Mental health conditions are the leading cause of preventable pregnancy-related death in the United States. According to CDC Maternal Mortality Review Committee data from 2017 to 2019, mental health conditions, including suicide and overdose or poisoning related to substance use disorder, were linked to 23% of pregnancy-related deaths. That statistic alone should change how we think about prenatal and postpartum care.

“Mental health is not a niche concern,” says Dr. Jennifer Kasirsky, OBHG Senior Market Medical Director and Site Director.

As an OB hospitalist, she sees firsthand how often mental health symptoms go unrecognized in the patients she treats, and she is direct about what that unrecognized risk includes: suicide and substance-related overdose or poisoning are part of the same 23% figure, not separate from it. In her view, a single hospital admission is often the best chance to catch what has already been missed elsewhere in a patient’s care.

Postpartum depression often starts earlier than “postpartum”

One of the most important things for patients and providers to understand is timing. Research cited by the American College of Obstetricians and Gynecologists (ACOG), based on a 2013 study by Wisner et al., found that among women who screened positive for depression after delivery, the onset had occurred before pregnancy in 27% of cases and during pregnancy in another 33%. Only 40% of cases began in the postpartum period itself.

In other words, a large share of what gets labeled “postpartum depression” was already present, and unrecognized, during pregnancy or the hospital stay. This includes symptoms that are frequently missed or dismissed:

• The “baby blues” masking something more serious
• Anxiety and PTSD, which are often overlooked in favor of a sole focus on depression
• Postpartum psychosis, which is rare (an estimated 1 to 2 per 1,000 births) but constitutes a true medical emergency
• Suicidal ideation, which patients often will not volunteer unless asked directly

Dr. Kasirsky is emphatic on that last point. Patients rarely bring up suicidal thoughts on their own, she explains, which means the clinician must ask the question directly rather than waiting for it to surface.

The hospital admission is a screening opportunity

ACOG recommends screening every patient at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool. The organization’s implementation toolkit specifically identifies the delivery hospitalization and the comprehensive postpartum visit, alongside the first OB visit and the 24-to-28-week visit, as natural points for this screening to occur.

For an OB hospitalist, that means the admission itself becomes a chance to catch what might otherwise be missed. This includes:

• Asking directly about mood, anxiety, and thoughts of self-harm as part of the standard history
• Reviewing risk factors already noted in the chart, such as prior depression or psychiatric history, prior use of psychiatric medication, bipolar disorder or a family history of it, and substance use
• Watching for indirect signals during routine care, such as flat affect or minimal engagement with the baby

During labor and delivery specifically, when stress and fear are often heightened, hospitalists can also help simply by explaining what is happening in plain language and involving support people in the room.

As Dr. Kasirsky describes it, much of a patient’s fear during labor comes from uncertainty about what is happening to her body and what comes next, and a clinician who takes the time to explain that in plain terms, and to bring a partner or support person into the conversation, is already doing meaningful mental health work, even without naming it as such.

Closing the gap when specialists aren’t on site

Many hospitals do not have immediate access to a perinatal psychiatrist. Dr. Kasirsky points to a few strategies that help close that gap:

Standing screening protocols. Every admission includes a validated screen, scored before discharge, with a clear pathway for what happens next if the score is positive.

A tiered response plan. Dr. Kasirsky draws a clear line between what a hospitalist can and should manage directly, such as starting a conversation, initiating first-line pharmacotherapy when appropriate, or safety planning for passive ideation, and what needs to escalate immediately to urgent psychiatric consultation, such as active suicidal or infanticidal ideation, psychotic symptoms, or suspected mania. Without that line drawn in advance, she notes, hospitalists are left making high-stakes judgment calls in real time instead of following a plan the hospital already agreed to.

Telepsychiatry and access lines. Many states now have Maternal Mental Health Hotlines or Psychiatry Access Programs that can be built into the discharge workflow, giving even a community hospital without an on-site perinatal psychiatrist a same-day or next-day consult option.

Warm hand-offs, not printed referral sheets. A direct call or a scheduled follow-up appointment made before discharge dramatically improves the odds a patient follows through, compared with simply handing over a phone number. Dr. Kasirsky is blunt about the difference between the two: a printed referral sheet asks a new mother to do the work of finding and scheduling care on her own, at exactly the point in her life when she has the least capacity to do it.

As Dr. Kasirsky puts it, screening without a plan for what happens after a positive result “is just documentation, not treatment.” Having both a screening protocol and a defined response plan is what protects patients.

What this means for hospital leaders

For hospital administrators and partners, the case for building maternal mental health into the OB hospitalist program is straightforward. Dr. Kasirsky frames it as a question of infrastructure, not intent: most clinicians already want to help patients with mood and anxiety symptoms, but without standardized screening, a defined tiered response plan, and a pre-arranged path to psychiatric consultation, that intent has nowhere to go.

An OB hospitalist program can give hospital leaders a structured way to close that gap without waiting for a perinatal psychiatrist to be on staff. In practice, that looks like:

• A hospital-wide screening protocol that runs on every admission, not one that depends on an individual clinician remembering to ask
• A documented escalation pathway so staff at every level know what triggers an urgent psychiatric consult versus what the hospitalist can manage at the bedside
• A standing relationship with a telepsychiatry service or state Psychiatry Access Program, established in advance rather than sourced during a crisis
• Discharge workflows that build in a scheduled follow-up appointment as a default step, not an optional one

Dr. Kasirsky’s core message to leadership is that a screening program only delivers value if it is paired with a response plan the whole hospital has agreed to ahead of time. Built well, it turns every delivery hospitalization into a consistent, repeatable safety net rather than something that depends on which clinician happens to be on shift.

Reducing stigma, one admission at a time

Stigma remains one of the biggest barriers to patients asking for help. Two practices can make a meaningful difference:

• Framing screening as routine and universal (“we ask everyone this”) rather than singling out any one patient
• Keeping educational materials about mood and anxiety symptoms visibly present in the hospital room, rather than handed out once, so the information feels normal rather than alarming

Dr. Kasirsky sees both practices as ways of normalizing the conversation before a patient ever has to decide whether to bring it up herself.

The hospital stay as a safety net

For many patients, especially those with limited access to care, the hospitalization may be the most reliable point of contact they have with the healthcare system before a six-week postpartum visit that they may or may not make.

Dr. Kasirsky describes this as a chance to “frontload” the safety net: rather than trusting that a patient will make it back for follow-up care on her own, the hospitalist puts as much support in place as possible before she ever walks out the door.

• Scheduling the postpartum follow-up, and any psychiatric referral, before discharge rather than leaving it to the patient to arrange
• Connecting patients to no-cost, immediate resources regardless of insurance status or geography

One of the most important of those resources is the national Maternal Mental Health Hotline: 1-833-943-5746. It is free, confidential, and available by call or text, for any patient who needs support during pregnancy or after delivery.

Insights in this post are drawn from an interview with Dr. Jennifer Kasirsky, OBHG Senior Market Medical Director and Site Director.