We are failing our most vulnerable moms; here's how to fix it

Mother's Day is fast approaching, a time when our focus turns to showing love to our moms with candy and flowers.

But the reality of motherhood is neither sweet nor rosy for a growing segment of Americans — namely, expectant women and their babies who are going through complicated pregnancies.

As we can all relate, the bond between a mother and child is foundational. It is powerful and unconditional. It starts from the second a mom sees her positive pregnancy test, or hears her baby's heartbeat for the first time.

You may be surprised that a national study of women [ages] 18 to 44 showed that complicated pregnancies are growing more prevalent in the United States, rising by 16.4 percent between 2014 and 2018. The same study, which looked at 1.8 million pregnancies, revealed childbirth complications increased by 14.2 percent and postpartum depression diagnoses grew by nearly 30 percent.1

Based on my 20-plus years caring for high-risk pregnant women, as well as my interactions with my fellow maternal-fetal medicine specialists from coast to coast, I believe America's hospitals and healthcare systems are largely failing moms and babies who need the highest level of care.

Before examining our shortcomings and potential solutions, let’s explore the underlying problem. While 80 percent1 of women have healthy pregnancies and deliveries, the others have one or more risk factors that can cause serious complications. For those moms, trouble can stem from heart disease, high blood pressure, diabetes or excess body weight. For babies it can come in the form of genetic or chromosomal abnormalities, or structural defects of the spine, heart or other vital organs.

These can pose life-altering and life-threatening consequences for mothers, both physically and mentally. Managing the situation can be extremely stressful for moms and can also affect their babies, both before birth and in their first few years of life.

This is where an important and often underappreciated part of the problem comes into play. An emerging field of study called epigenetics looks at how behavior and environment can affect the way a person’s genes work. Of particular interest in the field of complex pregnancies is the epigenetic effect that a mom’s mental health can also have on her baby, both during pregnancy and during the early, formative years of life.

A recent study published in the journal JAMA Pediatrics suggests that maternal depression and anxiety during the perinatal stage — spanning from conception through the baby’s first year of life — is associated with negative developmental outcomes in offspring through adolescence, including deficits in cognitive, language and motor development.2

This has important implications, because 15 percent to 23 percent of women worldwide experience anxiety during pregnancy3, and 15 percent experience it after giving birth.In the U.S., about one in eight women experience symptoms of postpartum depression and the rate of depression diagnoses at delivery has risen substantially in recent years.5

This brings us to one of the major failures of our nation’s healthcare system today — too often we don’t have the right team in place and organized in the best way to care for high-risk pregnant women. When a woman receives an unsettling diagnosis that her pregnancy has entered complicated territory, she is frequently left out on her own until her next appointment.

Questions arise between visits, with limited options to receive answers. Feelings of uncertainly and fear can set in. Stress can escalate into mental health issues like anxiety and depression, affecting mother and child alike.

To help keep patients from falling into this dangerous spiral, Scripps Health, where I work, recently added an important new role to our comprehensive maternal-fetal medicine program. It’s a position that I've observed to be rare in high-risk pregnancy clinics — a complex care coordinator, who takes on the role of patient navigator, a resource more commonly seen in cancer and organ transplant clinics.

This coordinator is available to every one of our high-risk patients — not only to ensure they receive necessary testing and follow-up care, but also to answer other questions as they arise. Our coordinator also ensures patients undergo ongoing recommended mental health screenings that are critical to identifying which patients need additional help, and even keeps an eye out for warning signs that may emerge between screenings so we can intervene as needed.

We now arrive at a significant bottleneck in caring for high-risk pregnant women: inadequate access to mental health services. A recent report from USAFacts, a clearinghouse for U.S. government data, shows that 37 percent of Americans live in areas with a shortage of mental health professionals and that the nation needs an additional 6,398 mental health professionals to fill the gaps.6

But perseverance can lead to solutions.

In May 2022, Scripps will begin a unique collaboration with a local nonprofit organization to expand access to mental health therapists for our high-risk pregnancy patients, with the goal of identifying those who need care and getting them into counseling within 72 hours of diagnosis.

By embedding a complex care coordinator inside our clinic and teaming with community partners for additional mental health resources, we’re building a bridge to connect vulnerable patients to more of the care they need. While we have much more work ahead and are continuously looking to improve, I believe our approach of seeking solutions inward and outward can serve other health systems well as they strive to improve their level of care.

This Mother's Day, we need more than bouquets and bonbons. I'm asking for this country to move beyond the status quo and find ways to improve care for complex pregnancies. Put in place specialized teams to surround and support these patients, and ensure mothers and mothers-to-be who need mental health services receive them in a timely fashion.

We have a responsibility to provide the care so desperately needed by these moms, babies and families. Their very futures hang in the balance.

Dr. Daneshmand is medical director of the maternal-fetal medicine program at San Diego-based Scripps Clinic, and treats high-risk pregnancy patients at Scripps Health's hospitals and outpatient centers in San Diego.

Footnotes:

1 -- https://www.bcbs.com/the-health-of-america/reports/trends-in-pregnancy-and-childbirth-complications-in-the-us

2 -- https://jamanetwork.com/journals/jamapediatrics/fullarticle/2770120, and https://www.cnn.com/2020/09/15/health/maternal-mental-health-childhood-development-wellness/index.html 

3 -- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343118/

4 -- https://pubmed.ncbi.nlm.nih.gov/28302701/

5 -- https://www.cdc.gov/reproductivehealth/features/maternal-depression/index.html

6 -- https://usafacts.org/articles/over-one-third-of-americans-live-in-areas-lacking-mental-health-professionals/#:~:text=Viewpercent20Report-,Overpercent20onepercent2Dthirdpercent20ofpercent20Americanspercent20livepercent20inpercent20areaspercent20lackingpercent20mental,mentalpercent20healthpercent20professionalpercent20shortagepercent20area.

 

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