May: Postpartum Preeclampsia

Written by Paityn Edwards and Alka Dev

Point of View:
RACE AS A SOCIAL CONSTRUCT SHOULD NOT BE CITED AS A RISK FACTOR FOR PREECLAMPSIA

In a letter to the editor, Camille A. Clare, MD, MPH, takes issue with the inclusion of “Black race” under risk factors, stating how race is a sociologic construct, not based on genetics or biology, and declares that the perpetuation of race as a biological construct leads to the disregard of strategies to address racism and mitigate health disparities, worsening maternal morbidity and mortality. She ends her letter with a call to action, “The inclusion of racially and ethnically diverse members of editorial boards, journals, and scientific study sections can note these race-based views in medicine and eliminate them before publication, thereby preventing the furtherance of racially based notions of biological differences.” See ‘Scientific Publication’ for a summary of the original article.

Resource:
PREECLAMPSIA FOUNDATION

The Preeclampsia Foundation aims to improve the outcomes of hypertensive disorders of pregnancy by educating pregnant and birthing people, supporting and engaging the community, and improving healthcare practices and research to find a cure. They have trained 100,00 healthcare providers in best practices for hypertensive patients, distributed 3 million patient-focused educational materials, and invested 1.5 million dollars in preeclampsia research. As of 2021, the Preeclampsia Foundation’s research goals are: to fund novel research and move promising research forward; to actively engage the patient perspective and experience in research studies, to catalyze the research field through funding, advocacy, and awareness; to communicate research results to our community. 

News Story:
“Knowing Her Story Saved My Life:” Twins Suffer Postpartum Preeclampsia

Samantha began her first pregnancy with an understanding of her increased risk of preeclampsia due to her twin sister, Ilana’s experience 37 weeks post-partum, and their older sister Gabby’s history of preeclampsia. When Samantha discovered she was pregnant, Ilana was six months along in her own pregnancy. She made sure to reiterate the importance of advocating for herself throughout her pregnancy, especially due to their family history. Samantha shares, “I went into my first Ob/Gyn appointment with the details of Ilana’s experience and her provider’s advice for me at the ready… My obstetrician decided that we’d monitor it as we went, but not to put me on aspirin.” Samantha continued her pregnancy focused on self-monitoring her blood pressure (BP) and staying active. Unfortunately, due to her own OB going on maternity leave, the various other doctors she met with throughout pregnancy did not make an effort to acknowledge her concerns. 

Ilana delivered a healthy baby, then spent six days in the hospital due to high BP, and was given the same medications as her previous pregnancy. By Samantha’s 37-week appointment, her blood pressure was elevated enough for her care team to do a 24-hour urine collection test for protein. Her provider decided to induce Samantha who delivered a healthy baby, and the care team assumed they caught her preeclampsia in time to prevent any postpartum complications. Samantha wasn’t so sure. She had to advocate for herself many times, asking for her BP to be checked before they tried to discharge her. Her fears were correct, her BP was still high, and her provider put her on magnesium. In reflection of her induced delivery Samantha shares, “ I was induced on the day I was because when I went to get the jug for my 24-hour urine test, I insisted I wasn’t feeling well and that I needed to be seen by the OB. Looking back, I feel aghast that my provider was willing to wait over the weekend to do the test, even after he’d urgently called me back to the office to do a second blood pressure check… So, when your body is insisting that you are not well, you insist, insist, insist at the nurses and doctors. Stand your ground.” While this story sounds unique because of twins expecting at the same time, the difficulty of going through post-partum preeclampsia is not. Scenarios like this are why these sisters and other women with similar experiences hesitate to plan future pregnancies.

Scientific Publication:
Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy

The authors call for improving the terminology surrounding postpartum preeclampsia (PE) onset within the first 48 hours after delivery as well as delayed-onset postpartum PE, which has traditionally been defined as new-onset PE between 48 hours to 6 weeks after delivery. Postpartum PE can develop after a pregnancy with no prior hypertensive disorder or after a pregnancy complicated by gestational hypertension or in women with underlying chronic hypertension. The prevalence varies considerably (between 0.3% and 27.5%), perhaps due to milder symptoms that get treated by providers who are unfamiliar with the disease. The authors propose that further study is needed to determine if new-onset postpartum PE or eclampsia is a distinct entity from PE with antepartum onset. The presence of any severe features (including severely elevated BP in women with no history of hypertension) should be referred to as postpartum PE after the exclusion of other etiologies. They suggest removing the term “mild preeclampsia” from current guidelines to capture the considerable maternal morbidity associated with pregnancy-related hypertension, and only using postpartum hypertension for women with nonsevere hypertension, and no other end-organ involvement. Among risk factors, the authors list demographics (older age, Black race, and maternal obesity) and intrapartum factors (cesarean delivery, higher rates of intravenous (IV) fluid infusion on labor and delivery). It is the designation of Black race as a risk factor that is disputed by Dr. Clare (see ‘Point of View’).

April: The Origins of American Gynecology and Their Implications for Care Today

Written by Ananya Pani

Point of View:
MEDICAL BONDAGE: RACE, GENDER, AND THE ORIGINS OF AMERICAN GYNECOLOGY

Owens’ Introduction and Chapter 1 of Medical Bondage: Race, Gender, and the Origins of American Gynecology cite the narratives of the Black women whose labor and bodies go unrecognized in discussions of the origins of American gynecology. From 1844 to 1849, Anarcha, Betsey, and Lucy – in addition to nine unidentified enslaved women – lived and worked in the first hospital for enslaved women in Montgomery, Alabama. The hospital was founded by Dr. James Marion Sims for the purpose of performing gynecologic reconstructive surgeries to treat enslaved women. Not only did the women who lived and worked at the hospital perform the duties of enslaved people under Sims’ command, but also served as Sims’ assistant nurses for his surgical procedures. Sims, amongst other White male physicians at the time, utilized enslaved women not only as sources of labor but as sources for experimentation, exploiting them on the basis of antebellum-era theories of racial formation; they justified their experimentation on Black women’s bodies due to their “higher pain tolerance” and “physical superiority,” both of which exemplify antebellum-era theories of racial formation in medicine and medical racism based on biological racial differences that were fabricated by white American male gynecologists to ‘advance’ American gynecology. “For pioneering gynecological surgeons, Black women remained flesh-and-blood contradictions, vital to their research yet dispensable once their bodies and labor were no longer required”. While Black women were critical towards American gynecological research and much of modern gynecological practice, their bodies were viewed solely as sources of labor and considered disposable once they no longer served White male gynecologists’ purpose. James Marion Sims has long been considered the ‘father’ of American gynecology after opening one of the first women's hospitals in 1955. The failure to credit the enslaved Black women who were foundational to American gynecological research perpetuates the neglect of the field’s racist origins as well as the maintenance of Anti-black racism in American gynecology today.

