While many women find pregnancy and the birth of a child exciting, joyful, and happy, many women also struggle with depression, anxiety, or other mental health conditions. If you are one of the women who struggles with their mental health during pregnancy or postpartum, you may have also had additional pregnancy or labor and delivery complications, struggled to bond with your baby, or had an increased risk of substance abuse problems. Untreated postpartum depression can become chronic and impact your long-term health and well-being. Women who experience postpartum psychosis may neglect or harm themselves or their baby and are at an increased risk of experiencing mental health issues outside of pregnancy or the postpartum period. There is a stigma associated with mental health that makes many women hesitant to bring up concerns with their doctor. However, doctors could still identify women who may be struggling by offering at least one mental health screening to all pregnant patients. If you took a screening as a pregnant patient and tested positively for mental health issues, or if you raised concerns regarding your mental health with your doctor, and did not receive referrals for assistance or other information to address the issues, you might have a claim for medical negligence. Call (505) 218-9949 to schedule a consultation with an experienced New Mexico maternity injury attorney and community advocate at Erin Marshall Law and learn more about your legal rights and options.
What Are Perinatal Mood and Anxiety Disorders?
According to the University of New Mexico Health Sciences, perinatal mood and anxiety disorders (PMADs) is the term used to describe the onset, recurrence, or exacerbation of new or existing mental health concerns while someone is pregnant or during the postpartum period after they have given birth. PMADs are used in particular to describe depression and anxiety-related symptoms.
Many PMADs are the result of a combination of hormonal fluctuations, physical changes, and psychosocial stressors associated with pregnancy, childbirth, and caring for a new baby. During pregnancy, progesterone and estrogen shift dramatically, while both hormones drop rapidly after birth. These shifts and drops can both contribute to symptoms of depression and mood swings, as can a decrease in thyroid hormone after childbirth. Additionally, the rapid and sometimes uncomfortable physical changes a pregnant body goes through, combined with the experience of labor and delivery, can make a pregnant patient feel as though they have completely lost control over their body, especially if there are complications. Feeling as if they have no control over their body may also contribute to anxiety and depression symptoms.
Why Is Mental Health Screening So Important for Pregnant Patients?
Mental health screening is vital for everyone, but it is imperative for pregnant patients. A pregnant patient is at higher risk of developing or experiencing mental health conditions like depression or anxiety. This is due to the significant physical and emotional changes that pregnancy brings. Untreated mental health issues can harm the mother’s well-being and the baby’s development. Complications such as low birth weight, premature birth, and developmental delays may result from a lack of mental health treatment.
Mental health screening allows for early detection and intervention when needed, improving mother and child outcomes. While a pregnant patient may be concerned about taking medication to treat their mental health, other interventions may be available as well, such as therapy and other support services. Screening also facilitates a stronger mother-baby bond and addresses the stigma that is still unfortunately associated with mental health conditions. If you were not screened during pregnancy or you raised concerns with your doctor that were ignored or brushed off, Erin Marshall Law may be able to review your case and determine whether you may have a maternity injury compensation claim.
What Screening Tools Are Used?
There are no medical diagnostic tests for mental health conditions. Blood tests, magnetic resonance imaging (MRI), or similar tests cannot detect these conditions. Instead, the only mental health screening tool available is a questionnaire. To screen a pregnant patient or any other patient for mental health, healthcare providers can give the patient a written questionnaire for the patient to fill out or ask the patient the questions orally. Some providers feel patients are more honest when filling out the questionnaire. In contrast, others believe that by verbally asking the patient, they can listen to the tone of voice and notice other body language that indicates whether the patient may not be providing candid answers.
The American College of Obstetricians and Gynecologists recommends mental health screening for pregnant or postpartum patients at the initial prenatal or obstetrician visit, at least once during the second or third trimester, and at least once during the postpartum period. They also suggest doing these screenings at well-woman and prepregnancy visits. They also recommend that the screening be implemented with systems in place to ensure timely access to assessment, diagnosis, treatment, monitoring, and follow-up based on the severity of the individual’s condition.
What Efforts Has New Mexico Made to Ensure Adequate Mental Health Screenings of Pregnant Patients?
In New Mexico, mental health contributes to 36% of pregnancy-related deaths. According to the Centers for Disease Control and Prevention, only 9% of pregnancy-related deaths nationwide have mental health as an underlying cause. Based on these numbers, it is evident that New Mexico needs to make some significant changes to improve maternal mental healthcare. The state has already taken some steps to do so. First, they have addressed one of the most common reasons a pregnant patient may not get a mental health screening: lack of adequate insurance coverage. While New Mexico has long provided Medicaid to pregnant patients, they recently extended coverage to one full year after childbirth. This can make a significant difference for postpartum mothers who might otherwise ignore their mental and physical health because they cannot afford it, particularly Black and Native American mothers who are more frequently affected by mental health issues during pregnancy and postpartum than White mothers.
