Trying to Hold Up the Falling Sky

I glance at my watch. It's 3 p.m., and, once again, I'm nearly 40 minutes behind. While I review the plan with a very pregnant woman in front of me, I hear the swift clomp of heels as my office mate stifles the urge to break into a full sprint down the hall to see her next patient. Clearly, she is just as behind as I am.

The pace of prenatal visits is brutal in a high-volume obstetrics faculty practice. With patients scheduled every 15 minutes, there is barely a moment to exhale and introduce yourself before realizing that your allotted time is about to expire. Due to the sheer number of patients needing to be evaluated, I am seeing most faces each day for the first time.

I quickly scan the medical record of my patient who is wearily waiting behind the next door. Unlike most charts that day, this one isn't overflowing with complex antepartum issues. She doesn't have hypertension, or twins, or a cardiac anomaly. I silently thank the universe for perhaps allowing me to get back on track for the remainder of the afternoon.

I swoop into the exam room with a practiced apology and a smile beneath my mask, and I lock eyes with someone familiar. I recognize the brittle voice, the trembling chin. I see her gaze become glassy as she recites that she is "feeling good, just tired," with the final word catching uncomfortably in the back of her throat. She delicately palms her abdomen as though terrified of what else might escape from her lips.

I sit for a moment and try to forget the clock, the incomplete notes, the patients sitting on crinkled paper in the adjacent rooms. I put down my clipboard and say, "I usually take some time during this visit to discuss your mental health in pregnancy. Is it okay if we talk about that?"

Her shoulders shake with exhaustion, relief. Words tumble out that she didn't realize she needed to say. It's grief for a life that is going to change, anxiety about an unknown future, and guilt that she feels this way at all. I hold her hand and listen, because it's the best thing I can do for her with the negligible resources I have.

The minute an elevated glucose challenge test results, an interdisciplinary team springs into action. Ultrasounds are scheduled, pharmacies are notified, and a high-risk specialist who can speak to the nuances of gestational diabetes pencils you in for a timely consultation.

Where is that preparedness for mental health?

Where are the battalions of specialists ready to help patients tackle this unfamiliar diagnosis? Where are the care coordinators ensuring that symptoms are being monitored and escalated appropriately? Where is the streamlined access to experts when we find ourselves out of our depth? In all the years we spent in training, why were we never taught how to do this as obstetricians in the first place?

And where is the time?

We created a system that promotes dismissiveness—a schedule that rewards those who are cursory, whose questions remain superficial. This system focuses on quantity, not care, and assumes that those preparing to give birth should have all concerns assuaged in seven minutes or less.

If this is the way we continue to value people during their pregnancy, we will fall even further behind in addressing and treating mental health for this population. Something has to change—and it must start with the acknowledgement that good care requires time and resources. Until then, it's just us, armed with nothing, running down hallways in sensible heels, trying to hold up the falling sky.

Dr. Olivia Myrick is an obstetrician–gynecologist and the associate program director of the obstetrics and gynecology residency at NYU Langone Health in New York, NY.

Disclaimer: The thoughts and opinions in the Frontline Voices initiative reflect experiences of individual ACOG members and do not represent official organizational opinions of ACOG.