Working Together to Reduce Maternal Suicide

By Kylie Hibshman, LCSW, PMH-C, CPCQC Director of Integrated Behavioral Health and Continuum of Care

September 14, 2023

This National Suicide Prevention Month, CPCQC joins communities across the United States to raise awareness, spread hope, and share vital information about suicide. Suicide is one of the leading causes of death in the U.S. that disparately impacts people of color, people living in rural communities, members of the LGBTQ+ community, veterans, and Indigenous people—especially if they are pregnant or postpartum. 

Last week, the Colorado Department of Public Health and Environment released the Colorado Maternal Mortality Review Committee (MMRC) legislative report. The sobering report reviews the leading causes of death for pregnant and postpartum people in Colorado from 2016 – 2020. While unintentionally aligning with National Suicide Prevention Month, the recently released report adds urgency to CPCQC’s efforts to improve perinatal behavioral health services across the state. 

Understanding the Maternal Suicide Crisis in Colorado 

The MMRC found that suicide was the leading cause of pregnancy-associated death in Colorado from 2016 – 2020. Pregnant and postpartum people were over twice as likely to die from suicide than the general population of women of reproductive age in Colorado. In addition, the committee found that mental health contributed to 40% of all pregnancy-associated and pregnancy-related deaths from 2016 – 2020. As the MMRC explained in the report, “Suicide can be determined to be related to the pregnancy in various ways, including pregnancy-related depression or anxiety that leads to suicide, or the inability to access wanted reproductive health care, such as abortion, as a driver of subsequent suicide.”

Perinatal mood and anxiety disorders (PMADs) frequently co-occur with substance use. Pregnant and postpartum people may use substances to cope with stress or manage unmet mental health needs. Unintentional overdose is the leading cause of pregnant and postpartum people in the United States, accounting for 1,586 deaths from 2010-2019.  In Colorado, the MMRC found that unintentional overdose via synthetic opioids was the second leading cause of pregnancy-associated death during the report period. Substance use contributed to 40% of pregnancy-associated and pregnancy-related deaths. 

The Need for Universal Screening

The MMRC report underscores the need for universal perinatal mental health and substance use screening, brief intervention, and referral to care for all birthing people across Colorado. The perinatal period provides a unique opportunity to connect individuals struggling with mental health and substance use disorders to care. The American College of Obstetrics and Gynecologists recommends that all perinatal individuals are screened for perinatal mood and anxiety disorders. However, universal screening for PMADs is not required in Colorado, increasing the likelihood that pregnant and postpartum individuals struggling with mental health or substance use disorders remain outside of care–impacting their wellbeing and the wellbeing of their infant(s). 

Advocating for Perinatal Mental Health Solutions

CPCQC works across the perinatal continuum of care to improve perinatal mental health and substance use outcomes in Colorado. Together with the Colorado Behavioral Health Administration, CPCQC implements the Improving Perinatal Access, Coordination, and Treatment for Behavioral Health (IMPACT BH)  program to address maternal outcomes by: 

• Investing in Community Solutions: funding community-based organizations piloting innovative peer support, community health worker, and care navigation programs for birthing people and their families 

• Improving Screening Rates: partnering with outpatient birthing clinics and hospitals to increase perinatal mood and anxiety disorder (PMAD) and substance use disorder (SUD) screening rates through CPCQC’s Colorado AIM: Substance Use Disorder Learning Collaborative (CO AIM: SUD) and the CU Practice Improvement Program. 

• Increasing Access to Treatment: providing rural outpatient birthing clinics access to coordinated care services and PMAD-trained telemental health clinicians through the Parent & Family Wellness Center’s provider leasing program

• Improving Birth Provider Responses to Substance Use: working through the CO AIM: SUD, MOMs+, The Naloxone Project, and the MOMS Initiative to help outpatient clinics and birthing hospitals provide equitable access to treatment and recovery services for perinatal patients with substance use disorders

Preventing Suicide – A Call to Action

As a Collaborative, CPCQC recognizes that we cannot do this work alone. Improving outcomes for pregnant and postpartum people–especially those experiencing the greatest disparities–requires collectively investing in systems-level change. From policy to collective impact initiatives, CPCQC is committed to advancing data and equity-driven solutions to address maternal suicide across the state. 

 We invite you to join us as we collectively work to improve infant and maternal outcomes. 

• Advocate for perinatal mental health solutions by taking the Perinatal Continuum of Care Toolkit for Action Workshop and implementing the IMPACT BH Toolkit in your community 

• Help prevent suicide by completing a free suicide prevention training and spreading the word about the National Suicide & Crisis Support Hotline (988) and the National Maternal Mental Health Hotline

• Help reduce unintentional overdose by learning more about and carrying free Naloxone

Help and Resources for Those in Crisis

Are you or someone you know struggling with suicidality? Help is available. Call 988 or visit www.988lifeline.org to access suicide prevention resources near you.