Maternal Mental Health Roadmap Released

May 22, 2023

Policy drives behavior change.

Though we wish it weren’t the case, we haven’t experienced much change in California that didn’t first start with a policy. We’ve seen firsthand the benefits of lactation-supportive policies on breastfeeding and human milk feeding rates in our state. 

Now it’s time to see that same level of change in maternal mental health. 

The 2023 Maternal Mental Health Roadmap, released this month by the Policy Center for Maternal Mental Health, provides clear guidance for states to take regulatory and legislative action:

  1. Form a cross-sector commission to study and develop a state strategic plan
  2. Declare May Maternal Mental Health Awareness Month
  3. Medicaid agencies can require plans to report maternal depression HEDIS measures
  4. Medicaid agencies can promote reimbursement strategies for maternal mental health for obstetricians and midwives
  5. Require health plans/insurers to develop quality management programs
  6. Propel peer support specialists for maternal mental health
  7. Support community-based organizations
  8. Require health plan/insurer coverage of group maternity care, birth doulas, postpartum doulas, and home health nursing care

Under Recommendation No. 8, the roadmap makes a strong case for how doulas support families throughout the perinatal period. Home health care is recommended for complicated births, including C-section deliveries. Doulas and home health nurses trained in lactation have the ability to fully support families in making their intentions with infant feeding a reality.

“When I delivered my son in 2017, the first thing the nurse told me was I’d never be able to breastfeed as an active-duty sailor,” recalls U.S. Navy veteran Gaby Cavins, who now serves as interim executive director and board chair of the California Breastfeeding Coalition (CBC). “Our birth was traumatic. I almost lost my life giving birth to my son. The nurse’s words put me in an emotional tailspin that took two years to come out of, and is still something I work on every day.”

Maternal depression and anxiety are often blamed on lactation-supportive policies and practices in news coverage, on social media and in ads promoting infant formula. CBC communications director Tonya Kubo believes the opposite is often true.

“My postpartum anxiety and depression had nothing to do with so-called pressure to breastfeed,” she said. “It was directly related to my doctor’s unwillingness to support my desire to breastfeed. Instead of referring me to a lactation consultant for feeding help, she threatened to hospitalize my baby if I didn’t switch to formula. What hurt the most was when she looked at my husband and said, ‘now you can take over night feedings while mom sleeps.’ I felt discarded, like I didn’t even matter.”

Though we have a long way to go in getting social structures to align with society’s demands of birthing parents, California has the highest grade among all states in the policy center’s 2023 U.S. Maternal Mental Health State Report Cards. Where our state falls short: provider- and prescriber-to-patient ratios, and private insurance prenatal treatment billing. Coverage of group maternity care, birth doulas, postpartum doulas, and home health nursing care would go a long way in closing that gap.

For families in crisis, the National Maternal Mental Health Hotline provides 24/7, free phone or text support in English & Spanish (interpreters services are available in 60 languages).