ACOG continuing efforts to ‘prioritize, normalize and destigmatize’ mental health

Key takeaways:

• Mental health is the No. 1 cause of maternal morbidity.
• ACOG has been at the forefront of mental health awareness, which will continue with the next president.

BALTIMORE — ACOG will continue providing a strong focus on the mental health of patients and providers as the current president’s tenure comes to an end, according to a speaker at the ACOG Annual Clinical & Scientific Meeting.

“The goal is to prioritize, normalize and destigmatize mental health,” Iffath A. Hoskins, MD, FACOG, immediate past president of ACOG, said during a press briefing on ACOG mental health initiatives. “All OB/GYN clinicians are taught the importance of mental health, but sometimes that is focused on the pregnancy portion, on the menopause portion or on a person who has substance use disorder and addictions. We wanted it more seamless across the board. That was the gap in education we needed to teach ourselves.”

To mend this gap, during her 2022-2023 ACOG presidential term, Hoskins developed her Presidential Initiative: Minding Mental Health to shed light on the importance of addressing mental health for both OB/GYN patients and providers.

Mental health for patients, providers

According to 2018-2019 CDC data, the No. 1 cause of maternal mortality is maternal mental health conditions, such as depression, anxiety and substance use disorder, which are present among 23% to 25% of mothers. This was a surprising statistic, Hoskins said, as OB/GYNs have always looked at hypertension, postpartum hemorrhage, infection, medical comorbidities and anesthesia as the main causes of maternal mortality with less focus on the mental health toll.

During the COVID-19 pandemic, mental health was brought to the forefront as physicians began to realize they were facing substantial stress, depression, trauma, fear and anxiety, which are all mental health. However, providers were often reluctant to speak out or ask for help regarding their mental health for fear of burdening colleagues, concealed their distress from patients and sought to keep mental health from influencing their medical record or license renewal. Because of this stigmatization, many providers died by suicide, left the specialty or were nonfunctional, according to Hoskins.

“We deserve for ourselves the same compassion that we give to our patients, the same understanding,” Hoskins said.

Realizing this was happening, ACOG wanted to get the word out about mental health and how it impacts patients and providers, Hoskins said.

“What ACOG did in this regard is provide excellent educational materials on pregnancy and postpartum/peripartum depression and substance use disorder through AIM, which is the Alliance for Innovation on Maternal Health,” Hoskins said. “We have patient safety bundles, and we have patient safety educational documents. One of the very important things we did in that rollout is we added in data collection. It’s in one document where we talk about what resources are available, what you should be doing, how you interpret for any patient across her life, but mainly during pregnancy.”

ACOG partnered with other organizations with a focus on mental health and is using social media platforms to help spread the word, according to Hoskins.

ACOG recently released two guidelines for addressing mental health during and after pregnancy. The first clinical practice guideline outlines how OB/GYNs can screen for and diagnose perinatal mental health conditions, including depression, anxiety, bipolar disorder, acute postpartum psychosis and symptoms of suicidality. The second includes recommendations for treating and managing the same perinatal mental health conditions.

More work to be done

Providers’ reactions to the Minding Mental Health initiative at ACOG have been overwhelmingly positive, according to Hoskins. Throughout her tenure, Hoskins said, many providers have approached her thanking her for prioritizing mental health to normalize and destigmatize it in the medical community.

ACOG now offers a submission space called Frontline Voices: Minding Mental Health where members can discuss mental health with their patients and share their own mental health struggles. This platform can help enhance mental health awareness by sharing personal experiences on the ACOG website, so providers know they are not alone, Hoskins said.

“There’s so much work that needs to be done, but so much work we’ve already been doing. I had 1 year. We can only make magic equivalent to 1 year, not 5 or 10 years, but ACOG has been front and center throughout,” Hoskins said. “All we’re doing is bringing it more to the front and filling in those gaps.”

To continue normalizing mental health, Hoskins recommends speaking with postpartum women about their mental health and telling them that these struggles following pregnancy are to be expected and are common. When women hear this, Hoskins said, they may start looking out for their mental health symptoms and get help.

According to Hoskins, each ACOG president borrows ideas from initiatives of past presidents to continue efforts to address those areas. For example, Hoskins said she utilized the telehealth portion from the initiatives of her predecessor, Martin Tucker, MD, because telehealth is a useful tool for mental health care, as telehealth gives patients the option to be on video or just on the phone for privacy and discuss their struggles. The president for the 2023-2024 ACOG presidential term is Verda J. Hicks, MD, FACOG, and her initiative will focus on leadership in health care. Hicks will be combining mental health with her initiative due to its importance, according to Hoskins.

“We all come and go, but our organization remains strong, and we have always had commitment to the full person, which includes mental health,” Hoskins said.

References:

• Pregnancy-related deaths: Data from maternal mortality review committees in 36 U.S. states, 2017-2019. www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html. Accessed May 24, 2023.
• Screening and diagnosis of mental health conditions during pregnancy and postpartum. www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/screening-and-diagnosis-of-mental-health-conditions-during-pregnancy-and-postpartum. Published May 2023. Accessed May 24, 2023.
• Treatment and management of mental health conditions during pregnancy and postpartum. www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/treatment-and-management-of-mental-health-conditions-during-pregnancy-and-postpartum. Published May 2023. Accessed May 24, 2023.