Addressing women's mental health disparities through an integrated midwifery model

Abstract

Perinatal mood and anxiety disorders (PMADs), including depression, anxiety, obsessive-compulsive disorder, and psychosis, can occur at any time during the perinatal period. These disorders are the most common complication of childbearing, affecting an estimated 20% or more of the global population of women. Left untreated, these illnesses cause devastating, life-long consequences. PMADs are caused by complex combinations of biological and psychological risk and social disparities, including poverty, history of trauma, and lack of social support in the community. While 1 in 5 women are impacted by these illnesses, simple and effective screening practices have not been employed in a majority of maternity care services, and mental health treatment is difficult to access, even when referrals to such care are provided. Willow Midwife Center for Birth and Wellness, a free-standing birth center owned and operated by Certified Nurse Midwives specializing in women’s health has partnered with Terra’s Place, a maternal mental health practice owned and operated by Doctors of Behavioral Health specializing in treatment of PMADs to provide integrated behavioral health screening, treatment, and medication consultations at the birth center. Willow and Terra’s Place owners aim to reduce the stigma of mental health conditions experienced during the perinatal period and improve evidence-based screening and treatment for vulnerable women and families. Integrating behavioral health care into a women’s health practice allows for a significant increase in access to behavioral health services for women and families by removing the barriers due to siloed care. Patients receiving maternity care, labor & birth services, and women’s wellness care through Willow are the population targeted for this practice change. Stakeholders include Willow practitioners, Willow patients and families, hospital providers, lactation and breastfeeding consultants, pediatricians, and Behavioral Health Providers at Terra’s Place. An integrated care model has been under implementation since October of 2017. Over 330 behavioral health consultations have been provided to women since the model began. Screening has effectively identified PMADs and treatment has been provided to 100% of identified women. Hospitalization for mental illness has only been necessary in 1 of the 330+ consultations. Mothers who have been referred for psychiatric medications are now receiving high-quality and evidence-based information about medication risks and benefits. The impact has inspired other OB/GYN practices in Maricopa County to design evidence-based integrated models. Plans are under way to launch this model at a hospital, a large OB/GYN practice, and a large pediatric practice, which would collectively impact mothers and families county-wide. Arizona has been identified by the CDC as a “hot spot” for perinatal mood and anxiety disorders; incidence of PMADs is higher in Arizona than in 45 other states. PMADs can effectively be identified and treated in a women’s health and maternity care setting without jeopardizing the workflow of women’s health providers. Willow’s model has discovered a viable and sustainable fee-for-service model. Using a midwifery model of care in concert with an integrated model of behavioral healthcare can improve outcomes for vulnerable perinatal patients with a PMAD.

Keywords

• women's health
• midwifery
• integrated mental health
• perinatal mood and anxiety disorders