By Brianna Wilson

Mental Health Awareness: Maternal Mental Health

About four million people give birth each year in the United States. According to Postpartum Support International, one in seven of those people—approximately 600,000 Americans—will experience perinatal depression. That number does not include those who have miscarriages or stillbirths. 

The University of New Mexico Hospital Journeys Program offers behavioral health services for patients in all stages of their reproductive experience. Some are struggling to conceive; others have miscarried a baby or they are dealing with Perinatal Mood and Anxiety Disorders (PMADs) up to a year after giving birth. 

The UNM Reproductive and Perinatal Mental Health team, made up of psychologists, reproductive psychiatrists, and behavioral health providers, offers a safe place for those patients to talk, work through their symptoms and manage any necessary medications. 

Jennifer Crawford, PhD, PMH-C, an assistant professor in Psychiatry and Behavioral Sciences at The UNM School of Medicine, with a secondary appointment in Obstetrics and Gynecology, said one of the most important steps in the maternal mental health process is finding those patients who need help. 

The UNM Maternal Mortality Review Committee found that mental health is a top contributor to pregnancy-related deaths nationwide. In New Mexico, mental health contributed to 36 percent of pregnancy-related deaths and substance use contributed to 40 percent. 

“To be able to help people who may be feeling alone, in such a huge transitional period of their life, is really an honor. A lot of it comes down to providing a seed of hope to people who may be feeling hopeless, and coming alongside them, helping them find their way to a life worth living and thriving.” 

Jennifer Crawford, PhD, PMH-C, Assistant Professor, Psychiatry and Behavioral Sciences, UNM School of Medicine

What are Perinatal Mood and Anxiety Disorders (PMADs)? 

In the updated Depression and Anxiety Screening Guidelines from The University of New Mexico, PMADs are described as, “onset, recurrence, or exacerbation of mental health concerns, particularly depression and anxiety related symptoms, during pregnancy and postpartum periods.” 

“Some women are at greater risk of developing depression or anxiety during that time period, and unfortunately, around 80 percent of PMADs will go undetected, undiagnosed and untreated,” Crawford said. 

She encourages any expecting or postpartum parent to tell their primary care or pregnancy care providers if they feel like something is off or different and to ask for screening for depression or anxiety—especially if symptoms impact their ability to care for themselves or their baby. 

Signs and Symptoms of PMADs

  • Cheer and happiness disappear quickly after birth
  • Frequent urge to cry
  • Isolation from supportive people
  • Not wanting to leave home, sometimes for several days
  • Deep exhaustion
  • Feeling down all the time or an inability to enjoy anything
  • Excessive worry that something bad will happen
  • Difficulty bonding with newborn

Patients experiencing any of these symptoms or others should ask their health care provider to refer them for behavioral health treatment. As a co-lead on the UNM Perinatal Mental Health Task Force, that is Crawford’s specialty. 

“We have been working on a project for the past year to really increase standardization and frequency of screening for PMADs for pregnant and postpartum patients at UNM,” Crawford said. “That is what helps identify the problem and moves people on to referral and treatment.” 

Crawford said awareness of these disorders has spread exponentially in recent years, with increased funding, education and guidelines from health care providers and professional organizations like the American College of Obstetricians and Gynecologists, as well as people sharing their mental health experiences online. More people are seeking help for depression and anxiety, but Crawford said there are still too many who go on without support and struggle in silence. 

“Untreated mental health conditions and substance use are playing a significant role in the lives of families and their communities during this really sensitive period of the postpartum year,” Crawford said. 

Something as simple as support from health care providers, loved ones, and community members, has the capacity to save and improve thousands of lives. 

“I was not a mom when I started this work, but we all have mothers, we all know mothers,” Crawford said. “We may have sisters and friends who have gone through these things, and I think there can be such a gigantic shift in that transition of life, that we should do everything we can, not just as behavioral health providers, but as a community to support moms and new parents through that.” 

If you are a UNM patient who may need behavioral health services, talk to your UNM health care provider about referring you to Journeys. 

If you or a loved one needs immediate support, call or text 988 for the National Crisis and Lifeline. In case of an emergency, please call 911 or visit your nearest emergency department. The National Maternal Health Hotline can be reached by calling or texting: 1-833-852-6262. Postpartum Support International offers a variety of free virtual support groups as well as resources for new parents, families, and providers 

For UNM Health System employees, click here for a list of mental health resources.  

If you are interested in joining the UNM team that offers this type of support, you can learn more about the UNM School of Medicine Reproductive Psychiatry Fellowship below. 

Reproductive Psychiatry Fellowship

  • Non-ACGME, 1-year fellowship for psychiatrists that have completed a general psychiatry residency
  • The fellowship offers specialty training in perinatal psychiatry, substance use disorders in pregnancy/postpartum, premenstrual dysphoric disorder, and opportunities for electives tailored to fellow interest 
  • Participation in the National Curriculum for Reproductive Psychiatry
  • Opportunities for specialty psychotherapy training

Read More Here

Around 1 in 5 pregnant persons will experience new onset or exacerbation of mental health symptoms in pregnancy or the postpartum period. Despite this statistic, there are very few mental health providers in NM with specialty training in pregnant and breastfeeding/chest feeding patients. This leads to the majority of patients being undertreated or untreated resulting in significant risks to the whole family unit. Our fellowship strives to increase the number of specialty-trained psychiatrists in NM to decrease this burden on New Mexico families.”  

Nina Higgins, MD, Reproductive and Perinatal Mental Health Medical Director
Categories: Education, Health, News You Can Use, School of Medicine, Women's Health