Maternal mental health conditions such as anxiety, depression, and posttraumatic stress are likely more common among childbearing women than generally realized (Bauman et al., 2020; Fawcett et al., 2019; Green, 2021; Toscano et al., 2021). Based on 2018 data from the Pregnancy Risk Assessment Monitoring System, prevalence of postpartum depressive symptoms (PDS) among women with a recent live birth was 13.2% (Bauman et al.). Prevalence varied based on state; from 9.7% in Illinois to 23.5% in Mississippi. Women in vulnerable populations were more likely to report PDS. Among women in their teens, those who were American Indian/Alaska Native, smokers during or after pregnancy, victims of intimate partner violence before or during pregnancy, had depression before or during pregnancy, or whose infant had died, prevalence was >20%. A similar prevalence of 20% for anxiety disorders among pregnant and postpartum women was noted based on a meta-analysis of 26 articles (Fawcett et al.). Hospitalization during pregnancy for complications is a major risk factor for mental health conditions. Findings from a meta-analysis of 39 studies showed that about a third of women hospitalized with complications during pregnancy reported anxiety or depression (Toscano et al.). This prevalence is twice as high as the general obstetric population (Toscano et al.). Prevalence of postpartum depression is greater among minoritized women and those of low socioeconomic status compared with white women, likely due to long-standing health and social inequities and racism embedded in society and the health system (Green).

Mental health and physical health are closely related. Risk of adverse pregnancy conditions and outcomes such as hypertension, preeclampsia, preterm birth, lower birthweight, lower rates of breastfeeding initiation, poorer maternal-infant bonding, and increased likelihood of infants with developmental delays have been associated with postpartum depression and anxiety. If mental health conditions are not identified and treated in a timely manner, there can be more untoward consequences for mother and baby such as sleep and eating disorders and infant behavioral problems (Bauman et al., 2020). Approximately 9% to 13% of maternal deaths have been linked to maternal mental health conditions, including ~5% to 6% that are due to suicide (Bauman et al., Toscano et al., 2021).

What Can Maternity Nurses Do?

Timely identification, referral, and treatment are key to helping women who are experiencing mental health conditions during pregnancy and postpartum. Yet screening during pregnancy and postpartum is not routine in all practices. In a national study, prevalence of women reporting that a health care provider asked about depression during prenatal care visits was ~80% and during postpartum visits was ~87% (Bauman et al., 2020). Screening can be done during well baby visits (van der Zee-van den Berg et al., 2017) and for mothers of babies in the neonatal intensive care unit (Berns & Drake, 2021). Once identified, prompt referral and treatment are indicated. Nursing care for women with mental health conditions that includes kindness, empathy, and nonjudgmental behavior is essential for optimal maternal and infant outcomes.

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