Amid pregnancy-related deaths, Herkimer midwife urges prioritizing mental health

In New York, 41 women died from pregnancy-related causes in 2018, with mental health conditions a contributing factor in nearly one in five of them.

Mental health issues are the third most common cause of pregnancy-related deaths within one year of giving birth in the state, behind embolism and hemorrhage.

The deaths from mental health causes all happened after pregnancy, most between 42 and 365 days after the end of the pregnancy, according to a New York State Department of Health issue brief on mental health and pregnancy-related deaths issued in late November.

All of those deaths, the Maternal Mortality Review Board determined, could have been prevented.

Certified nurse midwife Patricia Otis, with Bassett Healthcare Network in Herkimer, incorporates prevention in her practice, screening pregnant and postpartum women and counseling them on the importance of taking care of their own mental health. during and after pregnancy.

“I hope that having discussions during pregnancy, during the postpartum period, helps people to understand that there is treatment available,” Otis said, “that there’s support available, that they don’t have to be alone, that there are things they can do to feel better.”

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But, for many reasons, not everyone gets help or even admits they need it, Otis said.

“And they’re the ones," she said, "that stick with you."

How does it happen?

Because of confidentiality concerns, the state issue brief did not contain details of any individual cases. But it did include a fictitious, composite case, based on characteristics common among the women who died.

Through the case, the brief highlights how a mental health issue can escalate and how the health care system sometimes misses chances to intervene:

• Many patients with anxiety and/or depression choose to stop taking their medications while pregnant, fearing they might harm their unborn babies.

• Patients, even patients with a known history of mental health issues and even patients who exhibit possible signs of worsening mental health, aren't necessarily screened for depression during and after pregnancy.

• Women who miss their postpartum visits or who fail to schedule a recommended psychiatric appointment don't always receive follow-up calls from providers.

• Without mental health care or medication, some women deliver their babies, but die weeks or months later by suicide.

Midwife's perspective: First step is to overcome stigma

The stigma of mental health issues is the number one reason women don’t get help, Otis said.

“(It’s) that fear that they’re going to be perceived as a bad parent or a bad mom,” she said. “What I tell them is I’m proud of them when they do tell me they’re having a problem, that it’s hard and it takes bravery to speak up.”

Saying something about mental health issues is an act of advocacy for women and their babies, Otis added, a sign that a woman is a good mother.

Many women also get nervous and decide to stop taking, or not begin, medications, a decision Otis said is complicated by a shortage of good research on the impact of these medications during pregnancy and breastfeeding. But women who are stabilized on a medication may do better continuing it, she said.

“There’s risk to treating and there’s risks to not treating,” she said, “and it’s what they’re most comfortable accepting.”

Not treating mood disorders can increase the risks for pre-term birth, babies being born small, missed prenatal care (and, as a result, missing other medical conditions such as pre-eclampsia) and, in the postpartum period, an impact on a baby’s neurological development, Otis said.

And, of course, the woman’s mental health can deteriorate, a “profound” impact on its own, Otis said, and one that could lead to the worst possible outcome, a woman hurting herself or her baby.

Otis relies on shared decision making, laying out all the information and letting the patients choose between treatments and combinations of treatments, including medication, therapy and alternative therapies that can decrease symptoms, such as meditation, yoga and mindfulness activities.

There is no perfect scenario, she said, but women do have choices and can get better.

“You’re not to blame,” Otis assured struggling women who are pregnant or whose pregnancies recently ended. “With help and support, you can be better. You might not be able to make it perfect, but we can help them be better.”

Where to find help

Otis recommended the following mental health resources for pregnant and postpartum women:

MotherToBaby: Visit mothertobaby.org or call 866-626-6847

Infant Risk Center: Visit infantrisk.com or call 806-352-2519

This article originally appeared on Observer-Dispatch: 'It takes bravery': Herkimer midwife urges prioritizing mental health