The birth of a child is celebrated as a joyous occasion, but for pregnant and new mothers, data shared with the Centers for Disease Control and Prevention indicates mental health conditions are the leading underlying cause of death. Moms struggling with perinatal or postpartum mood and anxiety disorders are often hesitant to share with providers how they are feeling — and when they do share, they often find their concerns are not heard or prioritized. But things are changing across NoVA and the surrounding areas.
“I think there is much more attention paid to both screening and treatment of mental health conditions, both during pregnancy and postpartum,” says Dr. Amy Banulis, OB-GYN and associate medical director of Maternal/Child Health for Mid-Atlantic Permanente Medical Group.
Medical professionals see hope for the future of maternal mental health care in Northern Virginia with the creation of new initiatives and increased access and awareness.
Work in Progress
The Virginia Mental Health Access Program, or VMAP for short, announced in May that it had acquired additional funding to launch a perinatal expansion, VMAP+ for Moms. “It’s a really impressive statewide initiative that was funded through the legislature,” says Elizabeth Wilkins-McKee, a Manassas-based psychotherapist who experienced severe postpartum obsessive-compulsive disorder with her first child. The VMAP+ line will soon be joined by perinatal psychiatrists, licensed medical professionals, and care navigators who specialize in perinatal mental health. VMAP is also working to add mental health training to its education options.
Dr. Katherine Wisner, a renowned psychiatrist in the field of perinatal health, sees progress in the DC metro area. Wisner, the associate chief of Perinatal Mental Health at Children’s National, is working with clinicians at the DC Mother-Baby Wellness Program to help patients understand what illness they have and provide information on what therapies and/or potential medications might help. “We are integrating new perinatal psychiatry, education, and diagnosis into our DC Mother-Baby Wellness Program, which is available free to any woman who gets her obstetrical care in DC,” Wisner says.
Kaiser Permanente unveiled new initiatives in May to help address maternal health equity in the mid-Atlantic region. As part of this, a grant to Loudoun Community Health Center/HealthWorks for Northern Virginia was “used to provide educational, dental, behavioral, and emotional health support and postpartum family planning to reduce maternal morbidity and mortality for prenatal patients.”
A Public Health Crisis
Kaiser’s initiatives came the same month that the Biden administration released a national strategy to improve maternal mental health care in the face of an “urgent public health crisis,” with recommendations developed by the Task Force on Maternal Mental Health. The report said the United States has the “highest maternal mortality rate among high-income countries. Deaths from suicide, drug overdoses, and other causes related to mental health and substance use issues are the leading cause of pregnancy-related deaths in the U.S., accounting for more than 22 percent of those deaths.”
A Children’s National study that Wisner led found, “More than 80 percent of maternal deaths in the United States are preventable, particularly the nearly 1 in 4 maternal fatalities that are attributable to mental health disorders.” Wisner estimates that 1 out of 5 women experiences postpartum depressive illness in the first postpartum year.
Rates of anxiety are increasing, says Kim Ragan, director of Therapeutic Services and Women’s Behavioral Health Services at Inova. “I think what we’re seeing a lot of right now — and I think maybe in a post-COVID world — is anxiety, high levels of anxiety,” Ragan says. “And I think it coincides with isolation from COVID, the lack of support. And I think it’s just sort of stayed that way, where people are just anxious.”
Maternal health outcomes are particularly grim for Black women. “The data shows that a Black pregnant person is two to three times at higher risk of dying from pregnancy compared to someone who is white,” says Dr. Samrawit Berhanu, an OB-GYN at Inova, adding that CDC data indicates a widening gap. Berhanu points to “structural racism, implicit bias, and unconscious bias” as some environmental factors contributing to that disparity.
Regarding the Black maternal health crisis, Berhanu says there’s been “a huge call to close that gap and bring that disparity down” at the level of providers and at a systems level among hospitals and governing bodies. “They’re doing a lot of education on trying to get rid of systemic racism,” she says.
The doctors interviewed for this article mentioned the importance of having a diverse group of providers available to patients, in addition to providing robust diversity, equity, and inclusion training.
Mother of two Kamisha Battle-Jackson shares a “deep, dark moment” that occurred in the months after she gave birth to her first son in 2020, offering a trigger warning before she tells it. There was a night when her husband was at work, and she was having such a difficult time that she even considered waiting until the baby went to sleep and then taking her own life. “I felt like it was just too much, and he deserved a mom that wasn’t depressed. Fortunately — I still get emotional, obviously, telling that part of the story — he did not go to sleep. He was just smiling at me, wanting to play.”
Not long after, Battle-Jackson shared with her therapist how she was feeling. She was checked into a hospital for an evaluation, and, with her husband’s support, she put a plan together that prioritized rest. She started taking medication but was still racked with worry and guilt, specifically over the medication and how it might affect breastfeeding. A friend recommended Postpartum Support Virginia, and in her first weekly virtual meeting with her Women of Color support group, Battle-Jackson broke down. “I just cried, and these women heard me. They supported me, they listened to me, they encouraged me and told me the medication was safe,” she says. “They gave me so many tips and support.”
The former schoolteacher found that she had a knack for mentoring others who had been in similar situations, experiencing mental health issues like perinatal anxiety and depression. When a job opened up at the organization, Battle-Jackson applied and now holds the position of social support and volunteer manager. In her role, she works to help others understand that new parenthood doesn’t have to be isolating.
Care Challenges
Wisner says that there are still hurdles, particularly with a shortage of practitioners. “I think that we have not really done a good job in psychiatry in general, educating people about perinatal psychiatry. When I started this work, it was decades ago, but there was nobody in America really interested in this at all. And now at least we have training programs. But there’s still a terrible shortage of perinatal psychiatrists who are very comfortable and educated about treating pregnant and breastfeeding women.”
While the rate of screenings has improved, progress is still needed. Ragan points out that regular screenings exist for gestational diabetes in pregnant women but not for depression. Battle-Jackson says more resources need to be given during prenatal visits about postpartum mood and anxiety disorders; many people don’t realize that it’s common to experience mental health issues during pregnancy, not just after childbirth. Postpartum Support Virginia provides training to medical professionals across Virginia to help screen for those disorders.
There have been efforts to expand care, particularly insurance coverage, past the first six weeks postpartum. “Virginia has done a better job increasing the coverage for Medicaid,” Ragan says. “But we still find undocumented patients who don’t have access to care and really need it because they lack social support, lack financial means.”
“I think it’s really, really important for women to know that they aren’t alone,” says Wilkins-McKee. “It’s terrifying to make those first phone calls, but it’s essential that as a culture, as a community, we understand that women weren’t meant to do this alone.”
Feature image, stock.adobe.com
This story originally ran in our August issue. For more stories like this, subscribe to Northern Virginia Magazine.
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