Readiness
Every Unit
- Develop workflows for integrating mental health care into preconception and obstetric care before pregnancy through the postpartum period including provision of pharmacotherapy when indicated, including: *
- Identify mental health screening tools to be integrated universally in every clinical setting where patients may present. *
- Establish a response protocol based on what is feasible for each area of practice and local mental health resources.
- Educate clinicians, office staff, patients, and patients’ designated support networks on optimal care across the preconception and perinatal mental health pathway including prevention, detection, assessment, treatment, monitoring, and follow-up best practices. *
- Facilitate trauma-informed trainings and education to address health care team member biases and stigma related to perinatal mental health conditions, including anti-racism considerations.
- Develop and maintain a set of referral resources and communication pathways between obstetric providers, community-based organizations, and state and public health agencies to address patient needs, including social drivers of mental and physical health. *
Recognition & Prevention
Every Patient
- Screen for perinatal mental health conditions consistently throughout the perinatal period, including but not limited to:
- Obtain individual and family mental health history at intake, with review and update as needed. *
- Screen for depression and anxiety at the initial prenatal visit, later in pregnancy, and at postpartum visits, ideally including pediatric well-child visits. *
- Screen for bipolar disorder before initiating pharmacotherapy for anxiety and depression. *
- Screen for structural and social drivers of health that may impact clinical recommendations or treatment plans and provide linkage to resources.
Response
Every Event
- Initiate an evidence-based, patient-centered response protocol that is tailored to condition severity, and is strength-based, culturally relevant*, and responsive to the patient’s values and needs: *
- Activate an immediate suicide risk assessment and response protocol as indicated for patients with identified suicidal ideation, significant risk of harm to self/others or psychosis.
- Establish care pathways that facilitate coordination and follow-up among multiple providers throughout the perinatal period for pregnant and postpartum people referred to mental health treatment. *
Reporting & Systems Learning
Every Unit
- Incorporate mental health into multidisciplinary rounding to establish a non-judgmental culture of safety.
- Convene inpatient and outpatient providers in an ongoing way to share successful strategies and identify opportunities for prevention and evaluation of undesired outcomes related to perinatal mental health. *
- Identify and monitor data related to perinatal mental health care, with disaggregation by race and ethnicity at a minimum, to evaluate disparities in processes of care. *
Respectful, Equitable & Supportive Care
Every Unit/Provider/Team Member
- Include each pregnant and postpartum person and their identified support network as respected members of and contributors to the multidisciplinary care team. *
- Engage in open, transparent, empathetic, and trauma-informed communication with pregnant and postpartum people and their identified support network to understand diagnoses, options, and treatment plans.
Quick Links
- Patient Safety Bundle (PDF)
- Element Implementation Details (PDF)
- Implementation Resources (PDF)
- Data Collection Plan (PDF)
- Change Package (PDF)
- Implementation Webinar (Video)
- National Maternal Health Hotline
- Bundle Element Context and Reference List (xlsx)
- Patient Safety Bundle – Spanish (PDF)
- Element Implementation Details – Spanish (PDF)
- Implementation Resources – Spanish (PDF)
- Data Collection Plan – Spanish (PDF)
Patient Safety Bundle Acknowledgements
- This Patient Safety Bundle was originally developed by the Alliance for Innovation on Maternal Health in collaboration with Ariela Frieder, MD; Barbara Hackley, PhD, RN, CNM; Camille Hoffman, MD, MSCS; Pec Indman; Lisa Kay; John Keats*, MD, CPE, FACOG; Sue Kendig, JD, MSN, WHNP*; Emily Miller, MD, MPH; Tiffany Moore Simas, MD, MPH, Med; Kisha Semenuk, MSN, RN; Katherine Wisner, MD, MS.
- This patient safety bundle was revised by Nancy Byatt, DO, MS, MBA, FACLP; Camille Hoffman, MD, MSCS; John Keats, MD, CPE, FACOG; Sue Kendig, JD, MSN, WHNP; David Laflamme, PhD, MPH; Emily Miller, MD, MPH; Tiffany Moore Simas, MD, MPH, Med.
- The California Maternal Quality Care Collaborative, Chris Raines, MSN, RN, WHCNP, PMHNP_BC, PMH-C, Connecticut Hospital Association, Illinois Perinatal Quality Collaborative, and Policy Center for Maternal Mental Health reviewed and provided feedback on this document.
* = see implementation details document for more information
©️ 2022 American College of Obstetricians and Gynecologists. Permission is hereby granted for duplication and distribution of this document, in its entirety and without modification, for solely non-commercial activities that are for educational, quality improvement, and patient safety purposes. All other uses requite written permission from ACOG.