Reproductive Mental Health Blog

The Policy Center for Maternal Mental Health has released its Optimal Maternal Suicide Care Pathway, a valuable new resource to help healthcare providers assess and respond to suicidal thoughts and behaviors during pregnancy and the postpartum period. A key message of this pathway is that a positive response to a suicide or self-harm screening question does not automatically indicate imminent suicide risk or the need for emergency department evaluation . Instead, providers should conduct additional assessment to better understand the patient's level of risk and identify the most appropriate response. The pathway emphasizes a trauma-informed, individualized, and least-restrictive approach to suicide care, including: Going beyond initial screening: Using validated tools and clinical assessment to better understand suicide risk, protective factors, and appropriate next steps. Recognizing perinatal-specific considerations: Differentiating suicidal thoughts from intrusive thoughts associated with perinatal OCD, while also assessing for depression, mania, and psychosis. Supporting appropriate intervention: Emphasizing collaborative safety planning, connection to treatment, and coordinated follow-up based on the patient's clinical needs. The pathway aligns with recommendations from the American College of Obstetricians and Gynecologists (ACOG) and MCPAP for Moms and offers practical guidance for providers navigating these complex clinical situations. Explore the Maternal Suicide Care Pathway: https://policycentermmh.org/maternal-suicide-care-pathway/ Watch the Accompanying Webinar: Maternal Suicide Prevention Strategies The Policy Center also hosted a webinar exploring maternal suicide prevention, including suicide screening and assessment, differentiating suicidal ideation from other perinatal mental health symptoms, safety planning, and appropriate clinical responses. Watch the webinar recording: https://www.youtube.com/watch?v=LxP9xFEpmY8

The Levis Family lost their firstborn, Timothy, suddenly during labor in 2014. Since then, Timothy's mom, Chelsea, has become deeply aware of the complexities of grief and pregnancy after loss. For her, grief is not a moment to get through, but a lifetime to explore and cultivate. With support from Carol McMurrich of Empty Arms Bereavement in Massachusetts, Chelsea co-founded the statewide nonprofit, Empty Arms Vermont (EAVT ) , when she discovered that adequate peer support for bereaved parents was lacking. Modeled after the Massachusetts nonprofit, EAVT extends peer support and connects families and individuals through shared grief experiences. Their peer support groups meet monthly via Zoom and are free to attend. A variety of groups exists to help create spaces that best align with a loss experience such as their miscarriage, termination for medical reasons, and pregnancy after loss. Clinics and other OBGYN offices are invited to purchase Miscarriage Bags from the Empty Arms Vermont website, which are offered to patients who have just discovered they have miscarried a pregnancy. Each bag includes a few items of comfort: tea, chocolate, face wash, wooden heart (to hold), and a note from a peer at Empty Arms Vermont. Most recently EAVT has begun Hospital Companionship and Time of Loss programs at the UVM Medical Center and Porter Hospitals. With a patient's permission, nursing teams can invite trained peers or doulas to meet with them during their stay at the hospital. The intention of the program is to create continuity of care for those families once they are discharged from the hospital. Individuals experiencing loss and providers can find information about programming at https://www.emptyarmsvermont.org/ This October, Pregnancy and Infant Loss Awareness month, Empty Arms will also host their fifth annual Remembrance events in Brattleboro, Rutland, Roxbury, and Essex Junction. These events are free to attend and are opportunities for community members, family, friends, children, as well as members of the medical community, to remember the babies they miss and honor a journey where grief and joy coexist. Please see the Empty Arms website for more information on Remembrance events and to RSVP. During the event, attendees decorate luminarias, enjoy refreshments, and hear from community members. Empty Arms Vermont distributes childrens' books that help to process grief, which are paired with a craft activity. This year, EAVT will provide the book, "The Rabbit Listened", and materials to make rabbit ears that can be taken home. Luminarias are dispersed around the event venues and attendees are invited to walk amongst the lit luminarias as the sun sets. This is a reflective time to memorialize an experience of loss. Evy, a bereaved mom in the EAVT community shares: “No one imagines they will lose a child; we are not told stories of pregnancy and infant loss, despite its prevalence. After losing my son, Theo, at 20 weeks, I understand what a lonely experience it can be. Empty Arms seeks to support those experiencing the heartbreak of pregnancy and infant loss by creating community in a deeply isolating and stigmatized experience. I find healing each time I share space with those who ask me about my son and make a point to speak his name. I feel more connected and understood when I am with others who allow me to bear witness to their own grief. The Remembrance Night was a beautiful recognition of the complex and diverse experiences of losing a baby, a chance to be in community, and a powerful reminder of the memory of our children. Spending the evening honoring the short life of my son in community with others who hold each other in our grief, was not just a beautiful tribute to our babies but a powerful act of loving rebellion in a society that doesn't know how to grieve." For providers who would like to make a referral to Empty Arms Vermont, with patient permission, please email Chelsea Levis, chelsea@emptyarmsvermont.org , with the following information : Patient Name Patient Contact Info and Preferred Contact Method Any context about their loss that they are willing to share After a loss, it can be overwhelming for a patient to contemplate reaching out for support, and their provider offering resources can be a helpful first step for many families.

