Integrating Mental Health In Perinatal Care: Perspectives Of Interprofessional Clinicians.

Despite the prevalence of perinatal mental health issues in the United States, gaps in care persist. To address this, perinatal health care settings are asked to focus on patients' mental health by administering standardized screening and, increasingly, by integrating mental health teams in their clinics. Using in-depth interviews and ethnographic observations, I investigated these emerging practices, exploring the experiences of certified nurse-midwives, obstetricians, and mental health clinicians. I found that certified nurse-midwives and obstetricians lack time, resources, and expertise, restricting their ability to address patients' mental health. Integrated mental health clinicians are constrained by the stratified organization of health care and structural deprioritization of mental health. Redesigning perinatal health care and de-siloing mental health training are necessary to increase clinicians' effectiveness and to improve perinatal health outcomes.

Postpartum care for parent-infant dyads: A community midwifery model.

INTRODUCTION: Postpartum health is in crisis in the United States, with rising pregnancy-related mortality and worsening racial inequities. The World Health Organization recommends four postpartum visits during the 6 weeks after childbirth, yet standard postpartum care in the United States is generally one visit 6 weeks after birth. We present community midwifery postpartum care in the United States as a model concordant with World Health Organization guidelines, describing this model of care and its potential to improve postpartum health for birthing people and babies. METHODS: We conducted semi-structured interviews with 34 community midwives providing care in birth centers and home settings in Oregon and California. A multidisciplinary team analyzed data using reflexive thematic analysis. RESULTS: A total of 24 participants were Certified Professional Midwives; 10 were certified nurse-midwives. A total of 14 midwives identified as people of color. Most spoke multiple languages. We describe six key elements of the community midwifery model of postpartum care: (1) multiple visits, including home visits; typically five to eight over six weeks postpartum; (2) care for the parent-infant dyad; (3) continuity of personalized care; (4) relationship-centered care; (5) planning and preparation for postpartum; and (6) focus on postpartum rest. CONCLUSION: The community midwifery model of postpartum care is a guideline-concordant approach to caring for the parent-infant dyad and may address rising pregnancy-related morbidity and mortality in the United States.

Reimagining Perinatal Mental Health: An Expansive Vision For Structural Change.

Diagnoses of depression, anxiety, or other mental illness capture just one aspect of the psychosocial elements of the perinatal period. Perinatal loss; trauma; unstable, unsafe, or inhumane work environments; structural racism and gendered oppression in health care and society; and the lack of a social safety net threaten the overall well-being of birthing people, their families, and communities. Developing relevant policies for perinatal mental health thus requires attending to the intersecting effects of racism, poverty, lack of child care, inadequate postpartum support, and other structural violence on health. To fully understand and address this issue, we use a human rights framework to articulate how and why policy makers must take progressive action toward this goal. This commentary, written by an interdisciplinary and intergenerational team, employs personal and professional expertise to disrupt underlying assumptions about psychosocial aspects of the perinatal experience and reimagines a new way forward to facilitate well-being in the perinatal period.

Provider Impacts of Socioeconomic Risk Screening and Referral Programs: A Scoping Review.

BACKGROUND: Initiatives to identify and intervene on patients' socioeconomic needs in the context of health care delivery are expanding. Little information has been compiled across studies on health care providers' knowledge, attitudes, beliefs, and behaviors (KABB) regarding socioeconomic risk screening and referral interventions. METHODS: We conducted a systematic scoping review of providers' KABB related to health care-based socioeconomic risk screening and referral interventions using several search engines. Included studies assessed health care providers' KABB about screening and interventions conducted in clinical settings. RESULTS: Of 14,757 studies evaluated, 53 were eligible for inclusion. Study designs were heterogeneous. Outcome measures included attitudes and beliefs (n = 42), provider behaviors (n = 35), and provider knowledge (n = 26). The majority of providers expressed positive attitudes toward addressing patients' socioeconomic risks. Participants endorsed concerns regarding insufficient knowledge and resources, time and workflow disruption, and potential negative impacts of screening and referral programs on relationships. Exposure to screening and referral programs led to increases in providers' positive attitudes, socioeconomic risk screening rates, and reported knowledge about intervention options. CONCLUSIONS: Participation in screening and referral programs seems to influence providers' perception of implementation barriers. Future research should explore providers' concerns about addressing identified risks.