Maternal mental health is the silent epidemic we still aren't treating | Viewpoint

During my years in pediatrics, I met thousands of new parents through well-child visits.Officially, the appointment was about the infant. Unofficially, it was often about much more than that.

As physicians, we regularly see mothers with babies born at nearly 10 pounds. While they thrive, Mom often doesn’t. Exhausted and overwhelmed, many think they’re failing because they struggle to produce enough breast milk to feed babies without formula supplements. Every feeding feels like a test.

What these women need isn’t another instruction sheet—they need support from lactation specialists and their pediatricians, encouragement from those in their family and community, and someone to explain that combination-feeding plans developed with clinicians are healthy and sometimes necessary for Mom and Baby.

Such conversations and practical plans help. But over the years, I learned that maternal mental health is about as predictable as when an infant will finally snooze through the night. Some women struggle with anxiety that intensifies over the course of their pregnancy. Others experience depression months later, with the pressures of return-to-work and “bouncing back” crystallizing alongside sleep deprivation and continued caregiving. Their experiences reinforce a lesson our healthcare system is only beginning to fully embrace: Maternal mental health isn't confined to pregnancy or postpartum—it can affect women for up to two years after their child’s birth.

That's important to underscore, because maternal mental health conditions affect approximately 1 in 5 women. Yet despite growing awareness around the issue, many mothers and mothers-to-be continue to struggle without the support they need—and 75 percent of such cases go untreated.

Screening isn’t the finish line

Maternal mental health has become one of our country’s silent epidemics. Not because the healthcare industry isn't screening for it—especially via commonplace Edinburgh or PHQ-9 questionnaires—but because many of its earliest warning signs are remarkably easy to dismiss.

Whether symptoms first appear during pregnancy or emerge in the weeks and months after childbirth, they often overlap with experiences many women expect as part of becoming a parent: disrupted sleep, fatigue, difficulty concentrating, self-doubt, anxiety, and feeling overwhelmed. The challenge isn't that our screening tools are inadequate. It's that the symptoms they're designed to detect can masquerade as ordinary pregnancy and parenthood challenges.

In many ways, maternal mental health presents one of healthcare's most familiar challenges: the gap between identifying a real problem and helping patients successfully navigate a solution. The barrier isn’t just whether risk is identified. It's whether mothers understand the resources available to them, can secure appointments, transportation, and childcare, know what services are covered, and have built enough trust with their care teams to ask for help when they need it.

We need to move beyond identification to intervention

One of the lessons I learned early in practice is that patients don't always disclose their concerns to the first clinician who asks. Trust changes that dynamic.

A woman who minimizes her anxiety during a prenatal visit may open up weeks later to a nurse who has checked in multiple times. A new mother who insists she's "fine" during an office visit may eventually confide in a social worker or lactation consultant helping her navigate feeding. Often, the conversation starts somewhere entirely different than mental health. What emerges is a reminder that maternal mental health rarely exists in isolation. Clinical concerns, social drivers of health, family dynamics, financial stress, and access to care are inherently interconnected. Treating them as separate challenges often means missing the larger picture.

New research from Sage Growth Partners suggests many mothers feel they are navigating that larger picture with less support than we might assume. More than half reported that they did not fully understand their care plans, while 41% said they felt less than fully confident taking their babies home from the hospital. Even more concerning, 12% said they felt as if they received no support after discharge. Whether those perceptions reflect communication gaps, fragmented care, or both, it's easy to see how they can compound stress during an already vulnerable time.

That's why maternal mental health cannot be approached as a series of isolated touchpoints. The most effective care models do more than identify risk during pregnancy or after delivery—they build trusted relationships that continue across the perinatal and postpartum journey, helping women navigate changing needs as they arise.

That may mean coordinating behavioral health services, addressing transportation or childcare barriers, connecting families with community resources, or simply maintaining consistent outreach during periods of uncertainty. The intervention itself matters. But continuity is what makes intervention possible.

The next steps can’t be baby steps

Mothers struggling to breastfeed often need reassurance. Others may need therapy. And other moms may need help understanding their health plan benefits. The specific need changes from one mother and family to the next, but the principle does not.

For years, the conversation around maternal mental health has focused on screening. Yet awareness alone has not solved the problem and an estimated 3 out of 4 cases still go untreated. The question is no longer whether we should screen—it's whether we're prepared to help women act on what those screenings reveal through personalized support, trusted relationships, and continuous engagement.

The growing recognition of the fourth trimester has helped healthcare acknowledge that a mother's needs do not end when her baby is born. But maternal mental health deserves an even broader lens. Challenges can emerge during pregnancy, evolve after delivery, and continue well beyond those first weeks postpartum.

Support should be available whenever it is needed, not only when it is scheduled. Because once the cord is cut, there should still be a lifeline.

Dr. Thomas Lundquist is the chief medical officer for ProgenyHealth.