Last month, the American College of Obstetricians and Gynecologists (ACOG) launched a new patient safety bundle addressing perinatal mental health conditions.  The current revision addresses gaps in the safety bundle in 2016.  Patient Safety Bundles are a structured way of improving the processes of care and patient outcomes. They are clinical condition-specific and follow an evidence-based, 5R structure, that when performed collectively and reliably have been proven to improve patient outcomes.  According to ACOG, “The goal of PSBs is to improve the way care is provided to improve outcomes. A bundle includes actionable steps that can be adapted to a variety of facilities and resource levels.”

The Perinatal Mental Health Conditions Patent Safety Bundle and other PSBs can be found at SAFERBIRTH.ORG.

Greater Clarity of Recommendations

ACOG first recommended screening for perinatal mental health conditions in 2015.   While this was a ground-breaking step in supporting the mental health of mothers, the initial recommendations were preliminary.  Including what we have learned since launching the original recommendation, the new PSB is more specific about its guidelines and includes more  resources for those caring for pregnant and postpartum patients.  More specifically the new PSB: 

• Broadens the scope of perinatal mental health conditions to include more clinical information on anxiety disorders and post-traumatic stress disorder
• Highlights the importance of identifying women at increased risk for perinatal mental health conditions
• Includes information on validated screening tools for mood and anxiety disorders in pregnant and postpartum women 
• Provides very specific information on screening for bipolar disorder prior to the initiation of pharmacotherapy
• Outlines how to connect patients to mental health-specific resources

In collaboration with Dr. Nancy Byatt and other experts in perinatal mental health, ACOG have developed a guide providing a detailed guide on how to implement these guidelines.

At a time when the Canadian Task Force recommended rolling back universal and instrument-based screening, it is a relief to see that ACG has not followed suit.  

New ACOG Guidelines by Ruta Nonacs, MD PhD

For every patient, ACOG recommends the following:

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.

Useful Links

INFORMATION ON PERINATAL MENTAL HEALTH CONDITIONS

PERINATAL MENTAL HEALTH CONDITIONS IMPLEMENTATION WEBINAR (VIDEO)