Maternal Mental Health: You Are Not Alone

by Jennifer Christian-Herman, Ph.D., vice president of Clinical Strategy and Programs at Blue Shield of California and board member of the Policy Center for Maternal Mental Health

June 20, 2024

One in five birthing people* experience conditions like postpartum depression, anxiety and substance abuse — yet nearly 75% of those individuals go untreated. Even though maternal mental health struggles are commonplace, they are not always easy to talk about  — which is why it is especially important to bring attention to the mental health experiences impacting millions of people before, during and after pregnancy.

At Blue Shield of California, we believe mental health care should be a standard part of maternal care. We are committed to helping our members and their families receive better education and consistent care throughout their reproductive journeys, so they know what to watch for, and when and how to seek help.

Maternal mental health challenges

Individuals should be evaluated for depression and anxiety symptoms before, during and after pregnancy, but not all health systems or providers screen regularly or consistently. Unfortunately, there are multiple barriers to quality maternal mental health treatment in the U.S., including:

• Stigma associated with mental health. Shame around mental health can lead to isolation, with sufferers opting to ‘deal with it’ on their own without seeking therapeutic intervention, which can worsen symptoms. Pregnant or postpartum people may blame themselves or feel guilt about the symptoms they’re experiencing.
• People are scared of what may happen if they share. More extreme symptoms, such as thoughts of suicide or intrusive thoughts about harming the baby, can be terrifying to disclose. Individuals may have concern about being separated from their child if they share these feelings with their loved ones or care team.
• Gaps in access to maternal mental health. Birthing individuals may want help, but find it difficult to access the care they need. Seventy percent of U.S. counties lack sufficient maternal mental health resources.

Making maternal mental health care more accessible

Maternal mental health is a priority for Blue Shield of California and is available through all of our health plans. We emphasize mental health screenings and follow-up, collaborating with providers to ensure they have the tools they need to understand screening results and know what to do when a member needs mental health services. We offer mental health care both in person and through virtual care.

If you or a loved one are struggling with depression or anxiety before or after birth, reach out to your health care provider – whether it be your primary care provider, obstetrician, mental health care provider or even your baby’s pediatrician.

Blue Shield of California also offers Maven, a virtual clinic for women’s and family health, at no additional cost to most members. Maven offers virtual appointments with clinical practitioners and coaches, including lactation consultants, doulas, sleep coaches, career coaches and more. Members are also paired with a dedicated Care Advocate, who can help them connect with mental health specialists when needed. Virtual care can be especially useful for busy parents. Upon enrollment, Maven will verify eligibility. You can also reach out to the Member Services number on the back of your Blue Shield Member ID card to confirm eligibility.

Sixty percent of surveyed Blue Shield members enrolled in Maven reported improvement in mental health, and 74% said they were more productive at work while pregnant after utilizing Maven resources. Compared to Blue Shield members who did not use Maven, those enrolled in the program experienced better health outcomes:

• 10% reduction in emergency department visits
• 39% reduction in neonatal intensive care (NICU) stays.
• 60% reduction in inpatient days unrelated to delivery

Maven provides support, including mental health support, to people at all stages in the pregnancy journey — those considering children, those going through fertility challenges, new parents, pregnant people, and those who have suffered pregnancy loss or miscarriage. After losing a baby, people may feel ashamed and may not have the space or opportunity to talk about their experiences. While every pregnancy loss is different, feelings of shock and grief are common while processing the experience. Through Maven, members have 24/7 access to mental health providers who can help individuals and their families as they process and grieve.

“Every practitioner I’ve met with, every article I’ve read, and every aspect of Maven emits empathy and incredible knowledge. Maven, as a whole, just seems to get it and genuinely wants to help each parent on their journey. It feels like every practitioner I’ve encountered on Maven sees me and my pregnancy as a unique experience and treats me like a person, not just a patient” – Melissa, Blue Shield member

Resources

We hope to help break the stigma for birthing people and families who are struggling with mental health challenges. Know that you are not alone, and there are resources accessible for all Blue Shield of California members to help. 

