Maternal Mental Health:
A National Health Care Crisis

Nancy Byatt

Care for Your Mind acknowledges and appreciates the collaboration of the National Network of Depression Centers in developing this series.

Maternal Mental Health: A National Health Care Crisis
Nancy Byatt, D.O., M.S., M.B.A., F.A.P.M.

Few issues are of more importance to our society than the psychological well-being of pregnant and postpartum women. They are the guardians of current and future generations — our mothers, partners, children, daughters, and sisters.

Tragically, America’s mothers are facing a mental health care crisis. One in seven women who are pregnant or have recently had a baby suffers from depression, making it more common than diabetes during pregnancy. This is an epidemic that affects all of us, impacting hospitals, homes, schools, and workplaces.

Depression is also the leading cause of disability worldwide among women of reproductive age, and maternal suicide accounts for 20% of postpartum deaths among depressed women.

Perinatal depression has negative effects on birth outcomes, infant attachment, and children’s behavior/development. Although depression is by far the most common mental health condition women experience, many others live also live with anxiety and frightening thoughts.

Maternal depression has staggering economic impacts. According to a Healthcare Cost and Utilization Project report, nearly $15 billion annually is spent on childbirth-related hospitalizations for women who suffer from depression during pregnancy. In addition, children of depressed mothers tend to visit medical offices and emergency departments more frequently and utilize more health services. One study found that the annual cost of not treating a mother with depression is $7,211. Apply that to 800,000 mothers per year in the U.S., and, that’s $5.7 billion dollars.

Sadly, most women who are struggling with depression, anxiety, or other mental health issues during or after their pregnancy are not recognized, heard, or supported by their medical providers. Not because providers don’t care (to the contrary—providers care deeply), but because there is no system in place to allow doctors to provide appropriate treatment. Because of a severe lack of resources and education, perinatal mental health has become a national public health crisis, and it’s time for reform.

I am a psychiatrist who works with pregnant and postpartum women and the medical director for the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms), which helps pregnant and postpartum women get the mental health support they need and deserve.

Women, children, and families need us to work together to bring depression and other mental health issues out of the shadows. Women need to know they live in a culture that supports them, listens to them, and remains with them as they take on an extraordinarily challenging role: motherhood. Providers need to feel comfortable broaching the subject with patients and following up with appropriate treatment and/or referral. It begins here.

The good news is this issue is gaining momentum. The Journal of the American Medical Association (JAMA) just released new recommendations from the US Preventive Services Task Force (USPSTF) related to depression screening. It recommended all adults be screened (including pregnant and postpartum women), and stressed the importance of having systems in place in order to accurately diagnose, provide effective treatment, and offer appropriate follow-up.

Through this series, we aim to continue that momentum, and spark a national conversation about mental health during pregnancy and the year after birth. Recently, U.S. Congresswoman Katherine Clark (MA-5) introduced first-of-its-kind legislation, the Bringing Postpartum Depression Out of the Shadows Act  (H.R. 3235/S. 2311 is the companion US Senate bill) that could change the national landscape for maternal mental health. As these bills await action in Congress, stakeholders on the front lines are joining forces for a series of stories about this immensely important topic.

Engage in this groundbreaking dialogue with us as we strive to inspire advocacy and bring about positive change.

Over the next few weeks, read our posts and share your comments, suggestions, and personal stories with us. You are as much a part of this effort as we are, and we look forward to hearing from you and creating a truly powerful tool for change. Please read next week’s post: Why Doctors Can’t Treat Their Patients: Barriers to Mental Health Care for Obstetricians and Pediatricians. Subscribe to CFYM to so that you automatically receive each week’s post in this series every Tuesday.

Your Turn

  • How has perinatal depression affected you or someone you know?
  • What do you think is important as we address maternal mental health?
  • What have you experienced or heard of that has been effective in identifying and treating postpartum depression?

