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Federal Panel Prescribes New Mental 国产精品视频 Strategy To Curb Maternal Deaths

Federal Panel Prescribes New Mental 国产精品视频 Strategy To Curb Maternal Deaths

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BRIDGEPORT, Conn. 鈥 Milagros Aquino was trying to find a new place to live and had been struggling to get used to new foods after she moved to Bridgeport from Peru with her husband and young son in 2023.

When Aquino, now 31, got pregnant in May 2023, 鈥渋nstantly everything got so much worse than before,鈥 she said. 鈥淚 was so sad and lying in bed all day. I was really lost and just surviving.鈥

Aquino has lots of company.

Perinatal depression affects as many as 20% of women in the United States during pregnancy, the postpartum period, or both, . In some states, anxiety or depression afflicts nearly a quarter of new mothers or pregnant women.

Many women in the U.S. go untreated because there is no widely deployed system to screen for mental illness in mothers, despite widespread recommendations to do so. Experts say the lack of screening has driven higher rates of mental illness, suicide, and drug overdoses that are now the leading causes of death in the first year after a woman gives birth.

鈥淭his is a systemic issue, a medical issue, and a human rights issue,鈥 said Lindsay R. Standeven, a perinatal psychiatrist and the clinical and education director of the Johns Hopkins Reproductive Mental 国产精品视频 Center.

A group photo of Milagros Aquino (center, seated) with community health worker Massiel Olivo (left) and Jacqueline Carrizo (right).
Milagros Aquino (seated) with community health worker Massiel Olivo (left) and Jacqueline Carrizo, a doula who was assigned to her by the Emme Coalition. Aquino began experiencing depression symptoms about 11 weeks into her pregnancy. She says Carrizo was an important part of her recovery.(Massiel Olivo)

Standeven said the root causes of the problem include racial and socioeconomic disparities in maternal care and a lack of support systems for new mothers. She also pointed a finger at a shortage of mental health professionals, insufficient maternal mental health training for providers, and insufficient reimbursement for mental health services. Finally, Standeven said, the problem is exacerbated by the absence of national maternity leave policies, and the access to weapons.

Those factors helped drive a in postpartum depression from 2010 to 2021, according to the American Journal of Obstetrics & Gynecology.

For Aquino, it wasn鈥檛 until the last weeks of her pregnancy, when she signed up for acupuncture to relieve her stress, that a social worker helped her get care through the Emme Coalition, which connects girls and women with financial help, mental health counseling services, and other resources.

Mothers diagnosed with perinatal depression or anxiety during or after pregnancy are at about three times the risk of suicidal behavior and six times the risk of suicide compared with mothers without a mood disorder, according to recent U.S. and international studies in and .

The toll of the maternal mental health crisis is particularly acute in rural communities that have become maternity care deserts, as small hospitals close their labor and delivery units because of plummeting birth rates, or because of financial or staffing issues.

This week, the Maternal Mental 国产精品视频 Task Force 鈥 co-led by the Office on Women’s 国产精品视频 and the Substance Abuse and Mental 国产精品视频 Services Administration and formed in September to respond to the problem 鈥 that could serve as hubs of integrated care and birthing facilities by building upon the services and personnel already in communities.

The task force will soon determine what portions of the plan will require congressional action and funding to implement and what will be 鈥渓ow-hanging fruit,鈥 said Joy Burkhard, a member of the task force and the executive director of the nonprofit Policy Center for Maternal Mental 国产精品视频.

Burkhard said equitable access to care is essential. The task force recommended that federal officials identify areas where maternity centers should be placed based on data identifying the underserved. 鈥淩ural America,鈥 she said, 鈥渋s first and foremost.鈥

There are shortages of care in 鈥渦nlikely areas,鈥 including Los Angeles County, where some maternity wards have recently closed, said Burkhard. Urban areas that are underserved would also be eligible to get the new centers.