Additionally, the New Mexico Department of Health joined the New Mexico Behavioral Health Collaborative, which is intended to serve as a single, statewide behavioral health delivery system to manage funds efficiently and effectively. As such, they are following a State Action Plan created with the Health Resources and Services Administration, which calls for a contract with a single statewide services purchasing entity, service capacities monitoring, and utilization to achieve goals such as increasing access to perinatal care for women with the highest medical, economic, or social needs and using formalized partnerships to increase mental health screening during and after pregnancy. This action plan also emphasizes cultural, frontier, rural, urban, regional, and other issues and seeks input from Native American residents throughout New Mexico.
What Additional Steps Could Be Taken to Increase Pregnant and Postpartum Mental Health Screening?
While New Mexico has already made progress in increasing mental health screening for any pregnant patient who visits a healthcare provider, the state can still take further steps to improve access to screening. While some steps could be implemented easily with little additional effort or planning, others require time, funds, planning, or all three to execute effectively.
Extend and Enhance Medicaid Services for Some Pregnancies
New Mexico’s Health Care Authority reported in April 2022 that the state was expanding Medicaid services for postpartum care from 60 days after childbirth to one full year after birth. This has improved care for postpartum mothers, but it is still not enough for some. One way to ensure a pregnant patient or postpartum mother does not slip through the cracks is to extend and expand Medicaid Services for high-risk pregnancies. As high-risk pregnancies are also more stressful on the mother, these pregnant patients are at increased risk of mental health issues such as depression and anxiety. By extending Medicaid to two years after childbirth for these high-risk pregnancies, more women who screen positively for a mental health concern will be able to access care and address the issue.
Additionally, this extension will impact the communities that need it most. Women of color, specifically Black and Native American women, have disproportionately high rates of maternal mortality, experience structural and interpersonal racism or implicit bias, and experience disruptions in postpartum health insurance, all of which negatively impact their mental health and can contribute to a high-risk pregnancy. With expanded Medicaid coverage, these women will have more time to address their mental health without worrying about how to pay for it or what they will do when their coverage ends.
Screen for Maternal Depression During Infant or Other Pediatric Visits
Most often, a pregnant patient will get a mental health screening when she sees her obstetrician, if she gets one at all. While this can be an effective and efficient way to handle these screenings, it may not be the best method in New Mexico. New Mexico is well-known for being a maternal healthcare desert, with the March of Dimes reporting that 33.3% of New Mexico counties are maternity care deserts, compared to 32.6% nationwide. They also indicate that 23.3% of New Mexico’s pregnant patients received inadequate or no prenatal care, compared to the national average of 14.8%. Therefore, limiting mental health screening to the obstetrician’s office means that many patients who desperately need it may never get it.
Instead of only screening at prenatal or postpartum visits, healthcare providers could screen for maternal depression during infant well-visits or other pediatric visits. Even when mothers are unwilling or unable to care for themselves, they will still ensure their children are cared for. By taking a few extra minutes during an infant checkup or a pediatric visit for an older child, pediatricians or other healthcare providers could identify mothers who are struggling with their mental health and direct them to the necessary resources to assist them.
Promote Culturally Relevant Supports to Pregnant Patients
Modern healthcare in the United States often feels like a factory conveyor belt. Patients go to the doctor, are given medications and recommendations that are generalized and may not even apply to their circumstances, and are then sent on their way. For Black and Native American women, who experience much higher rates of maternal death and often have more high-risk pregnancies than white women, this can contribute to pregnancy complications. Even when healthcare providers are aware of this disparity, they still frequently treat Black and Native American women no differently than they would a White woman.
However, offering culturally relevant supports to Black and Native American pregnant patients could make a substantial difference in the outcomes of their pregnancies. For example, Black women may feel more comfortable with a midwife’s more holistic and personalized approach if they have had negative experiences with traditional healthcare. Native American women may want to incorporate traditional Native American medicine and healing in their prenatal or postpartum care. Healthcare providers may have better outcomes with a pregnant patient if they allow her to engage in ceremonies, rituals, or herbal remedies based on her culture where appropriate. In cases where the patient cannot engage in a culturally-relevant support, such as preeclampsia or a medically necessary C-section, providers should try to take a few moments to explain the circumstances and why the support cannot be included.
