For children to thrive, mothers need robust health care
By Angela Rothermel
Director, Early Childhood
Director, Early Childhood
October 21, 2019
“There is no such thing as a baby … if you set out to describe a baby, you will find you are describing a baby and someone.”
– Donald Winnicott, pediatrician and psychoanalyst
Not only do babies depend fully on adults to meet their emotional, nutritional and physical needs, but research consistently shows that adults’ health and mental health – especially moms’ health before, during and after pregnancy – has distinct and clear bearing on babies’ health and well-being.
Over the last few weeks, we’ve highlighted the importance of early brain development, as well as numerous stories of parents about the support they needed in those important early years.
Yet, anyone who is a mom (or knows a mom) knows that it is extraordinarily easy for mothers to neglect their own health in order to take care of their families. Pregnancy and parenting come with a thousand questions, stresses from many directions, and a lot of change to your body, your relationships, your understanding of yourself, and the demands on your time. This is especially true for new moms who may be juggling a newborn, physical recovery from childbirth, the challenges of breastfeeding, and social isolation.
Health is multi-dimensional, and inextricably separated from a parents’ own experiences with trauma, the neighborhood families live in, adults’ access to educational and economic opportunities, levels of social supports and more. For this reason, ensuring that every mom gets what she needs to thrive is complex. All families need support, but systemic adversity and structural inequities – created over time by historical policies that punished poor people, marginalized families of color and treated children’s health as fully independent from parents’ health – means that not all families in California begin on level ground. There are persistent race and income-based inequities in both maternal and child health outcomes that cannot be addressed without taking a comprehensive, systems-wide approach to maternal health.
To ensure that parents, and mothers in particular, have optimal physical, mental, and oral health during pregnancy, childbirth, and through the postpartum period will require a focus on multiple programs and policy areas that address diverse needs across regions, race and income levels. It will also require an approach that makes services and systems of support interconnected, efficient and sensible for families.
- Early, regular prenatal health care – beginning in the first trimester – improves the likelihood that babies are born healthy and on time. Prenatal care allows for common complications of pregnancy to be addressed early, and allows for women to ask questions and receive accurate health information. In California, 84 percent of women statewide received prenatal care beginning in the first trimester in 2016. Rates were as high as 91 percent in some areas, but in 23 counties more than 25 percent of moms did not receive early prenatal care.
- Experts recommend at least one dental check-up during pregnancy. Pregnant women have higher rates of certain oral health conditions, and some studies have associated oral disease during pregnancy with poor infant outcomes. Yet in California, although 53 percent of pregnant women report a dental problem, only 42 percent visited a dentist during pregnancy. Women living in poverty and women of color experience even higher rates of dental problems and lower rates of dental care.
- Maternal depression is the most common complication of pregnancy. Up to 20 percent of women will experience some form of mental health disorder, and less than 15 percent of those will receive treatment. Maternal mental health disorders can manifest as sadness, difficulty bonding, constant anxiety, rage and/or loneliness. But, these issues can be successfully addressed through proper screening and treatment from trained professionals.
- Dying in childbirth is still a real threat, especially for black women. The United States is the most dangerous country in the industrialized world for a woman to give birth. For black women, the threat of death is three to four times higher than for white women, even when controlling for income and education.
In California, steps have been taken recently to strengthen policies on these issues and improve outcomes for moms, including ensuring pregnant women here are covered by health insurance and receive comprehensive care. Over the last two years, maternal mental health screening has been expanded, and Medi-Cal, which pays for nearly half of all births in California, now covers women with a diagnosed maternal mental health disorder for one year postpartum. Recently, Governor Newsom also signed SB 464 (Mitchell) and AB 241 (Kamlager-Dove), two pieces of legislation focused on implicit bias training for health care providers.
Even so, more needs to be done. All moms and babies should receive the care, support and resources they need to thrive and be healthy right from the start, regardless of where they live, what color their skin is, or how much money they make.
Mental Health Resources
The Edinburgh Postnatal Depression Scale can be used as a self-test for depression during and after pregnancy. If you think you might have depression, take this simple online test here or print out the test here and take it to your healthcare provider.
If you are experiencing signs of a maternal mental health disorder, you can find help here.
Thank you to 2020 Mom Project for this information