鈥淎ll that mothers are asking for is maternity care that makes sense. Right now, none of that exists,鈥 she said.

Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas, people who provide guidance and support to the mothers of newborns.

In Montana, rates of maternal depression before, during, and after pregnancy are higher than the national average. From 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression, according to the The state had the sixth-highest maternal mortality rate in the country in 2019, when it received a federal grant to begin training doulas.

To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana鈥檚 population. Indigenous people, particularly those in rural areas, have of severe maternal morbidity and mortality compared with white women, according to a study in Obstetrics and Gynecology.

Stephanie Fitch, grant manager at Montana Obstetrics & Maternal Support at Billings Clinic, said training doulas 鈥渉as the potential to counter systemic barriers that disproportionately impact our tribal communities and improve overall community health.鈥

and Washington, D.C., have Medicaid coverage for doula care, according to the National 国产精品视频 Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. Medicaid pays for about in the U.S., according to the Centers for Disease Control and Prevention.

Jacqueline Carrizo, a doula assigned to Aquino through the Emme Coalition, played an important role in Aquino鈥檚 recovery. Aquino said she couldn鈥檛 have imagined going through such a 鈥渄ark time alone.鈥 With Carrizo鈥檚 support, 鈥淚 could make it,鈥 she said.

Genetic and environmental factors, or a past mental health disorder, can increase the risk of depression or anxiety during pregnancy. But mood disorders can happen to anyone.

Teresa Martinez, 30, of Price, Utah, had struggled with anxiety and infertility for years before she conceived her first child. The joy and relief of giving birth to her son in 2012 were short-lived.

Without warning, 鈥渁 dark cloud came over me,鈥 she said.

Martinez was afraid to tell her husband. 鈥淎s a woman, you feel so much pressure and you don鈥檛 want that stigma of not being a good mom,鈥 she said.

In recent years, programs around the country have started to help doctors recognize mothers鈥 mood disorders and learn how to help them before any harm is done.

One of the most successful is the Massachusetts Child Psychiatry Access Program for Moms, which began a decade ago and has since spread to 29 states. The program, supported by federal and state funding, provides tools and training for physicians and other providers to screen and identify disorders, triage patients, and offer treatment options.

But the expansion of maternal mental health programs is taking place amid sparse resources in much of rural America. Many programs across the country have run out of money.

The federal task force proposed that Congress fund and create consultation programs similar to the one in Massachusetts, but not to replace the ones already in place, said Burkhard.

In April, Missouri became the latest state to adopt the Massachusetts model. Women on Medicaid in Missouri are 10 times as likely to die within one year of pregnancy as those with private insurance. From 2018 through 2020, an average of 70 Missouri women died each year while pregnant or within one year of giving birth, according to state .

Wendy Ell, executive director of the Maternal 国产精品视频 Access Project in Missouri, called her service a 鈥渓ifesaving resource鈥 that is free and easy to access for any health care provider in the state who sees patients in the perinatal period.

About 50 health care providers have signed up for Ell鈥檚 program since it began. Within 30 minutes of a request, the providers can consult over the phone with one of three perinatal psychiatrists. But while the doctors can get help from the psychiatrists, mental health resources for patients are not as readily available.

The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce of community mental health workers, patient navigators, doulas, and peer support specialists in areas where they are most needed.

A new in reproductive psychiatry is designed to help psychiatry residents, fellows, and mental health practitioners who may have little or no training or education about the management of psychiatric illness in the perinatal period. A small that the curriculum significantly improved psychiatrists鈥 ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and is one of the study’s authors.

Nancy Byatt, a perinatal psychiatrist at the University of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Moms in 2014, said there is still a lot of work to do.

鈥淚 think that the most important thing is that we have made a lot of progress and, in that sense, I am kind of hopeful,鈥 Byatt said.

Cheryl Platzman Weinstock鈥檚 reporting is supported by a grant from the National Institute for 国产精品视频 Care Management Foundation.