Resource:
DIVERSITY, EQUITY, AND INCLUSION TOOLKIT FOR AMERICAN OBSTETRICS AND GYNECOLOGY

This toolkit, created by the Association of Physician Associates in Obstetrics and Gynecology (APAOG), emphasizes the importance of OB/GYN clinicians having an in-depth understanding of historical accounts towards mitigating health disparities. Included in this toolkit are Books, Articles, Webinars, and Podcasts regarding the roots of American Obstetrics/Gynecology, Anti-Black racism in American Obstetrics/Gynecology, and Anti-Black racism in the United States. Recommended resources include, but are not limited to,: “The Case for Reparations,” Remembering Anarcha, Betsey, and Lucy: The Mothers of Modern Gynecology, Medical Bondage: Race, Gender, and Origins of American Gynecology – whose themes are introduced in this blog. While the APAOG DEI Toolkit is primarily directed towards OB/GYN physicians, it includes important works that are accessible to all interested in understanding the history of American gynecology and mitigating Anti-Black racism in gynecology and medicine more broadly.

News Story:
WHY DO SO MANY BLACK WOMEN DIE IN PREGNANCY? ONE REASON: DOCTORS DON’T TAKE THEM SERIOUSLY

“The advancement of obstetrics and gynecology had such an intimate relationship with slavery, and was literally built on the wounds of Black women,” says Deirdre Cooper Owens, author of Medical Bondage. A shared reality amongst Black women in the U.S. are the disproportionate disparities associated with pregnancy and birth. Angelica Lyons, a Public Health professor at the University of Alabama at Birmingham, knows the dangers of giving birth as a Black woman in the U.S. and reinforces to her students that the rate of maternal mortality is three times as high amongst Black women as it is for any women of any other race. Lyons’ Public Health teachings became a scary reality for her own pregnancy during which she recalls being repeatedly shrugged off by physicians despite reporting severe abdominal pain; she was ignored by the physicians at the hospital affiliated with the very institution she taught at. Physicians dismissed Lyons’ symptoms as “normal Braxton-Hicks contractions”3; it wasn’t until her baby’s heart rate dropped that she was addressed and rushed in for an emergency cesarean section, almost dying of septic shock. Lyons' experience is not an isolated instance and exemplifies the ways in which the racist origins of American gynecology and institutionalized racism contribute to medical discrimination and racism. “The way structural racism can play out in this particular disease is not being taken seriously… we know that delay in diagnosis is what leads to these really bad outcomes,” says Dr. Riley, chief of OB/GYN at Weill Cornell Medicine and New York Presbyterian Hospital.

Scientific Publication:
CRITICAL RACE FEMINIST BIOETHICS: TELLING STORIES IN LAW SCHOOL AND MEDICAL SCHOOL IN PURSUIT OF “CULTURAL COMPETENCY”

The historical accounts of Anarcha, Betsey, and Lucy illustrate how enslavement, race, and gender are inextricably intertwined with American gynecology. Washington utilizes historical narratives to demonstrate the ways in which Black women were regarded as sources of both labor and reproductive labor citing that “some slave owners identified slaves for breeding and paired them”. The use and the characterization of enslaved Black women as ‘breeders’ by enslavers is inherently dehumanizing and reinforces how Black women and their children were regarded as sources of labor. Washington addresses Sims’ use of Black women as sources of experimentation based on the fabricated notion that Black women have a higher pain tolerance. Washington writes, “[Sims] purchased slave women in order to operate experimentally on them. Giving them no anesthesia due to their racial ‘differences’ (Blacks purportedly did not feel pain), he addicted them to opiates to regulate their bowel and bladder function. He operated on several of these women 20 or 30 times before obtaining the results he wanted”. In analyzing historical accounts, Washington emphasizes that while truth-telling is a central tenet of biomedical ethics, biomedical ethics must expand to include historical truth-telling. Historical truth-telling is critical for restructuring medical education in efforts to improve current and future generations of physicians' ability to exercise both cultural competence and cultural humility when treating patients.

March: Maternity Care Deserts in Rural Communities

Written by Esmeralda Abreu Jerez & Sophia Perez

POint of View:
The Life-Threatening Consequences of Rural “Maternity-Care Deserts”

Western North Carolina is a maternity care desert where the counties without a labor and delivery unit are all classified as rural areas. As defined by the article, a maternity care desert is an area with “no hospitals providing obstetric care, no birth centers, no OB-GYN, and no certified nurse midwives.” We are first introduced to Katlyn Moss, an OB-GYN nurse forced to travel 107 miles in the snow to give birth to her second child. Though she had given birth to her first child at Angel Medical Center, only 40 miles from the neighboring county, the medical center closed in 2017. Unfortunately, this problem is not singular. Four labor and delivery units have closed, and five counties in Western North Carolina have lost OB-GYNs since 2015.

Furthermore, new OBGYNs are not arriving in the area, and out of the nine residency programs for aspiring OB-GYNs in the state, none are in rural areas. Compounding the issue of maternity care deserts, the high mortality rates for Black women and frequent dismissal of their health concerns worsen the health outcomes for pregnant people of color in these deserts. Bringing in Moss’ lived experience as a nurse, the article poignantly articulates how this lack of maternal care only serves to treat pregnant people like an afterthought as they navigate a healthcare system that devalues them.

Resource:
Rural Maternal Health Toolkit

This toolkit is geared towards healthcare providers to create and implement a maternal program in rural areas. The resource is divided into seven modules, each focusing on different stages of creating a new healthcare program. Accessible to all, it clearly defines the unique issues associated with rural maternal care and highlights the intersectional issues pregnant people encounter in these areas. However, it can also be used by pregnant people in the rural maternity care deserts as the toolkit includes a list of successful rural maternal care programs. Two outstanding examples are Pacify, a 24/7 lactation support app, and Good Beginnings of Central Vermont, a post-partum home visitor program in Vermont.

