What We're Reading
By Joy Burkhard, MBA
Founder and Executive Director, 2020 Mom
News broke in January about a Massachusetts mother, Lindsay Clancy, reportedly suffering from postpartum psychosis, taking her 3 children’s lives and attempting to take her own. We picked the article that best describes the situation and the nuances of postpartum psychosis in this edition of What We’re Reading.
Also caught in this edition are new risk factors for maternal suicide: young age, personality disorder, and alcohol use (which has gone up significantly prior to and during the pandemic) and points to the need to integrate better alcohol use disorder screening with maternal mental health disorder screening. We also feature an article detailing new efforts by the Joint Commission, the hospital accreditation organization, to address maternal mortality.
Leave a note below about what resonates most with you from this edition of What We’re Reading.
ABORTION
Abortion and the Psychiatrist: Practicing in Post-Dobbs America
Changes to abortion law will affect both patients and providers. Although obstetrician- gynecologists face direct liability in a variety of scenarios following Dobbs, other medical providers, such as psychiatrists, face less obvious challenges. In this article, we explore some abortion-related dilemmas confronting psychiatrists and provide guidance on how we might approach the many complex clinical, ethical, and legal issues that may arise.
MATERNAL MORTALITY / SUICIDE
Prenatal Psychiatric Disorders Forecast Risk for Peripartum Suicide Attempts
Investigators from Japan have identified several factors related to peripartum suicide attempts, including younger age, personality disorders, and alcohol use.
A Cocoon Pregnancy Care Model to Reduce Maternal Morbidity and Mortality
Kaiser Permanente developed the Cocoon Pregnancy Care Model, the essence of which involved putting the pregnant woman in the center of a protective layer of a care team and services to optimize their health, enhance their care experience, and achieve the best possible outcomes. The Cocoon Pregnancy Care Model focuses clinicians, health systems, and the community in general on the three factors that can impact a pregnant woman’s health and overall risk of maternal morbidity and mortality — socioeconomic status, ability to access care, and the quality of care received.
The Maternal Mortality Rate Is 3 Times Higher for Black Women. Here’s What Employers Can Do to Help Post-Roe
This weekend was the 50th Anniversary of Roe v. Wade. It now marks a reminder of what has been lost and what uncertainty there is to come.
‘I Don’t Want to Die’: Fighting Maternal Mortality Among Black Women
A St. Louis doula program, part of a nonprofit that received funding in the $1.7 trillion federal budget bill, looks for solutions in a benefit largely associated with affluent white women.
The Joint Commission Targets Maternal Health Crisis
EQUITY
Experiencing Racism Tied to Doubled Odds of Depression During Pregnancy
Authors say respectful maternity care may help reduce maternal mental health disorder risk and address maternal morbidity in Black women
TREATMENTS
Woebot Health Enrolls First Patient in Pivotal Clinical Trial of WB001 for Postpartum Depression
A new clinical trial is underway to evaluate the safety and efficacy of WB001, an investigational digital therapeutic based Cognitive Behavioral Therapy (CBT) program for the treatment of mild to moderate postpartum depression (PPD) that was granted Breakthrough Device Designation by the U.S. Food and Drug Administration (FDA) in 2021.
COVERAGE & ACCESS
The Problem With Provider Directories
Podcast: The latest efforts to fix problems with directories of health care providers and the potential for a national provider directory.
If you have health insurance, maybe this has happened to you or someone in your family, you move or switch to another insurer and you want to find a doctor or a mental health practitioner in your health plan’s network.
Filling the Gaps in the Behavioral Health Workforce
Through regulation and legislation, policymakers and lawmakers should build on previous modest steps in two areas. First, they should nurture a greater role for behavioral health support specialists (BHSSs)—peer specialists, community health workers, and paraprofessionals…
Second, policymakers and lawmakers should augment the behavioral health care that patients receive by leveraging support networks that exist within communities but that often go unused for this purpose.
As Maternity Deserts Expand, Some Experts Endorse Turning to Midwives
The authors of a paper in JAMA Forum argue for expanding community-based approaches and addressing workforce shortfalls by widening the use of doulas, midwives and child birthing centers (CBCs) for low-risk births.
Elaine Welteroth: Using Midwifery Care Was the Best Decision I Ever Made
Like most American women, I set out to have a hospital birth—just as my mother had done. It wasn’t so much a choice as it was the default. Almost everything I knew about childbirth had been programmed by Hollywood’s frenzied depictions of screaming women being hauled, legs up, through fluorescent hospital halls. As scary as it all seemed, hospital births are the norm in America. Apparently, so is birth trauma.