Postpartum mood and anxiety disorders are getting a lot more attention these days, and it is great that people are aware of them, but the fear of developing symptoms can bring about anxiety of its own. In light of this, it's important to empower birthing people to understand how to mitigate the risks and to do everything they can to keep themselves healthy. There are many evidence-based strategies we can recommend to help people to lower their risks. Major risk factors include: Major risk factors for perinatal mood and anxiety disorders (PMADs) include a history of depression or anxiety, trauma, socioeconomic stress, relationship stress, and limited social support. It is also important to recognize that Black, Indigenous, and People of Color (BIPOC) individuals experience higher rates of PMADs and often face additional barriers to accessing timely, culturally responsive care. To learn more, read our recent blog post. Prevention strategies: Therapy: There have been many studies suggesting that proactive therapy can be helpful for postpartum outcomes. If your patient has risk factors for developing postpartum symptoms, it is a great investment to establish a therapist ahead of time. The therapist can support coping with symptoms, but also to help monitor for symptoms that require a higher level of support. Medical, mental health, and community providers including, but not limited to, home visitors and doulas can call VTCPAP to assist with finding therapists who take your patient's insurance and have openings. Sleep: There are many studies that link mental health outcomes to sleep. Poor sleep is associated with increased anxiety, depression, ADHD symptoms, panic attacks, as well as, in rare cases, postpartum psychosis. Sleep is the most important modifiable variable, but it can take extensive problem-solving to preserve it. Some patients have no support, and some struggle to ask for support. Tips include: If there is a partner involved, plan ahead to split the night into two shifts. The birthing person may have to breastfeed through the night, but at least for half the night, the diaper changing and soothing is not their responsibility. It is more successful to plan division of labor ahead, than to wait to get too tired to ask for help. If there are people involved in helping- line up times for naps. If they feel unnecessary in the moment, they can be used for other preventative strategies. Sleep hygiene- avoid using screens at night if there is any difficulty falling asleep. This can be the source of stimulation. Invest in some good magazines, novels, or listen to podcasts/audio books. Don't overschedule the early days- it's great to get out or have company, but sleep may need to happen around the clock. Community: There are clearly established connections between social support and lowered risk of postpartum depression and anxiety. It can be beneficial to schedule time with friends/family in advance, so there are points of connection to combat potential isolation in the postpartum period. Other options include Parent-Child Community Centers or playgroups, as well as online resources, such as Postpartum Support International support groups and peer mentors. Yoga has a growing evidence base for decreasing postpartum depression, and some centers offer classes where people can bring their baby. Medication: There is not sufficient data to recommend starting a medication prophylactically based on risk factors alone. However, if there has been a medication that has been beneficial in the past, it could help to have a low threshold for restarting it postpartum. Very few psychiatric medications are contraindicated in breastfeeding. Most of the common medications we use have a relative infant dose under 10 (see Lactmed or call VTCPAP as a resource). We mostly only avoid medications that cause enough drowsiness to interfere with waking at night to feed, if that is the birthing person's responsibility. Individual time: Self care is an overused, confusing term. It suggests spa days and manicures, but "self care" is very individualized and can require thought. For some people it is playing video games and eating ice cream. For others it is simply eating breakfast. I like to ask people to think about moments they enjoyed most before having kids. What were you doing? Connecting with friends? Hiking? Shopping? Whatever it is- that's probably not happening much after a first or subsequent baby arrives. Often, self-care becomes a moment to scroll or put laundry away. Social media is a natural way to connect to the outside world, but it isn't typically associated with increased mental health or a sense of contentment. Acceptance: Finally, it's helpful if people can avoid judging their own experience. Social media can cast an idealized version of what postpartum looks like: clean, calm and in love. For most of us who have had babies, there are few moments that encapsulate these qualities, and many more moments of overwhelm, sour milk smells, and questioning if we are cut out for the tasks at hand. Mindfulness practices locally (call VTCPAP), and online can all support self-compassion and acceptance, as can social support and therapy. If you're looking for more information and practical tools to help guide conversations with perinatal patients about sleep, check out this FREE, 90-minute online training: Prescribing Sleep in the Postpartum: Tools for Real-World Clinical Conversations This training offers practical strategies to help clinicians talk with postpartum patients about the importance of sleep and ways to protect it during this challenging period. Refrences US Preventive Services Task Force. Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;321(6):580–587. [ DOI ] [ PubMed ] [ Google Scholar ][ Ref list ] Leistikow N, Smith MH. The role of sleep protection in preventing and treating postpartum depression. Semin Perinatol. 2024 Oct;48(6):151947. doi: 10.1016/j.semperi.2024.151947. Epub 2024 Jul 14. PMID: 39048415. Cho H, Lee K, Choi E, Cho HN, Park B, Suh M, Rhee Y, Choi KS. Association between social support and postpartum depression. Sci Rep. 2022 Feb 24;12(1):3128. doi: 10.1038/s41598-022-07248-7. Erratum in: Sci Rep. 2022 Mar 4;12(1):3899. doi: 10.1038/s41598-022-08119-x. PMID: 35210553; PMCID: PMC8873474. Pan WL, Lin LC, Kuo LY, Chiu MJ, Ling PY. Effects of a prenatal mindfulness program on longitudinal changes in stress, anxiety, depression, and mother-infant bonding of women with a tendency to perinatal mood and anxiety disorder: a randomized controlled trial. BMC Pregnancy Childbirth. 2023 Jul 31;23(1):547. doi: 10.1186/s12884-023-05873-2. PMID: 37525110; PMCID: PMC10388457.

Emily Piazza, MS, RDN, CD, Registered Dietitian Nutritionist, Certified Intuitive Eating Counselor, Birth Doula at Nourished Journey ( www.nourishedjourney.co )

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Perinatal Mood and Anxiety Disorders (PMADs) affect birthing individuals across Vermont—but our data suggest that BIPOC birthing individuals may be under-identified and under-supported . At VTCPAP, our perinatal service is aiming in 2026 to work with providers to understand barriers and provide evidence-based strategies to improve detection and care for all Vermonters.