News Story:
How The Closing Of Small, Rural Hospitals Is Contributing To A Bigger Maternal Health Crisis | Sharon Hospital maternity services must stay open, state rules

Following the story of the maternity ward in Sharon Hospital in rural Connecticut, these two stories highlight people’s fight to keep the hospital’s maternity care ward open. Describing her emergency C-Section, Rachel Tuberville recounts the life-or-death situation she faced. She explains how the proximity of Sharon Hospital to her home was the deciding factor in her and her son, Colin’s, survival. Dr. Howard Mortman, an OB-GYN at Sharon Hospital who was part of Rachel’s care team, describes that in emergency maternity situations, “time is of the essence.” However, despite this need, the owner of the hospital, Nuvance Health, submitted a proposal to close its maternity to the state in 2022, citing financial burdens and low patient volume. According to Alecia McGregor, a Harvard Chan School of Public Health faculty member, this is common as these are low-income areas with few patients, driving hospital owners away. Luckily, the Connecticut Office of Health Strategy denied Nuvance Health’s request, deciding to keep the maternity ward open in February 2024 as Nuvance failed to prove how this would improve healthcare delivery in the region.

Scientific Publication:
Maternity Care Deserts and Pregnancy-Associated Mortality in Louisiana

When an area does not have proper healthcare, its people can suffer catastrophically. As maternal mortality continues to rise in the United States, rural inequities only grow, creating life-or-death situations for rural families. Hospitals in rural areas close their doors or move to more profitable areas, and pregnant women are forced to travel long distances for care or, sometimes, go without prenatal care. These trends aggravate the already-stark disparities for rural mothers.

Geocoding of maternal deaths in Louisiana showed that living in a maternity care desert was associated with a staggering 91% increase in risk of death during pregnancy or in the year following birth. Living in a maternity care desert was also associated with a threefold risk of dying directly from pregnancy. Without prenatal or emergency care nearby, physical health suffers, and so do other health measures: obstetric care provides a rare and critical opportunity to screen for intimate partner violence, mental health issues, or substance use. It allows healthcare providers to educate expecting parents on health behaviors like infant sleep practices or how to use a car seat. All these uses of obstetric care address and prevent death.

These findings show a need for resource sharing across hospital systems, support for women who need to travel for care, and increased access to care during pregnancy.

February: Zuranolone for postpartum depression

Written by Sophia Allen

POint of View:
THE WALL STREET JOURNAL: THE TRAGEDY OF BEING A NEW MOM IN AMERICA

This article follows several women who experienced severe postpartum depression (PPD): Jaclyn, Brenda, and Denise. Of the three, Jaclyn was the only one who found the help she needed and the only survivor of PPD. However, her journey to receiving help was still too difficult; the article centers Jaclyn’ story alongside a discussion of policies that fail to designate any one provider as responsible for a woman’s mental health after pregnancy. Jaclyn is pushed around from her obstetrician to the emergency room to an in-patient facility and to countless other specialists. Finally, she learns about and travels nine hours to UNC’s Center for Women’s Mood Disorders, “one of the three inpatient facilities in the U.S. for maternal mental health.” Here, she receives Zulresso (brexanolone), a 60-hour intravenous PPD treatment that would have cost $180K without insurance. Although she pays far less, she still accrues medical debt.

Brenda and Denise were not as “lucky.” Brenda stopped breastfeeding about 3 months after birth. Her husband noticed her mood was deteriorating, and she was self-harming. Doctors skimmed over questions related to Brenda’s mental health, leaving no room for Brenda to open up. After trying therapy, Brenda ultimately committed suicide via gunshot. The executive director of the Maternal Mental Health Leadership Alliance is quoted saying that women who have recently given birth often choose more lethal means of death as “they are so desperate,” underscoring the dire importance of helping the person out of their immediate mental health crisis. Denise developed PPD about a year after the birth of her first child, and her symptoms worsened while pregnant with her second child. She was hospitalized while pregnant and, when released, had her second child. After, her symptoms worsened, and, when she expressed a desire to kill herself and her children, her children were taken from her. Not long after, Denise died of a pulmonary embolism. Her sister, who now cares for her children, is quoted as saying, “The help wasn’t there for my sister.” These stories highlight the need for rapid, accessible, and affordable PPD treatments. This POV was published a week before Zuranolone was approved by the FDA, thus sparking major publicity around PPD.

Resource:
MATERNAL MENTAL HEALTH LEADERSHIP ALLIANCE: THE FIRST ORAL TREATMENT FOR POSTPARTUM DEPRESSION IS FINALLY HERE

MMLA answers frequently asked questions about Zuranolone, including how the drug works, side effects, what makes it unique, cost and insurance info, and other considerations. Zuranolone was FDA-approved in August 2023 after two randomized controlled trials found that a 14-day course of Zuranolone vs. placebo led to significant PPD symptom improvements, effects that were rapid and lasted four weeks after the final dose. Zuranolone is a synthetic version of allopregnanolone, a hormone related to progesterone that regulates GABA-a receptors in the brain (which affect mood and cognition). Since this hormone rises during pregnancy and drops sharply in the postpartum period, Zuranolone targets PPD specifically. Reported side effects include dizziness and drowsiness. The cost of Zuranolone is almost $16K. It is still unclear which insurance companies will cover the medication and, although the manufacturers have indicated that the drug will be available with a reduced copay or at no cost for certain eligible patients, the details are still in flux and it likely that Medicaid coverage will vary by state. Another notable limitation of PPD treatment with Zuranolone is that currently there is no research on the safety of taking the Rx while pregnant or breastfeeding, meaning that it is not advised.

News Story:
THE 19th: THERE’S A NEW PILL FOR POSTPARTUM DEPRESSION, BUT WHO CAN ACCESS IT?

This article critiques the high cost of Zuranolone and discusses both barriers and facilitators to mitigating the drug’s expense for low-income people in the postpartum period. Maternal mental health advocates and researchers interviewed expressed concern over insurance coverage stipulations that vary by insurance company and state Medicare policy. For example, some states have announced that they will require prior authorizations for the medication and/or “fail-first” treatment plans (meaning the patient has to try a different medication, this medication has to be rendered ineffective, and then they can try Zuranolone), or require a psychiatrist to prescribe the medication even though OBGYNs are approved to treat PPD and many psychiatrists do not accept Medicaid. Currently, only 1% of insurance companies have released any guidance on coverage of Zuranolone, leaving the affordability of this drug very uncertain. Since Medicaid covers 40% of U.S. births and approximately two-thirds of Black and Indigenous births, insurance coverage is key to realizing the benefits of Zuranolone and preventing maternal morbidity and mortality.

