By Dr. Janet L. Cummings, P.syD.
Editor’s Note: This month’s feature written by Dr. Janet L. Cummings, P.syD was written in response to the article that follows. Reading this first will undoubtedly provide some context and insight. Thank you.
Goodman, B. (2017, November 20). Death By Birth: Bearing the Burden of Maternal Mortality. Retrieved November 16, 2017.
When I read Death by birth: Bearing the burden of maternal mortality (Goodman, 2017, November 20), I felt both sad and outraged that a young mother would die unnecessarily from a treatable pregnancy/delivery complication, and that a mother’s race is a significant determining factor in whether or not she will die during or shortly after childbirth in the United States. I found it surprising and absurd that the United States, which spends more on healthcare than most other wealthy countries, has some of the worst medical outcomes for women giving birth.
Our healthcare system’s usual focus on the medical needs of the newborn baby at the expense of the mother’s needs, along with the healthcare disparities outlined in the Goodman (2017) article, are alarming. It is my hope that these issues will continue to be reported in the media long enough to create a public outcry and subsequent changes in our healthcare system that will improve the quality of care to all pregnant and post-partum women.
We are, however, faced with a much less publicized problem with maternal care: the lack of attention to the emotional/behavioral/psychological needs of pregnant women and new mothers. These are almost universally neglected, and even wealthier women with excellent insurance benefits suffer from this neglect.
Many years ago, I went through several years of infertility treatment that gave me a beautiful baby daughter after three miscarriages. After each miscarriage, I was told to take some time off of infertility treatment, but was never offered resources to help with my grief. I was simply supposed to return for more medical treatment when I was “ready.” Following the birth of my daughter, my post-partum depression was very severe because I was experiencing withdrawal and hormonal “crashes” for the long list of medications I had been using to manage pregnancy complications. At no time did my child’s pediatrician ask how I was doing. At no time did my obstetrician ask how I was doing psychologically, as her focus was solely on how I was healing from a C-section. I am a person with excellent coping skills and a lot of family support, but I very much could have benefitted from a professional to help me with my emotional needs. I can only begin to imagine what it is like for women who do not have good coping skills (perhaps because they are still quite young) and who do not have family support available to them.
Some years later, I went to work part-time in a reproductive endocrinology office with a doctor that specialized in infertility, doing patient education and helping to meet the emotional/behavioral/psychological needs of patients and their partners. Those needs were many. I noticed that people who had previously experienced no major emotional problems really struggled with infertility and the hormonal treatments used to help these people conceive. Since that time, I have seen a dearth of attention paid to the emotional/behavioral/psychological needs of infertile patients and couples, as I do not know of another such clinic with a behavioral care provider on staff.
The Goodman (2017) article certainly made the point that our healthcare system needs to improve medical services to pregnant women and new mothers. However, my fear is that the emotional/behavioral/psychological needs of these women will remain unmet even if we dramatically improve medical services to them.
Reproductive endocrinology and obstetrics are medical specialty areas in desperate need of behavioral care providers to meet the emotional needs of women and their partners who seek medical care for their reproductive health. It is my hope that some Doctors of Behavioral Health and others who are trained to work in integrated care settings will help make integrated care standard for obstetric and reproductive endocrinology practices.
