1. Wisner, Kirsten MS, RNC-OB, CNS, C-EFM

Article Content

Mood and anxiety disorders are common in the perinatal period and when left untreated, pose significant risks to women and their children. One in seven women suffers from perinatal depression, and prenatal and postpartum anxiety affects between 13%-21% and 11%-17% of women, respectively (Kendig et al., 2017). Adverse outcomes associated with these maternal mental health conditions include poor self-care and nutrition, impaired maternal-fetal attachment, lack of medical care, increased likelihood of tobacco and substance abuse, and a heightened risk of suicide. Maternal depression may increase the risk of preterm birth and low birthweight, and may correlate to childhood affective and anxiety disorders (Kendig et al.; Leight et al., 2010).


A coordinated and effective approach to detecting, treating, monitoring, and following up on maternal mental health conditions requires coordination and communication across the care continuum and a consistent, sustained approach to screening and response. In collaboration with an interdisciplinary group of stakeholders, the Council on Patient Safety in Women's Health Care (2017) recently released a consensus bundle that combines existing recommendations with assorted resources and tools to assist perinatal providers to successfully implement the bundle in various settings (Kendig et al., 2017). The bundle addresses four domains applicable across the care continuum: readiness, recognition and prevention, response, and reporting/systems learning.


Readiness centers on the selection and enculturation of a screening process and a response protocol tailored to available local resources in every maternity care setting. Emphasis is placed on ensuring that clinicians and office staff are well educated on the selected tools and protocol and that an individual is identified who is accountable for supporting protocol adoption (Kendig et al., 2017).


Recognition and prevention focus on initial and ongoing assessment through obtaining an individual and family mental health history during the initial obstetric visit, past and current medications, and use of a validated screening tool at designated intervals in the perinatal period. Although screening should be woven into each provider-patient encounter, formal screening should occur at least during the initial obstetric visit, later in pregnancy, and again during the postpartum period. This domain also focuses on providing awareness education to women and their family or support persons at appropriately timed intervals during the perinatal period in order to aid in the prompt detection of depression or anxiety (Kendig et al., 2017).


Response encompasses the development of stage-based protocols to implement for positive screening results, including emergency referral processes for critical situations such as psychosis or suicidal or homicidal ideation. This domain includes recommendations surrounding support for all stakeholders (women, their families, and staff), as well as recommendations for communication and follow up when referral occurs. Women with perinatal mental health issues may require care from multiple providers, making seamless care transitions especially important (Kendig et al., 2017).


Reporting and systems learning includes recommendations to promote a nonjudgmental culture of safety using multidisciplinary mental health rounds, and establishing processes to measure and track compliance and outcomes. This should include a trigger for a systematic multidisciplinary review when adverse mental health outcomes occur (Kendig et al., 2017).


This bundle is available for download along with many excellent resources, such as screening tools, educational resources, debriefing tools, and so on to support the recommendations in each of the bundle domains:




Council on Patient Safety in Women's Health Care. (2017). Maternal mental health: Depression and anxiety. Retrieved from [Context Link]


Kendig S., Keats J. P., Hoffman M. C., Kay L. B., Miller E. S., Moore Simas T. A., ..., Lemieux L. A. (2017). Consensus bundle on maternal mental health: Perinatal depression and anxiety. Obstetrics & Gynecology, 129(3), 422-430. doi:10.1097/AOG.0000000000001902 [Context Link]


Leight K. L., Fitelson E. M., Weston C. A., Wisner K. L. (2010). Childbirth and mental disorders. International Review of Psychiatry, 22(5), 453-471. doi:10.3109/09540261.2010.514600 [Context Link]