Scientific Publication:
SCREENING AND THE NEW TREATMENT FOR POSTPARTUM DEPRESSION

In this research column, Dr. Summer Hawkins reviews PPD risk factors, current PPD screening guidelines (by ACOG and other associations), and gaps in mental health care policy that perpetuate disparities in PPD screening, diagnosis, treatment access, and medication uptake (i.e., an analysis of why people “slip through the cracks”). She discusses how Zuranolone (Zurzuvae) fills an important and timely gap as the first oral medication to treat PPD specifically. Before Zuranolone, the only treatment explicitly targeting PPD was Zulresso (brexanolone), a costly intravenous treatment administered over 60 hours; this treatment was released during COVID-19 (in 2020) and required patients to show up in person to receive care, making it inaccessible to those who face barriers such as lack of transportation, childcare, inflexible work schedules, and/or any sort of health issue or disability that might prohibit in-person access. Comparatively, Zuranolone is less expensive (with the caveat that insurance coverage and Medicaid reimbursement plans are still underway), fast-acting (effects start within days), less invasive (daily pill vs. intravenous administration), and more private (taken from home). Her commentary concludes with a call to action that releasing this medication is not enough: it needs to be easily accessible to everyone who needs it, and there is no time to waste.

January: The criminalization of substance use during pregnancy

Written by Sharanya Subramaniam

POint of View:
Draconian Laws Deter Pregnant Women from Treating Drug Abuse

Experts in maternal health discuss the challenges faced by pregnant and postpartum persons during the opioid crisis. Neonatologist and Executive Director of Firefly, an opiate use disorder (OUD) treatment program at Vanderbilt University, Stephen Patrick, points out frequent occurrences of people with OUD being labeled unfit parents and being separated from their infants. State laws require healthcare professionals to report suspected prenatal substance use to Child Protective Services, which can have unexpected outcomes. Some parents are scared of asking for help because they are afraid of legal trouble. Mishka Terplan, an Ob-Gyn, points out that these laws contribute to many infants entering foster care, which harms both parents and children. The authors highlight the need for supporting pregnant people with substance-use disorders and making treatment more accessible. Miriam Komaromy, medical director of the Grayken Center for Addiction, advocates for creating an environment where pregnant people feel comfortable seeking help without the threat of legal consequences. By shifting the focus towards supportive treatment, the aim is to empower parents to address their OUD, supporting the well-being of families.

Resource:
Center for Addiction Recovery in Pregnancy and Parenting

The Center for Addiction Recovery in Pregnancy and Parenting (CARPP) at Dartmouth Health helps pregnant and parenting women recovering from addiction. It is a network of experienced healthcare providers and researchers focused on helping women and their children who are affected by substance-use disorder in the Upper Valley region and beyond. One of CARPP’s programs is Moms in Recovery. This program offers care for pregnant and parenting women with substance-use disorders, including group and individual treatment, care before and after birth, mental health support, and newborn care, all in one location. CARPP also offers other programs to support families affected by substance use disorder.

News Story:
Pregnant and addicted to opioids: A mother speaks

In this short clip from AthenaHealth, a young mother recounted her struggle with substance use disorder. She became addicted after using painkillers as prescribed by her doctor, but upon finding out she was pregnant, this mom was told that withdrawal would be too difficult on the baby. Although she was sad that her substance use put her baby at risk, she expressed how the doctors and nurses in her clinic have treated her with such kindness and compassion, without judgment, that she was able to get the care she needed to take care of herself and her baby. This mom’s testimony highlights the need for supporting moms in care rather than punishing them. Because the clinic made her feel safe and supported, this brave mother took control of her health to create a better future for her family.

Scientific Publication:
Association of Punitive and Reporting State Policies Related to Substance Use in Pregnancy With Rates of Neonatal Abstinence Syndrome

This study aimed to understand how state policies on substance use during pregnancy affect rates of neonatal abstinence syndrome (NAS), which includes conditions caused when a newborn withdraws from exposure to maternal substance use before birth. Using data from 4.6 million births across 8 U.S. states during 2003-2014, the authors studied two types of state policies: 1) those that punished substance use, and 2) those that mandated reporting of suspected prenatal substance use. The study found that the rate of NAS per 10,000 births was significantly higher in states with punitive policies compared with states without these policies. The NAS rate was 46 per 10,000 live births (95% CI, 43-48) in states without punitive policies; 57 per 10,000 live births (95% CI, 48-65) during the first full year after policy enactment in states with punitive policies, and 60 per 10,000 live births (95% CI, 56-65) in states with punitive policies in effect for more than 1 full year. The study points out the importance of focusing on prevention of NAS through treatment rather than criminalization of substance use during pregnancy.

December: HIV and Maternal Health

Written by Justin Herrera

POint of View:
VIDEO: 'We know little' about HIV treatment options for pregnant women

USC professor of medicine, Monica Gandhi, MD, MPH speaks about the lack of FDA approved antiretroviral treatment options that are approved or recommended in pregnancy. The lack of research stems from an exclusion of pregnant women in HIV treatment research. This exclusion leaves many questions unanswered surrounding possible treatment side effects on pregnancy. Dr. Gandhi posits that contrary to current practice where pregnant women are often excluded from trials, it would be unethical to continue excluding them since they are an important population for HIV treatment.

Resource:
Women Living with HIV: Undetectable=Untransmittable/Living Proof

HIVE, a San Francisco-based hub of positive sexual and reproductive health, has provided preconception and prenatal care to women and couples affected by HIV in San Francisco since 1989. Their ‘Women Living with HIV’ page features informational brochures, in both English and Spanish, on HIV and pregnancy, the transmission of HIV, the history of its criminalization, and many other resources surrounding family planning/conception. Along with the resources, there is a video of HIVE patients and their experiences, discussing shame and stigma surrounding HIV and pregnancy. Organizations like HIVE have been key in filling the resource/research gap surrounding pregnant women living with HIV.

Resource 2:
HIV and Pregnancy

In this extensive resource, the American College of Obstetricians and Gynecologists answers common questions about HIV. For example, it defines HIV and explains how HIV spreads. It also addresses living with HIV+ during pregnancy, birth, and postpartum. Additionally, this resource includes a glossary of important terms one should know surrounding pregnancy and HIV.

News Story:
Why Black women face barriers to accessing PrEP, an HIV-preventing drug

Black women face various barriers while trying to receive a prescription for PrEP (pre exposure prophylaxis), a highly effective drug for preventing sexual transmission of HIV.

Black women are among the most vulnerable groups in the ongoing HIV epidemic. A few key barriers to treatment include a lack of awareness about PrEP among both patients and medical providers, non-inclusive marketing that doesn’t portray Black women as potential users, insufficient treatment options tailored for women, and social stigma surrounding PrEP. These challenges are exacerbated in southern U.S. states where HIV transmission rates are the highest.

Ensuring access to affordable healthcare, reducing costs associated with PrEP treatment, and changing provider education and public health messaging are crucial to increasing PrEP uptake among Black women and curbing the HIV epidemic.