How Dobbs Is Making Healthcare Deserts Worse
— Ob/gyn advocates on how individual solutions to systemic problems are not viable in the long run.
‘We Are Not Thought of’: The True Impact of Western North Carolina’s Maternal Desert on Rural Women
In Western North Carolina, many of the region’s 153,000 childbearing-aged women often must travel long distances for prenatal care and delivery at the area’s eight hospitals. This often means pregnant people, especially those from rural WNC counties, have to drive hours to access health care. Maternal health experts and mothers discuss the causes, impact and potential solutions to addressing WNC’s “maternal care desert.”
POLICY
A Little Money for Mothers Improves Babies' Brain Development
The on-going Baby’s First Years research (https://www.babysfirstyears.com/ ) examines the impact on mothers and babies of modest cash gifts as a model of poverty reduction. It turns out that a little money goes a long way and affects the development of babies’ brains.
CMS Issues New Policy in Letter to State Health Officials that Medicaid and CHIP Will Pay Specialists for Interprofessional Specialist Consultations
CMS announced on January 5, 2023, that Medicaid and CHIP will pay specialists who provide interprofessional consultations to other providers. Previously, CMS did not provide coverage for most interprofessional consultations because CMS required a patient to be present for the service to be covered. Now, as long as the consultation is for the “direct benefit of the beneficiary,” CMS will reimburse the consulting specialist directly even if the patient is not present during the consultation. There is also no requirement in the new guidance that the specialist interact in-person with the treating physician who requests the specialists’ consult.
PSYCHOSIS
What Is Postpartum Psychosis? Rare Condition Is in the Spotlight After the Killing of Three Children in Massachusetts
Hallucinations and delusions that alter a mother’s sense of reality are part of postpartum psychosis. The illness, which is treatable, requires emergency care.
RESEARCH
Psychosocial Work Stress and Parent-Child Bonding During the COVID-19 Pandemic: Clarifying the Role of Parental Symptoms of Depression and Aggressiveness
Parental work stress and impaired mental health seem to have intensified during the current COVID-19 pandemic. Both can have a negative impact on parent-child bonding: psychosocial work stress in the course of a spillover effect from work to family and symptoms of impaired mental health as part of a crossover effect from parent to child. This potentially affects the child’s development in the long term.
Millions Could Lose Access to Free Preventive Care Services
In September, a Texas federal court judge invalidated parts of a popular Affordable Care Act (ACA) provision that guarantees millions of people access to preventive services with no cost sharing. The provision requires most insurance plans to cover more than 100 critical preventive services like immunizations, cancer screenings, some forms of birth control and well-woman visits with no copayments, coinsurance, or deductibles.
The ruling, which concerns a subset of preventive services, including contraceptives, and those recommended by the U.S. Preventive Services Task Force (USPSTF) including depression screening, has yet to have a nationwide impact as the judge seeks additional information before making a final determination. But the ruling could eventually be upheld by the Supreme Court.
Science Update: Postpartum Depression, Reduced Breastfeeding May Help Account For Developmental Delays Seen in Children Born to Women With Depression During Pregnancy
NIH study suggests physicians may want to offer depression treatment, breastfeeding advice to mothers with depression during and after pregnancy.
Genetic Links Found Between Endometriosis and Psychiatric Disorders
— Association evident even after adjusting for comorbidities and chronic pain, study showed.
What Is the Impact of Maternal Hypertension and Mental Disorders on Neonatal Outcomes?
The findings indicated probable correlations and mechanisms between mental illnesses, adverse neonatal consequences, and HDP in pregnant women. HDP mediated the links between PTB and anxiety, whereas depression moderated the association between PTB and HDP. HDP also mediated the relationship between SGA and anxiety, although depression had no moderating effect on this relationship. The researchers recommend medical professionals screen pregnant women for depression and anxiety as early as feasible in the first trimester.
Offspring Delusions and Hallucinations Linked With Maternal Childhood Adversity
Intergenerational transmission of childhood adversity is relevant in psychosis vulnerability etiology, and is potentially a modifiable risk factor.
Genetics May Be at Play in SIDS, Study Suggests
The cause of sudden infant death syndrome, or SIDS, continues to be a medical mystery but a new study suggests genetics may play a role. Over the course of 39 years, researchers found siblings of infants who died of SIDS had a four-fold higher risk of dying suddenly compared to the general population, according to the report. The large study reinforces previous research that shows SIDS may be more of a medical problem than previously thought, said Dr. Richard Goldstein, director of Robert’s Program on Sudden Unexpected Death in Pediatrics at Boston Children’s Hospital.