Dr. Byatt is a perinatal psychiatrist focused on improving health care systems to promote maternal mental health. She is an Associate Professor at UMass Medical School in the Departments of Psychiatry and Obstetrics and Gynecology.  She is the Founding and Statewide Medical Director of MCPAP for Moms, a statewide program that addresses perinatal depression in Massachusetts by providing mental health consultation and care coordination for medical providers serving pregnant and postpartum women. Her research focuses on developing innovative ways to improve the implementation and adoption of evidence-based depression treatment for pregnant and postpartum women. She has received federal funding from the Center for Disease Control to test an intensive, low-cost program that aims to ensure that pregnant and postpartum women with depression receive optimal treatment. Her academic achievements have led to numerous peer-reviewed publications and national awards.

Facebook Comments


Thank you for your work on this issue! You will help so many people.

  • How has perinatal depression affected you or someone you know?

I have depression and ADHD, treated by medication and therapy.  Becoming pregnant 4 months ago, I experienced a decrease in depressive days for my first trimester, and then a severe increase in depression for my second trimester.  Having suicidal ideation in pregnancy was doubly scary, because I knew that another human life depended on me. 

  • What do you think is important as we address maternal mental health?

Awareness of perinatal depression seems surprisingly low! 

The guilt that usually comes with depression doubled when I had depression as a pregnant woman.  I luckily found websites that assured me it wasn't my fault that I wasn't "glowing and happy". There was very little understanding when I sought help among good friends. They all dismissed it as "just the baby blues--everyone gets them," telling me that I should feel the joys soon. But I really needed help.  I was making a plan based on S.I..  Only my primary care physician understood how serious that was. 

It would be good if there were more articles, commercials and billboards about perinatal depression, that it:

-is common

-is serious

-has warning signs

-doesn't mean you are a monster or a bad mom

-requires medical help

A huge help for my survival was the support system and awareness I already had in place for my existing depression.  I recognized the severity of symptoms, had the vocabulary to describe them to my MD and family members, and had the reassuring knowledge that it was a biological issue.   If treatment and awareness for regular depression increases in general, I believe more pregnant women who experience perinatal depression will have better support.

  • What have you experienced or heard of that has been effective in identifying and treating postpartum depression?            

For me, I knew that suicidal ideation and beginning a plan was a red flag.   Not being excited anymore about my child's fetal development was another sign for me.   For treatment, my SSRI has been increased. I do feel a positive difference.  

A treatment that I have heard is effective for postpartum depression is progesterone shots.


I as a psyc nurse see to often the postpartum mother who has crossed from depressed to psychotic or with obsessed thoughts that lead to suicidal thoughts or actions. We wait to long to say to mothers do you know about postpartum depression and this is what can happen. We educate young couples pm medical issues and child care ....why NOT psyc issues??. So painful to c something that might have been prevented.


@Psycpam This is a good point.  It should be one of the requirements in prenatal care, that you and at least one family member are told--not in a handout that you will never read, actually told via a video or nurse--about perinatal depression.  It should include warning signs, steps to take for help (with local phone numbers), and reassurance that it has biological causes and is not your fault.

This way, pregnant women and those close to them understand perinatal depression basics, seriousness, causes, etc.  

Damona Mae
Damona Mae

Hello. On August 22, 2012 I brought my now three year old into this world when I was just 28 weeks pregnant due to Preeclampsia and HELLP syndrome. It wasn't until a year and a half later that I experienced PTSD and possibly postpartum depression. Unfortunately, I am still struggling greatly with anxiety and depression and have sought professional help. 

As you move forward, I think it is important that women be given not only information on postpartum depression/PTSD, but direct contact information for local therapists and psychologists. Perhaps having a person on staff at the hospital that specializes in this type of mental health problem would be helpful.

What has helped me most, besides my faith, is talking to a therapist in addition to take SSRI's for my anxiety and depression. I think that the two must go hand-in-hand if true healing is sought.


Philadelphia, PA


@Damona Mae Hugs and prayers and love for you!  It must be hard being a mom (which is already challenging) and having depression and anxiety at the same time.   I'm glad you have some help for it. I send you so many hugs.