Scientific Publication:
Achieving Elimination of Perinatal HIV in the United States

This 2023 journal article published by the American Academy of Pediatrics focuses on the goals set by the CDC’s Framework for Elimination of Perinatal Transmission of HIV in the United States. The study used data from the National HIV Surveillance System and the National Inpatient Sample of the Healthcare Cost and Utilization Project to calculate rates of perinatal HIV transmission from 2010 to 2019. The number of live births to women with HIV decreased significantly between 2010 and 2019. Additionally, the number of infants acquiring HIV through their birth dropped by half between 2010 and 2019. These decreases were driven by a reduction in the HIC diagnoses rate for Black mothers (from 6.6 per 100,000 live births to 3.1 per 100,000 live births) but in 2019, Black mothers still had rates that were ten times higher than that of White mothers and four times higher than Hispanic mothers.

The article also speaks about the continuing efforts of coordinated health care and public health spheres to eliminate perinatal HIV fully. Some of these efforts include a more widespread use of HIV PrEP, especially among Black women. They also recommend that women with HIV should be treated to lower their viral load before they become pregnant.

November: The return of midwives in Indigenous communities

Written by Sophia Perez

POint of View:
Indigenous Midwives | Wilson Center

Indigenous midwives can help protect Indigenous mothers from the worse birth outcomes that they face compared to others. In the US, Indigenous women are twice as likely to die from pregnancy-related causes than white women. Care from a midwife could eliminate a whopping 83% of maternal and infant death.

One powerful aspect of care from an Indigenous midwife is culturally appropriate care. Simply put, a care provider from one’s own community better understands how to care for an Indigenous mother while honoring the traditional, spiritual, and cultural preferences she might have. Birth evacuations - the practice of removing a mother from her community before she gives birth - is Canadian policy. Understandably, this practice can be difficult for a mother. With the rise of Indigenous midwifery, communities take back their honored practices and support their growing families.

Resource:
Midwifery - Pauktuutit Inuit Women of Canada

This resource illuminates the sacred importance of Inuit midwives. Inuit children have a special bond with the midwives who helped to bring them into the world. Using traditional storytelling, Inuit community members advocate for the importance of midwives in their communities and detail the many positive effects and challenges of care from Inuit midwives. Women who are evacuated from their homes in favor of Westernized care are separated from their family, community, language, and culture during a difficult trial of their lives. The impassioned speakers emphasize that midwifery care is their right, and it is not the place of outside peoples to infringe upon their culture and practices.

News Story:
Inside the push to end ‘birth evacuations’ in Indigenous communities

In 2022, Ashley Rabbitskin gave birth to her son in her home, with gentle cultural practices encouraging her and welcoming her son into the world. The birth of Ashley’s son marked the first birth in their community in the past 50 years.

Many remote communities do not have access to healthcare providers to assist them through childbirth. Therefore, they must go outside of their communities to give birth. This practice is known as “birth evacuation.” Birth evacuation is intended to make birth safer, but it comes at a hefty cost. Traveling away from the community at a vulnerable time severs Indigenous women from their support network and causes stress. Also, receiving care outside of their communities opens them up to anti-Indigenous discrimination in healthcare. The risk of discrimination in healthcare was the reason Ashley decided to stay in her community for her son’s birth. Because she was able to give birth inside the community, Ashley had more emotional, cultural, and spiritual support.

Ashley was supported by an Indigenous midwife. Long before the place in which she lives was called “Canada,” Indigenous midwives assisted women through birth. More recently, midwives have not been allowed to practice. However, midwifery in Indigenous communities is slowly coming back. The federal government now funds Indigenous midwives and doulas as well as a traditional birthing facility in Ashley’s community. With the uptick in midwifery support, more Indigenous women will be able to welcome their children surrounded by the traditions and support of their community.

Scientific Publication:
Indigenous Doulas: A literature review exploring their role and practice in western maternity care

Similarly to Indigenous midwives, Indigenous doulas can provide a birthing environment steeped in tradition and surrounded by community. Indigenous midwives and doulas can support people giving birth in remote locations, where otherwise they would be evacuated for the birthing process. Doulas bring Indigenous knowledge, traditions, and culturally appropriate care. When Indigenous mothers are supported through birth by care workers within their communities, the colonization of birth is disrupted in favor of cultural reclamation and spiritual preservation. Doulas supporting mothers within Indigenous communities is an act of political resistance and a show of sovereignty in contrast with the policy of birth evacuations. Keeping the birthing rituals in Indigenous communities preserves history, strengthens family, and shows respect for Indigenous culture.

October: Disability Awareness Month

Written by Uma Alagappan

POint of View:
‘Why am I having to explain this?’: Seven Stories of Barriers to Reproductive Care for Those with Disabilities – STAT News

Published in January 2023, this story centers the stories of seven women with disabilities: Stefanie (27), Leigh (34), Brianne (22), Sydney (24), April (44), CJ (42), and Linda (52) and their experiences of navigating maternal and reproductive healthcare including chronic illness, neurodivergence, and mental and physical health challenges. Their stories highlight the considerable emotional difficulty that comes with not only pregnancy and parenthood, but also with processing health risks and adverse outcomes. The article brings to light the systemic disregard of folks with disabilities as ‘nonsexual’ and ‘incapable parents’, resulting in the striking lack of support and resources shared in provider-patient interactions. This lack of support ranges from failing to provide patients with all of their reproductive care options to a gaping lack of emotional support through a strenuous time. Ultimately, by centering those who live with disability and chronic illness, the women share a myriad of ways in which people with disabilities and chronic illness know their own bodies and the detrimental impacts they experience when providers do not heed their expertise.

Resource 1:
Pregnancy and Motherhood in Women with Disabilities: Information and Opportunities for Local Health Departments

Increasing equitable access to reproductive healthcare for people with disabilities is important.

This brief guide is intended for healthcare providers to mitigate such disparities in reproductive healthcare experienced by women with disabilities– a task that becomes increasingly important as pregnancy rates rise in this population. The guide points to poor environmental accessibility, exclusion from informational resources, inadequate provider training, and social stigma as the primary barriers to quality care and makes the following three recommendations for healthcare improvement:

1. Improve accessibility and inclusivity of existing facilities, informational resources, and health promotion programming.

2. Provide staff training the needs of people with disabilities.

3. Collect data about pregnancy among women with disabilities in your city or county.

Resource 2:

Take Charge! A Reproductive Health Guide for Women with Disabilities

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This guide was developed by The Empowered Fe Fes, a young women's advocacy and peer support group at Access Living in Chicago. Special focus is given to empowering women with disabilities to understand their reproductive rights, self-advocate for those rights, and make informed decisions about their own bodies. Topics include:

• reproductive health, rights, and justice

• keeping up with reproductive health

• violence and abuse

• mental health

• mothering with a disability.

