discharge transitions, or building a seamless continuum of community-based support, every CPCQC initiative embeds universal mental health screening, structured patient-provider debriefs, and integration of behavioral health services.

For example:

• The upcoming SPARK postpartum discharge transitions initiative (launching July 2025) helps hospitals implement standardized postpartum discharge workflows with built-in suicide prevention training, universal mental health and intimate partner violence screening, and early connections to care.

• Turning the Tide, our perinatal substance use initiative, uses a dyadic approach, pairing maternal and infant health, and incorporates standardized mental health screening, peer recovery support, and stigma and bias training for healthcare teams.

• SOAR, our primary Cesarean reduction initiative, includes respectful care training, labor support workshops, and patient-centered debriefs for unplanned surgical births, recognizing the psychological impact of the birth experience itself.

• IMPACT BH, our behavioral health integration program, supports hospitals and clinics in building strong partnerships with outpatient healthcare providers, peer specialists, and community organizations, closing critical gaps in the maternal mental health care continuum, ensuring families receive timely, culturally responsive support beyond the hospital setting.

Our approach is rooted in collaboration. Lived experience experts help shape our strategies. Hospitals participate in regular learning sessions. And community partners co-develop culturally relevant resources that address longstanding disparities in access and outcomes.

At CPCQC, we believe mental health is maternal health, and we’re working to normalize it as a routine, expected part of perinatal care. Through collaboration, data-driven improvement, and the voices of patients and families, we’re creating a more just, responsive, and supportive perinatal system in Colorado.

By embedding mental health into every QI initiative, CPCQC is reframing what quality perinatal care truly means: not just preventing physical complications, but ensuring people have the emotional and psychological support they need during one of life’s most vulnerable transitions.

So we ask you: What would perinatal care look like if mental health were treated as essential as blood pressure monitoring? 

What’s one small step your team can take today to make mental health a central part of perinatal care?