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ACOG’s Clinical Practice Guideline 5: “Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum” recommends that …:

  • Obstetricians be prepared to counsel patients on the benefits and risks of psychopharmacotherapy for perinatal mental health conditions when clinically indicated
  • Obstetricians initiate psychopharmacotherapy for perinatal depression or anxiety disorders, refer patients to appropriate behavioral health resources when indicated, or both
  • A validated screening tool be used to monitor for response to treatment or remission of depression or anxiety symptoms. If clinically indicated, the pharmacotherapy dosage should be up-titrated with the goal of remission of depressive and anxiety symptoms.
  • Treatment for perinatal mood and anxiety disorders be equitably available and accessible to all pregnant and postpartum individuals

The guidance also recommends against withholding or discontinuing medications for mental health conditions due to pregnancy or lactation status alone. Please see Clinical Practice Guideline 5: “Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum” for additional recommendations and information.

This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. This information does not represent ACOG clinical guidance. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications, toolkits and other resources regularly; however, this information may not reflect the most recent evidence. View ACOG's complete disclaimer.

 

Talking to Your Patient About Mental Health and Treatment

When discussing treatment options, provide a balanced perspective of treated versus untreated illness and associated risks and benefits. Untreated illness has significant risk. Let women know that a healthy mother is critical to the health of the baby and it is important to prioritize a mother’s health, including mental health. Because of this, you will be checking in with her about her mental health regularly throughout her obstetric care.

Ask open-ended questions

  • “How are you managing to free yourself up to attend therapy appointments?”
  • “I’m curious, what seems to be getting in the way of [xyz]?”

Use reflective listening

  • “You’re really not sure if your new therapist can be helpful.”

Reinforce action, changes, and strengths

  • “With all the obstacles that you’ve described, it’s impressive that you’ve been able to make your therapy appointments. This really speaks to your commitment to yourself and to being the best mom you can.”
  • “It was difficult, and you still were able to make it to your visit today. That didn’t just magically happen; you had to take specific, concrete action to get to where you are right now.”

Normalize concerns

  • “It is common to feel concerned about how getting help for depression will affect your life.”
  • “Based on everything you’re going through, it would be odd for you not to feel overwhelmed.”

Summarize the conversation

  • “So, based on what you’ve described, it sounds like you’re concerned about your depression because it affects your relationship with your baby and your partner. You also said that you have to put in a lot of effort to attend therapy appointments and it costs money to get there, which makes you doubt the process. Do I have that right?”

Ask permission before providing advice/feedback and follow-up

  • “Would it be ok if we talk about your depression?”
  • “I have some thoughts about strategies to address this. Would you be interested in hearing them?”
  • “What’s it like for you hearing this feedback?”
  • “What questions do you have for me?”

Avoid saying, “I understand”

  • Say instead, “I can’t imagine what you’re going through” or “that must be very difficult.” Sometimes patients are looking for simple validation, rather than a solution.

Avoid using the word “but” because it negates what came before it

  • Avoid saying something like, “You’re working really hard, but you still feel overwhelmed.” Instead, use the word “and” to acknowledge both truths. “You’re working really hard, and it’s important to keep focusing on your mental health and self-care. You’ve already made progress by being here.”

Avoid talking about yourself and your personal challenges or situations

  • No matter how well-intentioned or seemingly appropriate, patients often perceive this as you not hearing them.