This guide can be used by people with disabilities, healthcare providers, parents, and community organizations.

News Story:
What It’s Like To Be Pregnant With a Disability

Scripps News follows Brittany King, a soon-to-be mother with disabilities, through the three trimesters of pregnancy. King acknowledges the stigma and ignorance around the sexuality of folks with disabilities with people asking her “Is [sex] a thing for people with disabilities?” Along with social stigma, King navigates severe health risks in her pregnancy. Though the challenges and potential complications arise in high risk pregnancy, typical for folks with disabilities, Dr. LaTasha Nelson, a maternal fetal physician at Northwestern Medical Group, reminds us of the excitement that pregnancy brings. King reaffirms this in sharing how happy she will be to bring the life that has been inside of her into the world. They remind us that we cannot lose sight of the typical nerves, and importantly joy, that comes with pregnancy, with disability or without. The story culminates with a photograph of King’s daughter. Her story highlights the public ignorance and social stigma that surround the sexuality of disabled folks as well as the emotional complexity of high risk pregnancies. Amidst the challenges that pregnancy brings, King centers hope, joy, and excitement. A related article is linked here.

Scientific Publication:
Perinatal Health Risks and Outcomes Among US Women with Self-Reported Disability, 2011-19

This study compared health risks and birth outcomes between pregnant people with disabilities and those without. A key contribution of this study is its use of a self-reported disability measure. With this metric, 19.5% of the study’s respondents have disabilities compared to disability rates based on medical diagnoses (~ 1-6.6%). Using National Survey of Family Growth data (2011–19), pregnant people with disabilities were found to have 24% higher risk of preterm birth and 29% higher risk of low birthweight as those without disabilities and were twice the liklihood of smoking during pregnancy (19% vs. 9%). The significance of modifiable risk factors such as smoking, obesity, and depression underscored the need for preconception care in this population. Since the proportion of pregnancies in which the birthing parent had a disability were substantially higher than in US studies using diagnosis codes to identify disability, it is important that providers collect self-reported disability data in health care settings to better assess patient needs and reduce disparities. It is also important to establish the timing of the onset of disabilities as occurring before the pregnancy in order to assess their potential for impacting birth outcomes.

To learn more about this work from the first author Willi Horner-Johnson, you can turn to the Health Affairs Briefing: Disability & Health Virtual Symposium. Horner-Johnson presents the findings of this paper in the “Disability & Health Video 3” at the 16:18 timestamp.

September: Intersectionality and maternal health

Written by Justin Herrera

POint of View:
From Birth Control to Death - Facing Black Women's Maternal Mortality

"From Birth Control to Death: Facing Black Women's Maternal Mortality" is a panel featuring experts in racial justice in maternal health. Featured speakers included: Prof. Kimberlé Crenshaw, Laurie Bertram Roberts, Dr. Joia Crear-Perry, Jennie Joseph, Kira Shepherd, and Aarin Michele Williams. This talk explores the ways in which intersectionality can be used to inform discussions of Black maternal mortality. As Crenshaw stated, “what many people don’t realize… is that Black women's vulnerability to mortality stretches beyond class or education…” The varied stories shared during the panel, from abortion restriction to the criminal justice system, are shining examples of how eliminating Black maternal mortality requires reform in more than one institution outside of direct healthcare. There is no separation of issues. As stated by Williams, “...we cannot save Black babies, we cannot save black children, we cannot save Black communities if we do not support Black women.”

In July 2023, we covered a news story and scientific article that further discusses these issues.

Key moments from the discussion:

08:56 - Background on high Black maternal mortality through an intersectional lens

31:05 - Discussion of stereotypes Black women face, the impact on care, and the need for more data surrounding Black maternal mortality

38:39 - The criminalization of pregnant Black women

58:08 - Black maternal healthcare conditions

Resource:
Intersectionality and health explained

Race, gender, and social class have all been observed to have a strong impact on health. Intersectionality is a term coined by Kimberlé Crenshaw to describe overlapping layers of discrimination. The intersectional framework allows us to analyze the ways in which multiple social identities simultaneously impact our day-to-day lives. This short video (3:35) describes how intersectionality can shed light on differences in health experienced by groups of varying identities.

News Story:
She hoped to shine a light on maternal mortality among Native Americans. Instead, she became a statistic of it.

Stephanie Snook, 37, was a member of the Tsimshian and Tlingit tribes of Alaska. She was pregnant with twins when NBC News contacted Stephanie for an interview on disparities faced by Indigenous Americans. As an activist in her community, Stephanie was enthusiastic about being interviewed. Before they got the chance to meet, Stephanie became short of breath and developed pain. Stephanie saw her doctor, but she was sent home. Then less than 24 hours later, she went into cardiac arrest. Stephanie underwent an emergency Cesarean section but tragically lost her life. Within the week, Stephanie’s twins died as well.

The death of Stephanie Snook and her twins shines a light on the many problems surrounding the maternal healthcare Indigenous women receive in this country. Bias can play a large role in the care mothers receive. Indigenous people also tend to have more complex social situations than their White counterparts, such as higher rates of unemployment, poverty, adverse childhood experiences, and violence. All of these factors can contribute to worse health outcomes. This example demonstrates the need for an intersectional focus on maternal healthcare: Stephanie, like many other marginalized women, faced many layers of disadvantage and ultimately became a victim of maternal mortality.

Scientific Publication:
Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States

Maternal mortality, or pregnancy-related death, is increasing in the U.S. Researchers for this project investigated how these deaths differ by race and ethnicity over time. They found that in most states, the people most likely to die from pregnancy-related causes were Black or American Indian Alaskan Native. Between 1999 and 2019, the ratio of people dying relative to the size of the population (maternal mortality ratio) increased for American Indian Alaskan Natives more than it did for any other population. Maternal mortality is a huge marker of inequity in the U.S., and Black and American Indian Alaskan Native people are at the highest risk.

August: The approval of Opill

Written by Sophia Allen

POint of View:
Why the FDA’s Approval of Opill Matters – And What’s Next

Having access to safe and affordable contraception is now more essential than ever. In an opinion piece, Dr. Carolyn Sufrin, MD, PhD (Associate Professor of Obstetrics and Gynecology at Johns Hopkins School of Medicine) discusses how timely and important the FDA’s decision to approve Opill is given the abortion restrictions in many states. Progestin-only birth control pills are safer than combination (progestin plus estrogen) pills, in fact “they are even safer than Tylenol”. Dr. Suffrin also hopes combination pills also become available over the counter. Along with corresponding education and risk-management efforts, both options will increase women’s control over birth control. Pharmacists will be key partners as they need to be able to relay accurate information to customers that come to them with questions.

