ALBANY — The State Department of Health’s Maternal Mortality Council is focusing on mental health as part of its efforts to reduce the number of pregnancy-related deaths in New York City.
Mental health issues are the third leading cause of pregnancy-related deaths in the state, with one in five maternal deaths attributed to a mental health issue, according to the council’s analysis of figures from 2016 to 2018. All Maternal deaths analyzed in the report occurred after pregnancy and all of them were preventable, according to the council.
The state guidelines, released in late November, are the first in a series of memos on the subject. It portrays a fictional patient – a composite of real-life situations – to illustrate the factors that contribute to mental health-related maternal deaths and offers strategies and resources to prevent them.
“This new information note with a composite case study, developed by expert review, serves as a practical guide for providers who – in consultation with their patients and mental health professionals – can use these recommendations and the resources of the TEACH project to materially improve the lives and outcomes of pregnant and postpartum women and their families,” state health commissioner Dr. Mary Bassett said in a statement.
The document advises health practitioners not to automatically ask pregnant patients to stop psychiatric medication.
Instead, providers should offer individualized mental health care to pregnant women with a history of mental health problems and take steps to ensure continuation of care postpartum when patients are most vulnerable to complications. It also recommends universal screenings for depression.
The council urges closer coordination between antenatal care providers and mental health practitioners, both during pregnancy and the postpartum period, using ‘closed loop’ referrals.
“Simply advising the patient to seek a mental health appointment is insufficient in this time of heightened stress and risk,” the brief states.
Experts and panel members said the instructions are particularly timely given the impact of the pandemic on mental health.
“These recommendations – especially relevant given the COVID-related constraints in recent years – are simple, can be used by a range of provider types and hospital systems, and have the potential to prevent further maternal deaths,” said Board co-chairs Dr. Vanessa M. Barnabei, Dr. Christopher Glantz and Dr. Amanda Victor said in a statement.
The United States has one of the highest maternal mortality rates in the world.
Since many states have on-the-books laws restricting abortion care, advocates fear that number could rise following the recent U.S. Supreme Court decision to overturn Roe v. Wade, which they say could lead to the criminalization of doctors who give life-saving abortions.
New York’s death rate has improved since 2010, when the state first established a Maternal Death Advisory Board to make pregnancy and childbirth safer. In 2010, New York ranked 46th among U.S. states in maternal mortality rate, but fell to 23rd in the most recent national ranking.
The state’s Maternal Mortality Council was established in 2019 and produced its first report earlier this year. Over the past two decades, the state’s maternal mortality rate peaked at 24.4 per 100,000 live births in 2008-10, but fell to 18.1 per 100,000 live births in 2016-18, according to the board’s report.
The report noted that black women were four times more likely than white women to die from pregnancy-related causes.
The health department is also promoting Project TEACH, an Office of Mental Health initiative that provides primary care providers with mental health expertise, resources and training. In the Capital Region, the program is offered through Albany Medical Center, according to the health department.
“The TEACH Project has been a key resource for pediatricians and primary care physicians, providing consultation and support to practitioners who want to help their patients get the mental health services they need,” said Dr Ann Sullivan, commissioner of mental health, in a statement. “And now, with the expansion of maternal mental health expertise, this service will be readily available to physicians treating women during and after pregnancy.”
New Yorkers can learn more about maternal mortality at health.ny.gov/MaternalHealthMatters.
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