Implementation of the Maternal Mental Health Safety Bundle: Standardizing perinatal depression screening and response in a federally qualified health center

Abstract

NPWomenshealthcare.COM Perinatal depression is the most common complication of pregnancy, with a higher incidence than gestational diabetes, preeclampsia, or preterm birth. Perinatal depression affects 1 of every 7 women.1 Antenatal depression is a significant risk factor for postpartum depression and, if left untreated, increases risk for preterm birth, low birth weight, preeclampsia, excess gestational weight gain, and operative delivery while decreasing rates of breastfeeding.2,3 The American College of Nurse Midwives recommends midwives integrate prevention, universal screening, treatment, and/or referral for depression into the care they provide for women.4 The American College of Obstetricians and Gynecologists, the US Preventive Services Task Force, and the American Academy of Family Physicians recommend screening all pregnant and postpartum women for depression and stress that screening should be implemented only when adequate systems are in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.5–7 A survey of 53 certified nurse midwives in Oregon showed that although 94% screened for prenatal depression, only 53% had a formalized screening process in place.8 A national survey of obstetricians and gynecologists reported that 53% universally screened pregnant patients for depression, but only 33.67% implemented guideline-congruent care.9 The Council on Patient Safety in Women’s Health Care, a multidisciplinary collaboration of organizations across the spectrum of women’s health, developed the Maternal Mental Health Patient Safety Bundle in 2016. The bundle has four key components: readiness, recognition and prevention, response, and reporting and systems learning. Patient safety bundles are developed to provide a small set of evidence-based interventions to achieve improved outcomes. They are based on the concept that when care processes are grouped into simple bundles, healthcare providers are more likely to implement them by making fundamental changes in how they work.10