The Biden administration has argued that cost of contraception should be covered; however, it is unclear if insurances will cover Opill and how much it will cost without insurance. Another concern is that laws enabling pharmacies to refuse to offer Opill could be passed by state governments that have already restricted access to abortion. We saw this happen when Walgreens refused to offer mifepristone, the first pill in a dose of two pills (the second being misoprostol) taken to terminate a pregnancy. Future shifts in federal administration could also impact the longevity of Opill’s success and hamper future efforts to increase contraception access. While this decision is very exciting, but we still have a lot of work to do to ensure contraceptives are equitably and sustainably available.

Resource:
OPILL FACT SHEET

Opill, often called the “mini-pill” because it contains progestin rather than a combination of estrogen and progestin, thickens the cervical mucus, preventing sperm from reaching the uterus. The pill, like other birth control pills, is 98% effective if taken at the same time every day (as intended) and has been found to have fewer side effects than combination pills. Those who have or have had breast cancer should not use Opill.

The Opill factsheet is a 1-page flyer including critical facts about Opill, including its effectiveness in preventing pregnancy, safety, and directions for use. The factsheet also includes a timeline of Opill’s history, from its original approval date in prescription pill form (1973) to its approval for OTC use in the US (2023) and intended availability in stores and online (2024). Lastly, the flyer covers potential side effects and links to additional resources for those who want to learn more.

News Story:
New York Times - Women React to News About an Over-the-Counter Birth Control Pill

Following the approval of Opill, the New York Times interviewed 18 women about their thoughts concerning the FDA’s landmark decision with mixed reactions. Teenagers mentioned that the pill benefits those with conservative parents or parents whose culture was less accepting of birth control. People of all ages cited convenience as the primary draw of an OTC pill. Alternatively, some had concerns about safety and side effects, the FDA’s choice not to impose age restrictions, or that one could procure the pill without medical guidance. For people who find providers are hard to reach or whole providers do not manage birth control, this was a good development. Although Perrigo (the manufacturing company that produces Opill) claims they are committed to keeping Opill “affordable,” a price has not yet been announced. Universal access to the pill does not mean that everyone who wants to buy the pill will feel

empowered, comfortable, or educated enough to buy it or be able to afford it. More will need to be done to ensure equitable access for all regardless of income or health insurance.

Scientific Publication:
Interest in Using Over-the-Counter Oral Contraceptive Pills: Findings from the 2022 KFF Women's Health Survey

In 2022 (before the approval of Opill), Kaiser Family Foundation conducted a nationally-representative survey, including 5,201 women ages 18 to 64, on the acceptability of OTC birth control pills. Three-quarters (77%) of women supported OTC birth control pills if they were proven safe and effective, with over half (56%) indicating their strong support, and 39% said they would be likely to use the pill. Not having plans to use any contraception was the most common reason reported for not being likely to use the pill.

Notably, of those who said they would use the pill, only one-sixth of people said they would pay more than $20 per pack. Additionally, many survey results varied based on demographic factors, including race, ethnicity, income, insurance status, and history of birth control use. For instance, confidentiality as a primary reason to use Opill was cited twice as often by Black survey respondents compared to White respondents (10% vs. 5%), despite overall support ratings for Opill being lower among Black respondents than any other racial/ ethnic group (including White, Hispanic, and Asian/Pacific Islander). This and other differences in perspectives on birth control (as well as factors such as how or at what age one should obtain birth control) allude to the impacts of structural medical racism and other interlocking oppressions that lead to unequal rates of unwanted pregnancy and subsequent poor outcomes for women.

July: Maternal health disparities in the U.S.

Written by Alka Dev

POint of View:
How we can improve maternal health before, during, and after pregnancy

Dr. Elizabeth Howell identifies several systemic issues that contribute to maternal health disparities. These include a lack of access to healthcare services, inadequate prenatal and postpartum care, insufficient support for mothers during the perinatal period, and implicit biases among healthcare providers. These issues are often compounded for women of color, who face additional challenges such as racism, discrimination, and socioeconomic disadvantages. Dr. Howell offers solutions such as increasing access to healthcare services, improving communication between healthcare providers and patients, and addressing implicit biases and emphasizes the need for a comprehensive and equitable approach to maternal healthcare.

Resource:
Birth Stories in Color

BSiC is a website that aims to amplify and celebrate the voices and experiences of Black and Brown birthing people. The website features a podcast that shares personal birth stories, as well as blog posts, resources, and a directory of birth workers of color. The podcast highlights the diverse experiences and perspectives of Black and Brown birthing people, including those who have faced systemic barriers and discrimination within the healthcare system. The website also provides information and resources to help birthing people make informed decisions about their care, and to support them in finding culturally responsive and compassionate care providers.

News Story:
In Louisiana, pregnant women struggle to get maternal health care, and the situation is getting worse

This 13-minute segment highlights the struggles women face in accessing quality maternal healthcare in Louisiana, a state with one of the highest maternal mortality rates in the country. Black women in Louisiana are three times more likely to die from pregnancy-related causes than White women. The segment follows the stories of several women who have experienced complications during pregnancy and childbirth and struggled to receive adequate care. The segment also explores the systemic issues that contribute to these disparities, including a lack of investment in healthcare infrastructure, a shortage of healthcare providers, and systemic racism and bias. The segment calls for systemic change, including increased funding for healthcare infrastructure, policies to address systemic racism and bias in healthcare, and efforts to center the voices and experiences of women and mothers in these efforts.

Scientific Publication:
Maternal and Infant Health Inequality: New Evidence From Linked Administrative Data

This study provides evidence of maternal and infant health inequities due to income and racial bias. By linking several administrative datasets from California, the researchers found that low birth weight (LBW) and preterm birth, were not consistently better for babies born to richer parents. Children of parents in the top 20% of income had lower average birth weight and higher LBW than children born to people in the bottom 20%, which is different from other outcomes like life expectancy that consistently increase with income. A major reason for this discrepancy was that worse birth weight outcomes at higher income levels were due to higher average parental age and a greater share of non-singleton births among those families. Advance maternal age is a known risk factor as well as lower birth weight and shorted gestation among multiple births (twins triplets etc.). However, infant mortality did not show this pattern. Children of richer parents were more likely to survive than children of poorer patients - meaning that even though their pregnancies were riskier, richer parents’ babies were least likely to die. These pregnancies were the most protected by resources such as high quality childcare and paid family leave despite their risk. The same relationships were observed for maternal mortality as well. Finally - and incredibly important - across all income levels, Black infants and mothers have much worse health than their non-Hispanic White counterparts. LBW and preterm birth rates for infants of Black parents in the top of the income distribution was around 1.5 times higher than those for infants of White parents in the bottom of the income distribution while the maternal mortality rate among the richest black mothers was similar to that among the poorest White mothers. The rates for these two groups never converged.

