This World Maternal Mental Health Day NACHC is joining organizations across the globe in raising awareness about maternal mental health (MMH) conditions. We are proud to share that health centers nationwide are responding to the urgent need for more MMH services —both during and beyond clinical visits.

“We used to give our pregnant and postpartum patients a mental health assessment like a PHQ-9, or the Edinburgh Postnatal Depression Scale screening once a trimester,” says Toni Tipton, Certified Nurse Midwife, Five Rivers Health Center, Columbus, Ohio. “A few years ago, we shifted to assessing every visit because of the increase in the presence of maternal mental health conditions.”

MMH conditions are the most common complications of pregnancy, affecting 800,000—or 1 in 5—families in the United States each year. Yet despite their prevalence, 75% of women affected by MMH conditions remain untreated, increasing the risk of long-term negative impacts on mothers, babies, and families. While depression and perinatal, postpartum, or pregnancy anxiety disorder are the most common diagnoses, many women also experience obsessive-compulsive disorder, post-traumatic stress disorder, bipolar illness, psychosis, suicidal ideation, and substance use disorders. These conditions stem from a mix of biological, psychological, and social factors. “Addressing non-clinical factors of health and mental health go hand-in-hand,” says Tipton. “If you don’t have housing or transportation, are dealing with intimate partner violence or food insecurities or finances, you are living with stressors that are going to impact the way you feel and think.” Additionally, social media which amplifies misinformation, idealizes the “perfect” pregnancy and creates additional social pressures increases anxiety and adds to the burden on today’s mothers.

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Confronting Stigma, Misinformation and Misconceptions

Many patients hesitate to seek help due to stigma or fear of being shamed and judged. “We really try to validate our patients,” says Celia O’Mara, Maternal Infant Support Manager, Great Lakes Bay Health Centers, Saginaw, Michigan. “We want them to understand that what they are experiencing is significant, and they are allowed to feel a different way than they have been told to feel.”

Common misconceptions about MMH conditions include:

• Fear that children’s or legal services will get involved
• Belief that medication is the only treatment (when it’s often a last resort)
• Confusion between the “baby blues” and postpartum depression
• Lack of awareness about behavioral health resources
• The myth that fathers can’t experience perinatal mood disorders (The reality is fathers are experiencing many life changes and pressures as they grow a family.)

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Integrating Behavioral Health Care Support In and Out of the Clinic

As we seek frameworks to incorporate in addressing the maternal mental health crisis, health centers should be our providers of choice, leveraging their existing innovative models and community-based expertise. At Five Rivers and Great Lakes Bay Health Centers, staff across maternal, behavioral, and social services collaborate to deliver tailored MMH support, where and how patients are most receptive to care.

• Integrated support during clinic visits: Behavioral health staff (i.e., social workers, case managers, and therapists) are available for consults, follow-ups, and therapy—even if mental health screener scores are low but signs of stress or depression are present.
• Centering programs: These group prenatal and postpartum sessions offer safe spaces to discuss mental health, intimate partner violence, social media, and more. “We really do get deep in our centering sessions when we talk about many issues impacting the women’s mental health,” explained Tipton.
• Doula services: Covered by many health plans, doulas support patients through pregnancy, birth, and postpartum. Not only do they provide education and help the mother advocate for herself, but they also address trauma, such as the loss of a baby.  “Our doulas are full spectrum doulas. They provide support from family planning through one year postpartum,” says O’Mara.
• Home nurse visits: Programs like Michigan’s Maternal Infant Health Program and the federally funded Healthy Start allow at-home assessments and follow-up care. Nurses and/or community health specialists can also coordinate additional mental or physical health care when needed.  
• Community partnerships: These expand support through additional home services, substance use recovery, and safe spaces—especially for Black women—to connect and heal.

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A CALM Approach to Maternal and Infant Health

In 2023, Five Rivers launched the Compassionate and Loving Maternity Program (CALM) to reduce its high rate of low-birth-weight deliveries. Patients who fall into a very high-risk group for low-birth weight babies are placed under the care of a certified nurse midwife and enrolled into CALM, an intensive wrap-around services program. In other words, keep calm and call the midwife.

“We focus on the mom’s health and pregnancy, the health of their growing baby, and work to alleviate the stressors that can impact their health,” says Tipton. CALM offers unique services such as monthly massage, relationship evaluations (like learning love languages), fatherhood programs, and marijuana cessation support.

The impact is clear: The low birth weight rate among newborns at Five Rivers was 8.97% at the end of 2024 and through the first few months of 2025 is 4.4% —down from 14.9% in 2015 and 12.8% in 2021.

Lessons Learned

Health centers looking to strengthen their MMH services may benefit from these insights:

• Start with leadership or start small: If leadership support is limited, focus on maximizing patient interactions during visits. Listen closely to your patients and watch for body cues that can guide referrals to behavioral health services.
• Hire a community health worker (CHW): CHWs build trusted relationships and help address social drivers of health by connecting patients to critical resources.
• Collaborate with hospitals: Learn from their behavioral health models integrated into their maternal health services and adapt them for your setting.

Lastly, give grace to the patient and grace to yourself. “You don’t know what people are dealing with, why they are late, or what has happened to them in the past,” says Tipton. “If a patient shares their experience, let them know they have every right to feel the way they are feeling. Then, you will work together to change, fix, and break any generational trauma.” To learn about NACHC’s maternal health programs and resources visit Maternal Health – NACHC.

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https://www.nachc.org/beyond-the-baby-blues-integrated-care-for-maternal-mental-health/

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