Imagine the overwhelming joy of bringing a new life into the world, only to be met by a crushing wave of darkness. For countless mothers, the postpartum period is a time of profound emotional turmoil, marked by anxiety, depression, and even thoughts of self-harm. As highlighted during a recent presentation on the “Maternal Health Access Project,” Kimberly Brandt, DO, and Elena Horvit, MPH, underscore how maternal mental health is a pressing public health concern that often goes overlooked or undertreated. 

One of the critical challenges in addressing maternal mental health is the shortage of trained providers, especially in rural and underserved areas. While the Missouri Maternal Health Access Project (MHAP) does not directly aim to expand the maternal mental health workforce, it focuses on capacity building by empowering existing providers — such as family doctors, OB-GYNs, and home care professionals — to recognize and treat mental health conditions. “Many OB-GYNs aren’t trained in mental health services or the use of screening tools. They need education on how to interpret screening results and what steps to take next,” said Nicole Wood, MSW, LCSW, MHAP’s senior program manager. MHAP is also leveraging telehealth services to bridge gaps in care, particularly in maternity care deserts, ensuring that women in rural areas have better access to essential mental health services. 

Launched in April 2024, MHAP has made significant strides in expanding access to mental health care for pregnant and postpartum women in Missouri. With more than 300 providers registered across 50 counties, MHAP is addressing the shortage of perinatal mental health providers and improving early diagnosis and treatment of conditions like perinatal mood and anxiety disorders (PMADs). A key element of MHAP’s progress has been its telehealth services, which have been essential for reaching underserved and rural areas. These virtual consultations allow providers to receive expert psychiatric support in real time, ensuring timely care for patients. 

MHAP also supports providers with ongoing training and care coordination services to connect women with appropriate local mental health resources. These efforts are critical, particularly in addressing the leading cause of pregnancy-related deaths in Missouri — mental health conditions, including substance use disorders.

According to Horvit, many providers want to help, but the infrastructure to support mental health care is lacking. “Providers are well-intentioned, but the resources available don’t meet the need,” she said. “Especially in rural areas, finding providers who can offer both maternity care and mental health services is a huge barrier.” Maternity care deserts and shortages of mental health providers, exacerbated by the lack of training in maternal mental health screening, are widespread, particularly in underserved areas.

MHAP provides ongoing education and resources to help health care professionals across Missouri manage maternal mental health conditions. This includes access to perinatal psychiatrists, care coordination, and toolkits covering PMADs screening, assessment, and treatment options. To accommodate providers’ busy schedules, MHAP is developing recorded trainings and toolkits for flexible learning options. According to Wood, “Over the next year, we’re focusing on rolling out a variety of trainings around PMADs, substance use disorders, and crisis situations. Our goal is to help providers feel confident in addressing these complex issues.”

Empowering Doulas, Midwives, and Perinatal CHWs

To improve maternal mental health care access, MHAP is extending its training and resources to doulas, midwives, and perinatal community health workers (CHWs). These community-based providers are often the first point of contact for many pregnant individuals, particularly those in low-resourced areas. Doulas and CHWs, in particular, play a vital role in providing culturally competent care and offering emotional support, making them invaluable in recognizing early signs of mental health struggles.

Wood emphasized the importance of integrating these providers into MHAP’s network: “Anyone who interacts with pregnant individuals can access MHAP’s resources. This inclusivity ensures that those on the front lines, including community health workers and doulas, have the tools they need to assist their clients effectively.”

By enhancing the capacity of these providers, MHAP enables them to offer much-needed mental health screening and referral services, ultimately reducing the burden on the strained health care system.

The Impact of Maternal Mental Health

Untreated maternal mental health conditions can have serious consequences, affecting pregnancy outcomes, relationships, and child development. As noted in their Maternal Health Access Project presentation, Brandt and Horvit emphasized that mental health issues, such as PMADs and substance use disorders, can lead to complications during pregnancy and childbirth, including preterm birth, low birth weight, and an increased risk of postpartum hemorrhage. These conditions can also strain relationships with partners, family members, and caregivers, creating additional stress during a critical period. 

The impact extends to the child, as untreated maternal mental health conditions can disrupt bonding and attachment, which are crucial for emotional and cognitive development. According to the Mayo Clinic, children whose mothers experience untreated mental health issues are at greater risk for developmental delays, behavioral problems, and emotional difficulties. 

There are several misconceptions surrounding perinatal mental health, such as the belief that maternal mental health issues are rare or that they are simply a case of the “baby blues” that will resolve on their own. In reality, these conditions are among the most common complications of pregnancy. They are often overlooked and misunderstood, which can delay critical care and support. Many women do not seek help due to stigma, fear of judgment, or lack of awareness about the severity and prevalence of the conditions. 

Recent data underscores the urgent need for maternal mental health interventions. According to Missouri’s 2023 Pregnancy-Associated Mortality Review (PAMR), the state had a pregnancy-related mortality rate (PRMR) of 32 deaths per 100,000 live births between 2018 and 2020. That rate was three times higher for Black women. The leading cause of pregnancy-related death was mental health conditions, including substance use disorders. 84% of these deaths were preventable, as indicated in the PAMR. 

By focusing on these critical issues, Missouri’s MHAP aims to provide comprehensive mental health support, reduce stigma, and ensure that all pregnant and postpartum women receive the care they need. This is particularly true for birthing people living in low-resourced communities.

A Critical Need for Screening

An ongoing issue is that many providers do not offer routine maternal mental health screenings, leading to underdiagnosed and untreated mental health conditions during and after pregnancy. MHAP’s goal is to integrate mental health screenings into routine prenatal and postnatal care, ensuring that these services are not an afterthought but part of comprehensive care for all pregnant and postpartum individuals.

“We anticipate that as providers become more educated about screening tools, the number of women identified with mental health issues will increase,” said Wood. “The challenge is making sure providers are prepared to act on those results.”

The Road Ahead: Policy Support and Sustainability

Missouri’s MHAP is still in its infancy, but its potential to transform maternal mental health care in the state is clear. By focusing on capacity building and providing real-time support for providers, MHAP is actively tackling the shortage of specialized perinatal mental health care, directly improving patient outcomes. As the program continues to evolve, it’s crucial for health care professionals across the state to register and take advantage of the invaluable resources and support MHAP offers. 

Health care professionals in perinatal or maternity care, as well as community-based providers like doulas and midwives, are encouraged to register with MHAP to access the training and resources necessary to enhance maternal mental health outcomes for their patients. By joining MHAP, providers can gain access to care coordination and evidence-based education, ultimately improving their ability to diagnose and treat maternal mental health conditions. 

Policymakers can also champion initiatives to reduce the stigma around maternal mental health and ensure long-term sustainability of programs like MHAP. By supporting public awareness campaigns, funding culturally competent resources, and investing in provider education, state leaders can create a more inclusive environment that encourages women to seek help without fear of judgment. Additionally, fostering collaboration across health care providers, community organizations, and social services can help create a more integrated and accessible network of care for mothers in need. 

For questions or more information, please contact the MHAP program at musompsychiatrymh1@missouri.edu.