June: Working while pregnant: The Pregnant Workers’ Fairness Act

Written by Sophia Perez

POint of View:
Working in extreme heat is risky for pregnant workers. Advocates say passing the Pregnant Workers Fairness Act could help

Studies have shown that heat exposure can lead to a range of negative health outcomes, including preterm birth, low birth weight, and stillbirth. The COVID-19 pandemic made things much worse for pregnant workers. Women of color disproportionately work in low-wage jobs, like in kitchens or warehouses that might have no air conditioning or poor ventilation. And due to the climate crisis they now have to contend with the rising temperatures when they are back in their homes. Low-income communities of color also face higher exposure to heat in their neighborhoods due to factors like lack of shade and green spaces. A Better Balance, an advocacy organization that aims to improve conditions for caregivers in the workplace, collected similar evidence and testimonies in their fight to pass the Pregnant Workers Fairness Act (PWFA). For pregnant people working in extreme heat, the law would require employers to provide reasonable accommodations for pregnant people, like water breaks or rest breaks, or a temporary change in work duties. In the face of extreme heat and wildfires accelerated by climate change, which will worsen working conditions, advocates are urging Congress to pass it.

Resource:
What You Should Know About the Pregnant Workers Fairness Act

The current legal framework does not support pregnant workers. The Pregnancy Discrimination Act has vague language that makes it hard to enforce and the Americans with Disabilities Act requires workers to prove they need an accommodation. Therefore, discrimination against pregnant workers remains and approximately two-thirds of workers are still losing their accommodations cases and continue to be forced out of work. The Pregnant Workers Fairness Act (PWFA) is a new law that requires private and public sector employers with at least 15 employees, Congress, Federal agencies, employment agencies, and labor organizations to provide “reasonable accommodations” to a worker’s known limitations related to pregnancy, childbirth, or related medical conditions, unless the accommodation will cause the employer an “undue hardship.” This act goes beyond the current legal framework to require accommodations for pregnant workers, andd to ensure that employers develop these accommodations in discussion with the employee, don’t withhold employment due to the need for accommodations, require the employee to take leave if accommodations can be provided, harass the employee, or interfere with their rights. The site links to other laws that protect pregnant and nursing workers. Currently passed by the House in 2021, the PWFA is up for Senate vote in June.

News Story:
“I’m Terrified”: Pregnant Health Care Workers at Risk for Coronavirus Are Being Forced to Keep Working

This article investigates the working conditions of pregnant healthcare employees during the COVID-19 pandemic. It highlights the ethical concerns and risks faced by pregnant healthcare workers who are being forced to work in an environment where they are exposed to the virus, without adequate protective equipment. Despite the growing evidence that pregnant women may be at higher risk of severe illness from COVID-19, many pregnant healthcare workers have been unable to take time off work, either due to lack of accommodation from their employers or because they cannot afford to take unpaid leave. The article also highlights the challenges faced by healthcare workers who are advocating for their rights, such as fear of retaliation or job loss. It calls for more protection and accommodation for pregnant healthcare workers, including access to paid leave and protective equipment, as well as greater recognition of the unique risks they face.

Scientific Publication:
Examining the Effects of Perceived Pregnancy Discrimination on Mother and Baby Health

The researchers aimed to examine how discrimination might affect the health and well-being of the employee and her baby. They used an online survey to examine the role of perceived pregnancy discrimination in the workplace on health outcomes for mothers and their babies via mother’s perceived stress. First, they examined the effects of perceived pregnancy discrimination on mothers’ postpartum depressive symptoms via perceived stress. Second, they replicated and extended their first study and examined the effects of perceived pregnancy discrimination on mothers’ postpartum depressive symptoms and babies’ gestational age, Apgar scores, birth weight, and number of doctors’ visits, through the mechanism of perceived stress. They found that perceived pregnancy discrimination in the workplace was associated with increased perceived stress which was subsequently associated with elevated levels of postpartum depression. Moreover, the mother’s experienced stress led to lower birth weights, lower gestational ages, and an increased number of doctors’ visits for the babies a few weeks after birth. Thus, perceived pregnancy discrimination led to negative health consequences for the mother and the baby.

May: Maternal Mental Health Awareness Month

Written by Sophia Perez

POint of View:
”Baby Blues” — or Postpartum Depression?

Patients and experts from the National Institute of Mental Health talk about postpartum depression in the U.S. They explain the difference between the Baby Blues, which are mild mood swings that happen to many new mothers and last a week or two versus postpartum depression, a more severe and persistent form of depression that can occur within a few weeks of childbirth and can last for months or longer. This expert perspective emphasizes that postpartum depression is normal but it is important to seek help rather than try to manage it yourself.

Resource:
Postpartum Depression Therapist: What Is It, How To Find One, and What To Look For

This resource provides information about postpartum depression, which is a type of depression that can occur after childbirth. It explains that therapy can be an effective treatment option for postpartum depression and describes different types of therapy that may be helpful. The webpage also provides tips for finding a therapist who specializes in treating postpartum depression and emphasizes the importance of self-care and support from loved ones during this time.

News Story:
Warning signs and resources for local families struggling with postpartum mental health

The news story from Boston discusses postpartum mental health and provides resources for local families who may be struggling with postpartum depression and other related conditions. It lists common warning signs of postpartum depression, including feelings of sadness, hopelessness, and guilt, and provides information on support groups and treatment options for affected individuals. The story highlights the importance of seeking help from a mental health professional in the form of individual psychotherapy, group interventions, or medication. At the end, the story covers some resources in Massachusetts as well as the National Maternal Mental Health hotline – 1-833-TLC-MAMA (1-833-852-6262).

Scientific Publication:
Trends in postpartum mental health care before and during COVID-19

The researchers assess the impact of COVID-19 on postpartum mental health care use, including diagnosis for depression, anxiety, or stress-reaction and prescription drug treatment. By analyzing mental health diagnosis and treatment claims among the insured in the 90 days after giving birth, they found that new postpartum mental health diagnoses increased significantly during COVID-19 compared to pre-COVID. However, there was a decrease in treatment utilization, particularly for those insured through Medicaid. Researchers indicated that the postpartum mental health crisis may be improved by extending Medicaid coverage of postpartum conditions to 12 months, expanding insurance coverage of community-based maternal care, and expanding access to telehealth services.