Expand the Number of Specialty-Trained Mental Health Providers
New Mexico suffers from a shortage of providers in almost all practice areas and in all regions of the state. This is true of mental healthcare as well, with a substantial lack of psychiatrists and behavioral health providers who are specialty-trained. Many providers are leaving the state due to low reimbursement costs, higher malpractice insurance premiums, and increased administrative burdens.
The state could improve the mental health screening process by expanding the number of specialty-trained psychiatrists and behavioral health providers. This would likely require raising reimbursement costs, finding a way to lower malpractice insurance premiums, and reducing the administrative burdens providers currently face.
Utilize Telehealth Services to Provide Access in Rural and Underserved Areas
Telehealth services, which became quite popular during the pandemic, substantially improve access to healthcare services. Rural and underserved areas could particularly benefit from telehealth services, as these can be used from the comfort of home on a computer, tablet, or phone. Individuals without internet access at home can go to a neighbor, friend, or relative’s home or a nearby library to access services rather than potentially taking public transportation or relying on someone to drive them longer distances to attend in-person appointments.
While telehealth services are not appropriate for all healthcare, they can be beneficial for mental health screening and can be used by a pregnant patient to determine whether a specific concern may require an in-office visit. This can save these patients significant time, effort, travel expenses (such as gas or bus fare), and anxiety by allowing them to receive care from home. Additionally, it can increase the chances that those patients who screen positively for mental health concerns will follow through with treatment if that treatment can be offered via telehealth services.
Develop Universal Screening Protocols Across Every Clinical Setting Where Pregnant Patients May Present
While the obstetrician’s office may seem like the most obvious and convenient place for a mental health screening for a pregnant patient, because it can be difficult for New Mexico pregnant patients to find prenatal care, limiting such screening in this way significantly reduces the chances that the patients who are most in need of the screening are least likely to get it. Instead, New Mexico should develop universal screening protocols in every clinical setting where a pregnant patient may present. This includes hospitals, emergency rooms, primary care offices, specialists’ offices such as dermatologists or cardiologists, dentist offices, urgent care clinics, and pediatricians’ offices. By ensuring that any healthcare provider who comes into contact with a pregnant patient can offer a mental health screening, the odds of identifying and being able to assist those patients who need mental health care are significantly increased.
Create and Establish a Clear Protocol for Handling Positive Screenings
When a pregnant patient screens positively for mental health concerns, New Mexico should have an established, clear protocol for how to proceed. This protocol should address matters such as how to tell the patient the results of the screening, how to determine when to refer them to a mental health professional and who to refer them to, and ensuring that all healthcare providers are kept in the loop regarding the patient’s mental health going forward. This protocol should be consistent in all healthcare settings across New Mexico to ensure the highest standard and most continuity of care.
Support and Expand Doula Use During Pregnancy and Postpartum Period
Doulas provide emotional and practical support to pregnant patients during their pregnancy, labor and delivery, and postpartum. Many patients, particularly women of color who have had one or more negative experiences with other healthcare providers, may feel more comfortable with a doula’s services. Doulas offer information and education on pregnancy, labor and delivery, and postpartum and collaborate with traditional healthcare providers. They do not provide medical advice or perform medical tasks, but they often spend more time with the pregnant patient due to their role. They can offer insights into the patient’s mental state or persuade them to seek or accept treatment from a traditional healthcare provider when hesitant.
By supporting and expanding the use of doulas, New Mexico can provide additional support to pregnant people while also reducing some of the load on healthcare providers. At the same time, doulas can bridge a gap that often allows mental health to go unnoticed, even if a mental health screening is not done. The time they spend with their patient will enable doulas to get to know the individual’s usual state of mind and mood and to see when it is different and whether it is a short-term difference (such as a mood swing or bad day) or a long-term difference (such as symptoms that indicate depression or anxiety and last longer than just a day or two). The doula can then inform the patient’s healthcare provider of the concern while also gently broaching the subject with the patient so that the healthcare provider can start the treatment process and the patient can be prepared for what may happen next.
Why Should You Hire a Medical Negligence Attorney?
Mental health can impact every area of your life, and the birth of and bonding with your new baby is no exception. If you have untreated depression, anxiety, or other mental health issues during your pregnancy, this can create pregnancy complications, as well as labor and delivery complications or struggles to bond with your child once they are born. As a pregnant patient, a relatively simple mental health screening a few times during your pregnancy and again after your child is born may catch an issue early and allow you to seek treatment before it can negatively impact your relationship with your new baby. If you brought up concerns about your mental health during your pregnancy or postpartum period and your doctor did not listen to you or offer appropriate assistance, you may be eligible to file a claim against the doctor. A maternity injury attorney with Erin Marshall Law may be able to review your case and discuss your options with you during a free consultation. Call (505) 218-9949 to schedule an appointment in our Albuquerque office.
