Normalize Mental Health During Pregnancy: Providers say ‘Start these discussions early’

Photo By Jason W. Edwards | Air Force Col. (Dr.) Veronica Gonzalez-Brown, Chair, Department of Gynecologic Surgery & Obstetrics, performs an ultrasound scan on patient, Tynice Gardner, at Brooke Army Medical Center, Fort Sam Houston, Texas, Jan. 27, 2022. Ultrasound scans uses high-frequency sound waves to create images of the inside of the body and are often used to evaluate fetal development. (U.S. Army photo by Jason W. Edwards)  

BETHESDA, MD, UNITED STATES

01.23.2023

Story by Sarah Marshall 

Uniformed Services University

*Erica Smith had a history of postpartum depression as well as severe depression. The mother of three had previously suffered from depression, and was recently diagnosed with placenta accreta, a serious condition that occurs when the placenta grows too deeply into the uterine wall during pregnancy, and can cause severe blood loss after delivery. During this pregnancy, Erica stopped taking her antidepressant medication, despite her doctor’s advice. She struggled to cope with her mental illness and the stress of her placenta accreta diagnosis and had a hard time finding joy in her pregnancy. It wasn’t until after her fourth child was born that she went back on her medication, and started feeling more like herself.

For patients like Erica, it’s often a normal reaction to want to go off medication at the beginning of a pregnancy. However, for most individuals, continuing medication is the safest option, especially with increased stressors or having a difficult delivery such as an unexpected diagnosis, changes to a birth plan, or an unexpected cesarean delivery. It’s also normal to need support during and after pregnancy, and to need additional care moving forward for future pregnancies, especially if there were stressful or unexpected events at birth, explains Dr. Monica Lutgendorf, chair of USU’s Department of Gynecologic Surgery & Obstetrics.

“Making patients aware of the potential emotions and feelings that they might experience is really important,” Lutgendorf says. “It’s really important to offer help and encourage patients to start doing counseling or therapies, especially after a really traumatic or stressful delivery.”

More than 80 percent of maternal deaths in the U.S. are preventable, and 23% of pregnancy associated deaths (in the first year after delivery) are due to maternal mental health conditions like suicide, overdose, poisoning, or substance use disorders, according to the Centers for Disease Control and Prevention. Therefore, Lutgendorf says, it’s particularly important for providers to address and be sensitive to mental health during and after pregnancy. Start these conversations early on, and continue to offer support throughout pregnancy and after delivery, she advises.

“As much as we wish for our patients that things will be easy, sometimes that’s not possible,” she says. “It’s so important for us as health care providers to identify these issues early and to be proactive, and then normalize getting treatment and getting help.”

As a maternal-fetal medicine provider, Lutgendorf makes sure her patients feel comfortable talking about not only their physical health, but also their overall mood and their mental health. When a patient feels as though they can be open and honest with what’s going on, this can be helpful in getting patients the help they need, she says.

The first step is initiating these discussions with patients, she says, but then these should continue to take place as long-term conversations, and be part of the patient’s journey. For patients with a history of mental illness, who might be taking antidepressants, for instance, it’s important to address any concerns or fears they might have with continuing to take their medications during their pregnancy – it’s not always beneficial to stop taking medications, Lutgendorf explains. There are many medications that are safe and effective for pregnant individuals to take. Lutgendorf doesn’t force the issue of medications during pregnancy, but she always makes sure patients are aware of the risks and benefits, especially when it comes to untreated mental health conditions, and how that could impact pregnancy.

“Talk with your provider about the risks and benefits [of taking medication during pregnancy], your personal medical history, your mental health history, and whether it makes sense to stop taking medication during pregnancy because those risks are low overall, and whether there’s maternal benefit for taking the medication during pregnancy,” she says. “We know that some medications can cause a transient neonatal withdrawal, but in the grand scheme of things, the risk could be quite low for babies.”

During perinatal appointments, Lutgendorf also notes that it’s important for providers to listen to their patients and hear their story, so that they know whether there’s a history of mental illness, postpartum depression, or prior traumatic birth experiences. Knowing a patient’s story, and being able to talk about these issues, can help get to the root cause of an issue. For instance, a patient with gestational diabetes who is struggling to monitor their glucose might have stopped taking their ADHD medication because they were afraid of how it could harm their baby. But now, they cannot track their insulin without getting distracted. In this case, providers could help the individual find another medication or counseling that has a better balance for mother and baby to better focus and manage things like diabetes, while also being able to find joy in the pregnancy. Lutgendorf says these are conversations that should take place early on to ensure patients are aware of all their options, which can ultimately impact their overall mental health and wellbeing.

Lutgendorf adds that there are available resources for expecting individuals in the Military Health System, such as Military OneSource. Also, the Health and Human Services Department’s Health Resources and Services Administration has also launched a Maternal Mental Health Hotline, which expecting and new moms can call if they’re experiencing mental health challenges.

“We as family members, providers, and friends, should be bringing up and having these discussions, so that we can prevent a lot of these pregnancy-related deaths, which occur within the first year after delivery,” Lutgendorf says. “This is such an important topic … Being open and honest can be really helpful, and just being there and being there for the [patient’s] journey is really important.”

* Not patient’s real name

• Date Taken: 01.23.2023
• Date Posted: 01.24.2023 09:23
• Story ID: 437135
• Location: BETHESDA, MD, US