If you are concerned about your mental health, you can also reach out to your doctor, OB-GYN, or call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262).

 *Birthing people is defined as someone who gives birth, regardless of their gender identity. 

BLACK MATERNAL HEALTH WEEK: HOW BLUE SHIELD OF CALIFORNIA IS CHAMPIONING BLACK MOTHERS

CVV News l April 17, 2024

Maternal health is not equal in the United States. Black maternal health, specifically, is in crisis due to health inequities driven by experiences of interpersonal and institutionalized racism in healthcare settings. Black women are three to four times more likely to die from pregnancy-related causes than white women. They are also more likely to experience life-threatening conditions like preeclampsia, postpartum hemorrhage and blood clots. 

In response, Blue Shield’s Maternal Child Health Equity program started in 2022 as a regional pilot in Fresno, Los Angeles and Sacramento. It brought together doula services, technology, educational support, and comprehensive perinatal and postpartum wraparound care, shepherded through Mahmee, a maternal healthcare company, as well as community-based organizations.

As of August 2023, nine employer groups are a part of an expansion plan for our work with Mahmee in a provider network market test, focusing on those in the Los Angeles, Sacramento, Inland Empire and Bay Area regions.

Leigh Purry, senior manager of Health Equity at Blue Shield of California, shares how Blue Shield’s Maternal Child Health Equity initiative is working to improve maternal health care by supporting Black mothers in new ways.

What do you wish people knew about maternal health inequities?

Maternal health inequities are deeply rooted and affect women from diverse backgrounds. It is important to understand that these inequities extend beyond medical care and include social, economic and systemic factors that disproportionately impact marginalized communities. Recognizing and addressing these disparities is essential in taking the first steps in achieving equitable outcomes in maternal health.

How do members feel the impact of Blue Shield’s new maternal health programs?

I’ve witnessed firsthand the positive impact of Blue Shield’s Maternal Child Health Equity initiative in improving access to care, reducing disparities, and empowering women to confidently navigate their pregnancy and childbirth journeys. Focusing on education, doula support, mental health support and advocacy, these programs have made a meaningful difference in the lives of women and families, promoting healthier outcomes and fostering greater equity in maternal healthcare.

These outcomes include a decreased rate of cesarean section deliveries for Black mothers participating in the doula program (24%) compared to the statewide average (30%). Our goal is to reduce C-section disparities between black and white mothers by 50% by 2028.

What is Blue Shield’s maternal health focus?

We are currently focused on:

• Enhancing access to comprehensive maternal health care services for all women, regardless of socio-economic status or location.
• Implementing culturally sensitive and inclusive health care practices to address diverse community needs and preferences.
• Advocating for policies and initiatives that promote health equity and address the root causes of maternal health disparities.

Why are you passionate about maternal health equity?

My passion is deeply rooted in my own experiences and fuels my deep commitment to social justice. During my pregnancy as a young mother, I faced significant challenges navigating the healthcare system and barriers to receiving adequate support and understanding. Like many women, the shame I felt prevented me from attending prenatal appointments, and I neglected my own postpartum care needs.

However, one particular moment during childbirth remains vivid in my memory. Despite my clear request to turn onto my side for delivery, a nurse insisted on keeping me on my back, causing distress and discomfort. It was only through the intervention of a compassionate nurse, who advocated for me and helped me turn, that I was able to deliver my daughter smoothly. Reflecting on my experience, I realized the profound impact of having a supportive advocate during a major life – and health – event. This experience fuels my determination to advocate for maternal health equity, ensuring every woman receives the respect, dignity and support she deserves during pregnancy and childbirth.

What is your hope and vision for the future of maternal health?

My hope is that every woman receives equitable, high-quality maternal health care. I envision a healthcare system that prioritizes equity, addresses disparities, gives access to diverse providers (who understand the communities they serve respective to race and ethnicity and cultural needs and differences), and empowers women to make informed decisions about their reproductive health unashamedly.

For more about Mahmee, visit: https://www.mahmee.com/.