Orange County Perinatal Mental Health Toolkit Provides Model for Other Counties

By: Hoda Shawky, 2018-2020 Pritzker Fellow with First 5 Orange County

While many women experience some mild mood changes after the birth of a child, commonly known as the “baby blues,” in California 1 in 6 women experience more significant symptoms of depression or anxiety. Perinatal depression or anxiety, referring to mental health conditions affecting mothers or fathers during the pregnancy or within the first year after birth, can affect men as well. In fact, one in ten men are impacted nationally. Although not often talked about, Perinatal Mood and Anxiety Disorders, or PMADS, are the number one complication of pregnancy and childbirth, surpassing gestational diabetes and preeclampsia combined.

PMADs can affect all new parents, regardless of ethnicity, level of education, or socio-economic status. However, they are more common among mothers experiencing multiple stressors, such as racism, poverty, or having experienced adverse events during their own childhood. As the COVID-19 pandemic continues, pregnant and post postpartum moms are experiencing increased stress and isolation, which may exacerbate our state’s already existing maternal mental health crisis. African American mothers, who are disproportionately affected by PMADs, face an even greater risk as a result of the pandemic.

It is common for new parents to not receive any treatment for PMADs. Nationally, half of perinatal women with a diagnosis of depression do not get the treatment they need. PMAD symptoms left untreated can cause long- and short-term negative impacts on children. These include adverse birth outcomes, impaired maternal-infant bonding, poor infant growth, and childhood emotional and behavioral problems, resulting in negative impacts on the entire family. Those kinds of impacts have a number of ramifications, including costs to the state of California. Mathematica Policy Research estimated that the societal costs of untreated PMADs in California is $2.4 billion per year, largely borne by employers and health care payers. Despite the fact that PMADs are so common, serious, and widely unrecognized, they respond well to earlier intervention. So why aren’t we doing more to identify, and support at risk and affected mothers and fathers?

As a Pritzker Fellow with First 5 Orange County, I helped to bring together public and private partners with a shared interest in promoting maternal mental health, and we formed the Orange County Perinatal Mood and Anxiety Disorder Collaborative. Catalyzed by recent state legislation requiring obstetric providers to confirm screening for maternal depression at least once during a pregnancy or the postpartum period, the collaborative developed Orange County’s perinatal mental health toolkit. Intended to provide educational, screening, treatment, and referral resources, the toolkit helps providers identify at-risk parents who may benefit from preventive services such as mentorship, classes, home visiting, and support groups. It includes the best practice recommendations of the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.

Although the toolkit was developed for Orange County, my hope is that other counties will be inspired to use and customize it with their own local resources. Much of the toolkit is generalizable across the state including the most up to date information on prevention, identification, training, and billing.

While PMAD screening often falls on the obstetric or pediatric health care provider, there are numerous other sectors in which parents and babies interact, creating the opportunity for other service providers to intervene. Home visitors, for example, and other local California systems like Help Me Grow can play a role in recognizing the need for additional support and connecting parents to needed services. Only when early childhood advocates begin to champion perinatal mental health to support whole-family wellness, can we bolster the optimal development of young children. After all, it takes healthy parents to raise healthy children.


Hoda Shawky is the 2018-2020 Pritzker Fellow with First 5 Orange County. She was selected to lead a community effort to advance policies and programs focused on increasing the availability of high-quality programs and services for infants and toddlers from birth to age three. Ms. Shawky is a primary care pediatric nurse practitioner, a primary care mental health specialist, an international board-certified lactation consultant, and proud mother of two boys.